What the End of the PHE Means for Your Back Office

The COVID-19 Public Health Emergency (PHE) is officially coming to an end on May 11. On that date, any accommodations, changes in guidelines, or benefits that were in place due to the virus will come to an end. How will this exactly affect healthcare back offices? What should providers be paying attention to? On a recent episode of The Modern Healthcare Back Office, our HME/DME back-office expert Melissa Wagner discussed the most prominent changes that may take place in the industry.

Coverage Waivers

During the pandemic, Medicare granted patients access to home-based care and HME products that otherwise would not have been approved based on pre-COVID-19 requirements. Since patients had limited access to doctor’s offices, several accommodations had to be made to take the place of in-person visits. Resources like Telehealth were used to replace doctor visits.

On May 11, insurance coverage may come to an end for many products and services. When will providers get the guidance on what will still be covered or not? We don’t have that information yet, but it’s important for providers to keep in mind that change is coming.

Referral Sources

It’s imperative for referral sources to also understand the upcoming changes. This way, they don’t continue to send patients to providers who no longer qualify for their services. There needs to be some sort of community education process in the healthcare industry to limit the amount of problems from taking place after May 11. 

Whenever a coverage issue occurs, the patient is ultimately the one who ends up suffering. A significant consequence providers may face is continuing to bill for services that they won’t get paid for, due to them no longer being covered.

Stay Informed

Providers and their employees need to dedicate time towards staying current on definitive policy changes leading up to May 11. To stay in the loop, providers can utilize informational resources such as AAHomecare, state associations, software vendors, and VGM. There’s no shortage of available knowledge out there.

We know certain procedures are going to end, however, we can only speculate when it comes to specifics. As mentioned above, will the patients who were provided care continue to receive the same services? Will new patients simply no longer qualify while the previously approved patients will be grandfathered in? Things of that nature are currently still up in the air.

Think Ahead

To be proactive in dealing with new guideline uncertainties, it would be in a provider’s best interest to identify and segment which patients could be affected. Understanding and preparing for the changes that are about to occur will enable providers to resolve them as quickly as possible once they arrive. 

There’s never been a more crucial time to tune in to The Modern Healthcare Back Office each week to receive the latest updates on things taking place inside the industry. Listen to the full episode below and find all other episodes here or on YouTube


Prochant has a proven track record of helping HME and pharmacy providers meet their financial goals. Our scalable solutions, years of experience, and advanced technology provide best-in-class results to the healthcare community. Headquartered in Charlotte, North Carolina, our client base includes national pharmacy and HME providers and health systems.