In this article, you'll learn about the main effects of telemedicine on medical bills, how to deal with prolonged hospitalizations and what changes will occur when charging for hybrid care, among other relevant information.

A digital transformation in healthcare has been gaining momentum with the consolidation of telemedicine in supplementary healthcare.

Since the COVID-19 pandemic, remote care has become part of the routine for beneficiaries, but now the challenge for operators is different: adapting billing, auditing and technical analysis models to this new hybrid scenario.

Keep reading until the end to get up to speed! ; )

 

The growth of telemedicine and its effects on the care model

Telemedicine is already a reality, regulated by Law No. 13.989/2020 and subsequent ANS rules, opening up space for a new dynamic of care. Today, consultations, reports, screenings and even psychotherapy can take place virtually. This expansion has brought countless benefits, such as

 

• • Increased access to healthcare for remote regions;

• • Reduced travel and logistics costs;

• • More agile service in cases of low complexity.

However, it also brought challenges for the billing and technical analysis of remote services.

 

Reflections on billing models: how to evolve?

With virtual services gaining ground, new billing formats are emerging that require special attention from medical bill analysts:

1. Charging for remote consultations

 

• • It must contain the date, the professional responsible and a record in the electronic medical record.

• • It is essential to guarantee the provider's contractual relationship with the operator.

• • The TUSS codes must be correctly used and identified as teleservice.

2. Hybrid billing (face-to-face + remote)

 

• • It is increasingly common for patients to be monitored in combination.

• • Charging criteria must avoid duplication between face-to-face and online services.

• • The technical analysis needs to consider the therapeutic plan as a whole, and not isolated acts.

Attention: The use of technology no clear criteria can lead to disallowances, legalizations and conflicts with providers.

 

Hospitalizations and long-term stays: how to monitor intelligently

Even with the advances in telemedicine, hospitalizations continue to account for the majority of care costs. What has changed is the form of monitoring and auditing:

1. long hospital stays and undue charges

 

• • The lack of real-time monitoring can lead to overcharging, such as unnecessary per diems, duplicate tests or poorly justified OPMEs.

• • Continuous technical analysis helps to identify deviations before the hospital account is closed.

2. Use of intelligent systems for auditing

 

• • Solutions such as Saudi make it possible to monitor hospitalizations in real time, with automatic alerts for overstays.

• Remote monitoring of clinical conditions and medical justifications speeds up the release of per diems and OPMEs, avoiding delays and disallowances.

The role of the medical accounts analyst in this new scenario

With the arrival of new care formats, the role of the medical bill analyst has become more strategic. It's not enough just to check values and tables: it's necessary to understand care models, validate clinical evidence and ensure that charges are in line with contractual and regulatory guidelines.

To do this, the analyst must pay attention to:

 

• • New TUSS codes and updated TISS guides for telemedicine;

• • Evidence of care according to clinical protocol (including remotely);

• Integration between remote, face-to-face and hospital care in the line of care.

How technology supports this transformation

Solutions such as the Saudi System are key allies for operators who need to deal with the complexity of the new care model. With Saudi, it's possible:

 

• • Automate the auditing of face-to-face, remote and hybrid consultations;

• • Monitor admissions and identify excessive stays;

• • Integrate clinical information with administrative data, ensuring safer and more efficient technical analysis.

The result? Reduced disallowances, better negotiation with providers and more control over healthcare costs.

 

Telemedicine in Supplementary Health

Telemedicine in supplementary healthcare is here to stay - and with it come new challenges and opportunities for operators. By adapting billing models, monitoring hospitalizations and using intelligent tools, it is possible to evolve towards more efficient, transparent management that is connected to the real needs of beneficiaries.

Is your operator ready for this new era of digital health? Meet Saudi and transform the way you analyze, audit and manage medical bills.