Telemedicine billing is complicated as it is, but with the onset of the coronavirus, it has grown in complexity. The guidelines for telemedicine billing are not set in stone and are constantly changing with the changes in the economy and healthcare sector, but that doesn’t take away from the rising use of this practice because of distance issues rising from the coronavirus.

In case you’re unclear of what Telehealth is; it is when healthcare services are delivered to a patient or healthcare facility where distance is an obstacle. It allows for doctors and professionals to exchange information and diagnosis of patients, while working towards providing more education about medical practices and procedures.

Telemedicine entails clinical services being provided to a patient, where billing is done through telemedicine billing. This helps provide you with a reliable place to carry out your practice and helps patients be able to see another doctor if you aren’t available, making it a convenient option for both parties.

Telemedicine works in several different ways, where you can either set up an appointment with patients or allow for a virtual waiting room where patients can wait until you are available to see them.

Here’s what you need to know about Telehealth Billing and how it works:

What Is TeleHealth Billing?

If you want to start medical billing through a telemedicine program, you have to get in touch with a potential partner to work with you. Partners such as Doctors on Demand or MDLive offer the platforms that you need in order to start carrying out your doctor visits.

For effective telemedicine billing, you need to keep in mind the location that you are in, the payer coverage, and the patient’s coverage with their insurance providers. Depending on the payer, the rules for medical billing can vary, which means you have to be cautious about moving forward with this practice to prevent you or any other parties involved from encountering any losses.

There are a number of questions that medical billers think of when they’re working with telemedicine, such as what codes they need to use, the restrictions they have to keep in mind, and if there is a specific bill technique that they should be aware of.

Most major payers cover for telemedicine costs, even when they did not used to do so previously. Due to the rise of the coronavirus, most insurance companies have updated their guidelines to include telehealth.

The three major kinds of telemedicine services that you may be covering include Medicare telehealth visits, where you use telecommunication to connect the patient with the health professional, virtual check-ins, where you have a small, 10-15 minutes check-in with a patient over the phone or another telecommunication device and includes checking images that the patient submits to you, which then determines if another in-person visit is needed based on the situation.

The last kind of telemedicine practice is known as an e-visit, where a patient and healthcare provider have an appointment that is set up through an online portal, such as the ones mentioned above.

What Do You Need to Keep in Mind When It Comes to Telemedicine Billing?

In order to avoid any problems when working with telemedicine, make sure that you check the guidelines for all payers before proceeding.

You need to ask them which healthcare providers are eligible for telemedicine billing, what kind of services are allowed to be carried out over online portals or the phone, and whether these payers allow for live video calls to be counted under the telemedicine billing that they pay for.

You should also know whether particular payers have certain limitations to how many appointments via telephone or video a patient is allowed in a given year because chances are that most payers have changed the number since the pandemic began.

You must also know if there is a facility fee for the local place where the patient is situated when they are receiving your medical services. These facilities usually charge a fee for hosting a patient, and need to be included in the telemedicine billing. Often, organizations require that a patient come in to a certain site in order to start using telemedicine services.

Use the Correct Codes

You should also know what kinds of Current Procedural Terminology (CPT) codes are qualified for billing telemedicine. Using the wrong codes can result in improper evaluation and management. While some providers need a CPT code, others can ask for a telemedicine specific code to help streamline the process.

You should ideally call the payers and ask them which codes are eligible for telebilling to avoid any misunderstanding. Because the guidelines are changing quite rapidly, it is possible that the representatives that you speak to are not completely up to date with the new requirements and you will have to spend some time waiting for more accurate information.

There are GT and 95 modifier codes that need to be conveyed to the payer in order for them to know that a specific telemedicine service was provided to a patient. By using the correct codes and modifiers, E&M CPT codes, and the service code, you reduce your chances of denials, especially when you are dealing with a commercial insurance company.

Final Words

To learn more about telemedicine billing and avail the full services of a medical billing company, get in touch with PCS Revenue Cycle Management, a medical billing company that can guide you through CMS and efficient billing practices for your medical office, healthcare organization, or hospital.

We guide you through following up claims with your payers, initiate appeals, and create collection lists in order to streamline your work, lead to 20-30% increase in collections and an 80% reduction in denials, all with full transparency. With the changes taking place because of the coronavirus, it can be difficult to keep up with the requirements, which has led to a turbulent and complicated time for healthcare providers.

That’s why we’re here to help you spend less time with billing and more time with giving your patients the dedication and care they need!

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