Amid the COVID-19, a considerable shift towards telemedicine has been observed. This increased importance, as well as scope, is due to the closing of many hospitals for non-COVID patients. As the COVID-19 pandemic takes center-stage, healthcare providers are relying more on telemedicine to provide consultations. Improvements in information technology also reinforce this importance as healthcare providers can cater to patients in a better way and with greater convenience.
Telehealth billing, even before the COVID-19 was a tricky task. The constantly changing regulations and their overlapping features with other medical codes have seen it become the center of much confusion. This increased confusion can be easily rectified by following the guidelines mentioned here.
Make Sure the Patient Has Coverage
The first and foremost thing to take care of while managing telehealth billing is to make sure whether the patient has adequate coverage. Although most major healthcare insurers these days offer telemedicine coverage, it is still prudent to check for it. This measure helps the provider any unwanted denial of claims later. This can easily be done by ensuring a filled-out form by the payer that explicitly verifies telemedicine insurance coverage. By showing this form along with a reference call number, you can easily fight any denied claims.
Be Aware of the Latest Rules and Regulations
After checking your client’s coverage for telehealth billing, it will be wise that you keep abreast of all the rules and regulations that are revised regularly. This will help you assign the correct codes for the services you render and avoid any unwanted scenarios. Moreover, amid the COVID-19 pandemic, healthcare providers are adding more rules so that a greater number of patients can benefit. This includes Medicare’s acceptance of new patients that were previously not available.
Documentation is The Key
Documentation of the proceedings at all times makes your life a lot easier when billing the payer. The ease this creates for telehealth billing is immense, it provides adequate proof of services rendered and hence more chances your claims won’t be denied. This includes documentation about the time spent during the consult and any other peripherals that were used during this consultation. It is important to note the face to face consultation time is noted, as most codes bill for just this time.
Peripherals may include thermometers, glucose monitors, spirometers, oxygen saturation monitors and so on. Noting the use of all these peripheries will help ease telehealth billing by making use of the appropriate CPT codes to be entered when charging the payer for services.
Billing a Facility and Place of Service rules
The HCPS Q3014 code lets you bill for a facility fee which is important as telehealth medicine mostly requires a visit to the local healthcare facility. The cost that this facility bears for this initiating visit can be borne under this coding. Moreover, telehealth billing must bill under the E&M code with the place of service code as 02. Not adhering to this will result in an insurance provider not honoring the claims.
The GT 95 Modifier and CPT Codes Applicable
The GT 95 modifier is used in medical billing whereby a video component is employed for providing telemedicine services. Care must be taken to not bill asynchronous encounters under this head. These refer to services such as email, ultrasound studies, radiographs, etc.
CPT codes that are suitable for telehealth billing must be inquired from the payer beforehand. Whether using designated E&M CPT codes such as (99201-05, 99211-15) along with some GT modifier or using specific codes such as 99444, the payer must be inquired beforehand. This is important to avoid any undue errors resulting in the denial of claims.
Asking the Payer for Its Coverage Guideline
As simple as it may seem, getting to know the payer can be a hassle. Most of them are caught unaware of the constant regulatory changes or have to update their systems. Providers should ask these basic questions to ascertain whether they can provide telemedicine to patients or not. A Performa containing these questions is a simple idea that can time.
Telehealth billing has become an important healthcare question these days. With the fast-growing COVID-19 pandemic and the ensuing lockdowns, more patients are turning to avail telemedicine. Even before the pandemic, confusion remained as to how to bill telemedicine with no single policy covering regulations for all. This has made it vital that healthcare providers know how to accurately bill the payers, know the relevant codes, each insurer’s policy as well as the changing landscape of telehealth billing rules. The pointers mentioned above will help providers to be alert to these changes in the field. Moreover, consulting an experienced medical billing and coding company can avoid denial of claims, costly litigations, and audits.
