Respiratory Practice Management
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Respiratory Practices and the COVID-19 Pandemic: Strategies for Survival

Respiratory practices have faced unique challenges as a result of the COVID-19 pandemic. Respiratory Practice Management recently interviewed Elizabeth Johnson, LPN, CPC, PACS, Lead Biologics Coordinator, Allergy Partners, Asheville, NC, to discuss these challenges and how practices can respond accordingly to maintain financial stability amid these uncertain times.

At the beginning of the pandemic, practices witnessed substantial decreases in patient volume. “Patients panicked. We had to figure out how to make them feel comfortable and feel safe to come back,” noted Ms Johnson. As a result, practices instituted numerous safety measures to protect their patients, clinicians, and office staff.

During this time, the use of telemedicine expanded dramatically. For routine visits and follow-up appointments, telemedicine is a great option, according to Ms Johnson. Routine prescription refills of epinephrine autoinjectors and yearly medication refills can be accomplished via telemedicine appointments. The use of telemedicine, however, cannot replace all in-person visits. For example, patients must still come into the office for such procedures as allergy shots, skin testing, and food allergy assessments.

The COVID-19 pandemic has also disrupted the revenue cycle for practices. Initially, reduced patient volume was the primary cause, although external factors contributed to this issue as well. Employees of payer organizations transitioned to working from home and manpower and communication shifted. Some claims departments are still experiencing slower processing times due, in large part, to the increased volume of telemedicine. Prior authorizations have also been a challenge, particularly in the biologics space. Ms Johnson said that a lack of communication within some payer systems led to initial denials of claims despite automatic authorization extensions already being in place because of the pandemic.

Despite these challenges, practices can remain financially solvent and even thrive. The Coronavirus Aid, Relief, and Economic Security Act has provided assistance to small businesses, including medical practices.1 The Paycheck Protection Program, administered through the Small Business Administration, has also been helpful—particularly for smaller practices. In many cases, the Paycheck Protection Program has allowed practices to keep their doors open during these challenging times.

3 Key Strategies

Ms Johnson identified 3 key strategies that practices should adopt:

  • Ancillary Lines of Income. Respiratory practices have an opportunity to purchase and bill for medications provided in their office, particularly for patients with asthma. According to Ms Johnson, Allergy Partners has found that their patients with asthma have been highly compliant throughout the pandemic, maintaining strong adherence to biologic therapy. These medications can be acquired by a practice, billed to patients’ medical insurance, and reimbursed. Although the margins are small, they can provide a steady income stream.
  • Dedicate Office Staff to Ensure Adherence to Policy Changes. Payer policies have been changing rapidly during the pandemic. Among these changes are extensions of existing prior authorizations, waiving of coinsurance for some specialist office visits, and expanded telemedicine coverage and reimbursement.2 It is critical to have dedicated office staff monitoring these changes and confirming patients’ insurance eligibility. For patients without active insurance coverage, alternative solutions should be explored, including a discussion of payment plans. Practices should also monitor point-of-service collections and confirm that specialist copays are collected in a timely fashion. In addition to verifying authorizations, respiratory practices should keep abreast of changes in reimbursement policies, especially as they pertain to biologic agents. Although the expansion of telemedicine coverage has allowed many more patients to receive care remotely,3 it also has complicated coding and billing for practices. To ensure appropriate reimbursement for telehealth services, practices should have staff assigned to monitor policy changes and updates.
  • Adjust to Staff and Patient Schedules. As children return to school, be it with in-person or remote learning, the effect will be experienced by staff with school-aged children and by patients’ families. “Really evaluate your patient demographics and your staff demographics, and see if you can find better times to work or to have your doors open, so that it works for everyone,” said Ms Johnson. Staff members may have different needs, depending on childcare responsibilities. Practices should evaluate employee work schedules to accommodate their individual needs.

Similarly, patients’ families will be affected by changes in school schedules and the workforce. Practices should evaluate patient demographics to consider the adjustment of scheduling needs and to determine whether extended office hours might be beneficial. Changes made with respect to extending office hours or adding weekend availability should be advertised widely, to ensure that patients are aware of these new resources. Practices should make use of websites, newsletters, e-mails, and social media to get the word out.

The COVID-19 pandemic has presented practices with many new challenges that will continue into the foreseeable future. Responding to these hurdles requires planning and flexibility, but respiratory practices can survive and even thrive during these uncertain times.


  1. US Department of the Treasury. The CARES Act provides assistance to small businesses. Accessed August 8, 2020.
  2. United Healthcare. COVID-19 ongoing patient care updates. Updated July 24, 2020. Accessed August 8, 2020.
  3. Centers for Medicare & Medicaid Services. Medicare telemedicine health care provider fact sheet. March 17, 2020. Accessed August 8, 2020.

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