Medical Billing for Telemedicine, Here’s What You Need to Know

by | Apr 14, 2020 | Medical Billing

For many people, telemedicine works as a cost-effective alternative to the traditional face-to-face appointment. It helps some, such as elderly patients and those with disabilities better navigate the obstacles that may otherwise make it hard to see their doctor. For all patients, it tends to lend itself to better satisfaction and convenience.

Despite the fact that telemedicine is becoming more common, many health care providers still have trouble with reimbursement. Getting used to new rules for billing and coding procedures properly in order to get paid appropriately can take time and effort. Add to that payer differences in telemedicine coverage and policies and it can become even more complicated. Here are a few things to keep in mind about billing for telemedicine.

Ensure that telemedicine is covered by the payer

A lot of trouble is caused by the mistake of neglecting to submit claims without first checking if the payer covers telemedicine services. Before providing those services, it’s recommended to call the insurance provider for that verification. If the provider assures you that they do, be sure to document it as it may be helpful in the event of a denied claim later.

Know the specific insurance provider’s policy

As mentioned, different payers have specific policies regarding telemedicine, and you should take the time to verify this as well. This can include making sure the specific services you are covering are covered, whether it applies to the type of telemedicine you are using, any qualifying criteria, and any restrictions for telemedicine coverage.

The major payers, such as Medicare have their own restrictions and rules for reimbursement. In that case, the patient can only be reimbursed for telemedicine services if they are seen at an authorized site like a skilled nursing facility, public hospital, doctor office or certain private hospitals. The patient has to also be seen by a nurse, doctor MD, or clinical psychologist and the service itself must be within the regularly covered codes. The facility providing the telemedicine must also be located in a Health Professional Shortage Area (HPSA) and not within a Metropolitan Statistical Area (MSA). 

Meanwhile, Medicaid approves reimbursement for telemedicine on a state-by-state basis, with the policy differing within each state as well. For instance, some may cover real-time visits only, while others cover remote monitoring services as well. Private payers tend to cover telemedicine more widely, but again, the reimbursement policies can differ between each individual payer, so care must be taken to get the detail you need on their policy before submitting a claim.

Tips to help you with better billing and coding for telemedicine

As the points above have hopefully detailed, telemedicine billing and coding can be a source of some confusion and care must be taken to ensure that you’re getting the right amount of reimbursement for the services that you provide. As such, the following tips can help you ensure that you’re protecting yourself.

Be sure to document the services you provide

Documenting time spent is crucial, just as it is with all other kinds of coding. You must document the time spent for each encounter in telemedicine billing but ensure that you account for that time accurately. For instance, with some codes, the only time that counts is the face-to-face time you spend with the patient or caregiver when deciding which level of service accurately describes the appointment. 

Know about the 95 Modifier

With the video component of telemedicine encounters, you can also ensure it is accurately documented by adding the 95 modifier to the standard CPT code for the service. However, while this modifier can be used for the video component of live telemedicine services, it should not be used for any encounters that are asynchronous like emails, radiograph studies, or video services that do not involve both parties being live and actively involved at the time that the service is provided.

Don’t forget about any devices used as part of the treatment

Telemedicine assessments often include the use of peripherals and wearable devices. For instance, you may use spirometers, thermometers, glucose monitors, oxygen saturation monitors or blood pressure monitors. Make sure you document the use of any of these devices when coding as they will support the CPT code you use to bill. If you do not, you can end up having a bill rejected because your documentation doesn’t support the service you are billing for.

Billing with telemedicine doesn’t have to be so difficult

Though telemedicine billing may seem somewhat complicated, don’t let that get in the way of the benefits that it can provide. The ability to monitor your patients remotely and provide services without having to always be face-to-face can be greatly convenient for your patients, improving their outcomes as well as their satisfaction with your services.

With Medicare continuing to support and reimburse more and more telemedicine services as time goes on (and many other payers following suit if not surpassing that coverage) we can expect to see the service become more and more widely used in the 2020s. Ensure your practice is taking advantage of this new technology with help from teams like Medical Healthcare Solutions.

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