The utilization of Telehealth has been necessary to meet people’s healthcare needs during the coronavirus outbreak. With virtual care, medical practices can still be operational while maintaining the necessity of social distancing and providing access to care for those who have not been seen before. Telehealth is increasingly being used, and long stayed even after the crisis is over. According to a poll conducted by MGMA Stat, the most significant operational issue concerning Telehealth is the regulations and reimbursements enforced by insurers.
If your medical practice is still getting acquainted with the new regulations for Telehealth reimbursements, what can you do to make sure you get paid? Here are three suggestions to guide you through the Telehealth billing process.
Understand the Different Types of Telehealth Services
Telehealth billing encompasses numerous services and interactions. According to the Centers for Medicare & Medicaid Services (CMS), three kinds of virtual care services can be distinguished – traditional Telehealth visits, virtual check-ins, and electronic visits.
- Traditional visits via Telehealth: These visits involve an interactive audio and video communication system that connects both the provider and patient in real-time.
- Virtual check-in: This is instant communication with a provider lasting between five and 10 minutes, which various technologies can assist. It could include a telephone call or exchange of a digital or video image to determine if an office visit or another service is required.
- E-visit: This type of non-face-to-face communication between the patient and provider is done through an online portal for patients.
It is necessary to comprehend the distinctions since the form of appointment will affect coding, which can be attended to, who is eligible to offer Telehealth services, and how they can render those services.
Collect Data from Various Sources of Payment.
When obtaining data from insurers, consider that every one of them will have its own language and regulations. Payers have made numerous changes in this evolving situation, and this pattern is predicted to persist. Payers use different methods of communication to get the word out. Examples of these are:
- Medicare could provide updates via Local coverage determinations (LCDs) and nationwide coverage determinations (NCDs) as well as, in recent times Medicare’s Medicare Learning Network (MLN).
- Humana has medical coverage.
- Anthem Blue Cross and Blue Shield could publish their own in accordance with usage management (UM) guidelines.
While you are looking for reimbursement adjustments, bear in mind that these could differ depending on the state, insurer, and even the type of service being provided. Make sure that any modifications are available for all services provided in your area. A significant concern is how long payers will support payment for Telehealth services. Secretary of the Department of Health and Human Services (HHS) declared an extension of the public health emergency (PHE) for a duration of 90 days or more, thus lengthening the reimbursement modifications for Telehealth.
After the declaration, several payers revised their regulations in agreement. The time frame for each payer varies, so it is important to be informed of any changes. The Centers for Medicare and Medicaid Services has stated its intention to make Telehealth services available to Medicare patients on an everlasting basis, especially those who live in rural locations. By introducing these modifications, CMS has further highlighted that Telehealth is a useful option that works well with in-person medical treatment.
Here are Some Ideas to Keep in Mind when Programming a Telehealth Appointment
As you utilize the codes for Telehealth billing in your clinic, be sure to specify the appropriate code for the proper setting – a code for a Telehealth assessment in the emergency room instead of a subsequent visit to a hospital, for instance.
Depending on the payer, different Place of Service (POS) codes may be needed for Telehealth services. During the start of the Public Health Emergency (PHE), Medicare utilized POS code 02 for Telehealth visits. Subsequently, the 95 modifiers were applied to POS code 11 for specific visits. It is essential to check with payers as the requirements for Telehealth billing can differ and may continue to fluctuate. Moreover, it is essential to think about if you need to get permission. Even though it is not mandatory in all states, you should look into your state regulations and acquire consent before initiating the Telehealth session.
When it comes to billing for different types of Telehealth visits, there are several factors that need to be taken into account, such as the HCPCS/CPT codes, modifiers, who is providing the service, whether it’s a synchronous or asynchronous session (e.g., video call vs. sending a pre-recorded health report), and if the patient is new or already established with the healthcare provider. There are numerous advantages to utilizing Telehealth services.
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