Medical Billing’s ‘New Normal’

May 01, 2020

6 minute read

Anyone following the news knows that the medical community is hurting. Elective procedures were mostly eliminated, ‘non-urgent’ visits were postponed and Independent practices are closing their doors. 

While we can’t be sure what the ‘new normal’ will look like after we’re through the other side of this pandemic, there are some clear trends growing. 


No one will argue that there has been a foundational shift in how medical care is being administered during the pandemic. Age demographics that would normally shun telehealth and e-payments are now the cohort embracing them the most due to their higher risk factors. (According to recent CDC stats, 8 out of 10 COVID-19 deaths reported in the U.S. have been in adults 65 years old and older.) The geriatric patient who normally prefers to shake hands with her doctor and drop a check in the mail is now asking her grandchildren for help to visit with her doctor digitally, and is submitting a payment post-visit from the comfort of her own home – from the same computer she just saw her doctor on. 

Telehealth is not new. There was an article in Lancet from the 1890s about providing care via the telephone to reduce the need to come into the doctor’s office. Doctors have been providing medical advice to clinics on ships since the 1920s. In more recent times, telehealth has been used to provide specialized care to the more remote rural towns in the United States, but there had been significant roadblocks to more widespread adoption of telehealth from both patients as well as policy makers. 

COVID-19 is knocking down all the hurdles. The Centers for Medicare and Medicaid Services has temporarily suspended inter-state restrictions, expanded reimbursement coverage, and reduced certification requirements to allow for doctors to provide medical care “via phone, radio, or online communication, without having to be physically present.”

Normally, telehealth can’t be charged at the same rate as an in-person visit. So doctors were/are losing money on virtual patient visits while trying to maintain the same clinical structure to spring back from the pandemic most effectively. To help make sure people can get the care needed, the US government has recently provided relief allowing clinicians to immediately bill for telehealth services under the Physician Fee Schedule at the same amount as in-person services. This policy change alleviates a lot of the financial burden placed upon practitioners, especially those part of an independent practice that don’t have the capital backing of a large healthcare system.

It can be safely assumed that a lot of people will prefer to go back to in-person visits after the pandemic. However, it should also be assumed that the percentage of patients who continue to elect for telehealth visits in place of more expensive in-person visits will also be much higher post pandemic. Once Physician Fee relief for telehealth is exhausted patient receivables will become more important than ever. The coronavirus pandemic has brought Telehealth out from the fringes and into mainstream medical care.

The unemployed and uninsured

The US unemployment rate increased from 3.5% in February 2020 to 4.4% in March 2020. While that is still low by historical standards, a 1% increase in unemployment means more than 2 million more Americans of working age (15-64) are now without a job. 30 million Americans overall have filed for unemployment including data from April. Without diving into the political debate, the fact is most of these additional unemployed are now also without health insurance. 

Most people avoid going to the doctor when they are not insured. However, emergencies happen. When they do happen, patient billing becomes the sole means of collection when someone doesn’t have insurance. Therefore, while the number of overall bills being collected will decline, billers should expect to see increased patient responsibility for bills the longer the pandemic continues on. 

Medical bills are not on the top of the list of payments when people are financially strapped. CNBC recently posted an article instructing people to de-prioritize their medical bills if they are financially strapped due to the pandemic, and to focus instead on their mortgage, utility and car payments. However, most people do want to pay their medical bills – at least a portion of them. 

Payment flexibility has not kept up with the demand for more options when paying medical bills. While medical billers are constrained on what they can offer here, there is one thing in their arsenal that has proven to be highly effective – patient-driven payment plans.

Patient-driven plans are different from a normal payment plan in that they allow the patient to set-up the plan themselves without the need to call a biller or practice. While this might seem a small difference, it is a key one. During times of financial trouble people are less likely to take action in paying down debt if it means having an uncomfortable conversation. Allowing the patient to choose from a pre-approved list of payment plans negates the need for the patient call. It’s another hurdle that, once eliminated, will make patient payments easier (and more common) during the coronavirus pandemic.

Medical Billing and the ‘New Normal’

The coronavirus pandemic has had a highly disparate impact across different regions and demographics. One key commonality though is that it has acted as the catalyst for change in the medical and medical billing communities – no matter how prepared we were for that change. Telehealth will become a much larger percentage of billing after social distancing measures are dropped. Employment will take time to get back to pre-pandemic levels, and more patients will require payment plans – while not wanting to make the uncomfortable call into the biller to set them up. 

COVID-19 has changed our business but it has not defeated it. Medical practices need their billers more than ever right now, and embracing the above trends will prepare your organization for the ‘new normal’. Medical billing will survive this pandemic, and those who adopt the best strategies to help patients adjust to this new reality will survive and even thrive in the years to come.

Inbox Health is proud to be a part of the medical billing community, and we’re here to help you succeed during, and after, COVID-19.  Drop us a line to find out how.