November 3, 2021 - Two new reports say that the financial crisis in health care caused by the pandemic is showing no signs of letting up for PCPs and hospitals. A new survey by the Primary Care Collaborative found that less than one-third of practices said they are financially healthy and 32% said their practice revenue has yet to recover from the pandemic.
Perhaps even more alarming, 52% of practices reported that pandemic-related strain is now severe/near severe. (A survey conducted in May/June of 2020 found that same level of strain.) While some physicians have reported in other surveys that telemedicine has helped them weather the financial storm by bringing in new revenue, 21% of practices said they had to pull back on telemedicine because of reduced payments for the technology, and 25% worried that telemedicine would weaken primary care over time. On the hospital side of the equation, finances are also looking shaky. The National Hospital Flash Report from the consulting firm KaufmanHall found that hospitals are financially strapped from a combination of rising expenses and sagging volumes compared to pre-pandemic levels. HealthLeaders reports that between August and September of this year, the median operating margin at hospitals dropped 18%. Hospitals in areas hit the hardest by covid took the biggest hit to their operating margins in part because they're treating sicker patients who are staying longer.
Payment delays, denials heating up in covid?
Further hurting the finances of hospitals and physicians is what a new report is calling a "revenue grab" by insurance companies. A Medscape report says that even though insurers have reported record profits during the pandemic, they are delaying payment on claims and putting up more barriers to any form of payment for more complex claims. One practice consultant said that complex claims (those with -25 modifiers) now routinely generate requests for more information, which slows down payments. And an internist interviewed by Medscape said that multiple payers are now asking for documentation for prepayment review for higher-level claims for established and new patients. One academic system recently made a complaint against Anthem in which it said that the insurer is requiring itemized bills for any claims over a certain dollar limit, asking for detailed medical records for even clean claims, and requiring the system to upload documents to a Web portal that has technical issues and loses claims. The complaint says that the insurer owes $171 million in claims that are over 90 days old.
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