Are you one of those medical practitioners using telehealth services_possibly the first time? Do you have a long term plan to continue with such services even post-pandemic? Then you must have in-depth knowledge about the billing and coding basics for telemedicine.
As it is a totally new concept for many healthcare providers, who began offering telehealth services last year. They may find it challenging to get reimbursements for the healthcare services provided from a remote location. Because medical billing and coding for telemedicine are entirely different from normal billing services.
No doubt managing the patients remotely can result in various benefits in terms of eliminating the stress, expenses. And more importantly, the chance of getting an infection. But it has been observed that the majority of the medical practitioners are lagging behind their revenue goals.
They are not getting complete payment due to the inefficient management of medical claims for the telehealth services. The reasons are obvious. The rules for billing telemedicine are yet to complete. Moreover, due to the ongoing pandemic, the medical codes and guidelines for billing are changing almost on a daily basis.
In addition to this, the rules are not only evolving quickly but also varying from payer to payer i.e. private insurance companies, Medicaid, Medicare etc. So, it’s very challenging for healthcare providers to stay at the top of the changes. Meanwhile, they have to stay engaged in improving the patient’s lives by providing them standard medical aid.
Therefore, claim denials have become a common phenomenon in today’s challenging era. However, by getting a complete understanding of the basics of telemedicine billing, you can keep your denial rate minimal.
What Is Telemedicine?
Telemedicine refers specifically to remote clinical services, in which healthcare providers evaluate, diagnose and treat patients remotely by using telecommunications technology. In this pandemic affected era, the trend of telemedicine is picking up pace, particularly in the United States.
Things You Should Know Before Billing Telemedicine
Due to the growing complexities in telemedicine billing, medical billers and practitioners are looking for the answers. Such as: how should they bill telemedicine? What codes can they use? How to deal with the payers for getting reimbursements?
Are you searching for these answers? Then your search ends here. Here are the complete guidelines for managing the medical claims for telehealth services.
Common Medical Codes For Telemedicine
Medical coding is a complicated procedure. That involves the accurate translation of a particular illness, diagnoses, treatments, medical services and procedure into universal medical alphanumeric codes.
Here are the most common Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes used for telemedicine billing.
1. Telehealth Visits
Synchronous audio/visual evaluation and management visit:
- 99201-99205: Office/outpatient E/M visit for new patients
- 99210-99215: Office/outpatient E/M visit for regular
- G0425-G0427: Consultations, emergency department or initial inpatient (Medicare only)
- G0406-G0408: Follow-up inpatient telehealth consultations for patients in hospitals or SNFs (Medicare only)
2. Telephone E/M Services
- 99441: 5-10 minutes of medical discussion
- 99442: 11-20 minutes
- 99443: 21-30 minutes
3. Digital E/M Services
- 99421: 5-10 minutes
- 99422: 11-20 minutes
- 99423: 21 or more minutes
Qualified non-physician professionals report:
- 98970 or G2061: 5-10 minutes
- 98971 or G2062: 11-20 minutes
- 98972 or G2063: 21 or more minutes
- For Medicare, non-physicians report: G2061-G2063
4. Virtual Check-Ins
- G2012: Brief communication (5-10 minutes) technology-based service, new or established
- G2010: Remote evaluation of recorded video and/or images submitted, new or established, including interpretation and follow-up within 24 business hours.
Stay Informed With The Payers’ Guidelines
Regardless of whether you are dealing with private or government insurance agencies. You should get complete information about their conditions that need to be met before a patient qualifies for telemedicine.
The most important factor to verify is which type of healthcare services can be rendered through telemedicine. Moreover, you should ask payers about any restriction of treating a fixed number of telehealth visits a patient can have in a given time period.
There are possibilities that you get different answers to these questions from the payers. Because the guidelines for telemedicine billing can vary from state to state and payer-to-payer.
So, in order to avoid delayed, denied or partial payments. It is crucial for the healthcare providers to confirm the criteria for telemedicine billing before filing medical claims to the payers.
Proper Medical Documentation
Medical documentation plays an important role in the entire billing process. Whether you are providing medical care in your clinic premises or through remote locations, you must have a proper record of the patients. Which includes:
- Total time spent on each session.
- Diagnosis, associated risks, prescriptions, instructions, treatments and medical services, a patient received.
- In case of co-coordination with another associate healthcare provider, you must include it in your records.
- Patients’ complete data including both personal as well as insurance information.
Medical practitioners should never compromise on the medical documentation, particularly for the telemedicine consultation. Because medical coders and billers will use this information to assign the right codes and submit the medical claims.
Hence by maintaining an active connection with the payers, accurate medical coding, becoming knowledgeable about the strict payers’ policies. You can improve the process of telemedicine billing and get paid faster.
If you want to stay at the top of the changes regarding billing guidelines for telemedicine or other healthcare reforms. Then you must stay in touch with the Medical Billing Benefits. It’s a reliable healthcare newswire that contains the latest information about the recent trends in the medical industry.