Telehealth Billing Guidelines and How to Avoid Billing and Coding Errors
If your healthcare organization struggles to navigate recent telehealth billing guidelines, you’re in the right place. Keep reading to learn about the importance of telehealth, common pitfalls in billing and coding, and how you can ensure you receive maximum reimbursement on services rendered.
The Rise of Telehealth
Over the last few years, it’s become much more common for a physician or other qualified healthcare professional to provide care over the phone or through a video conference, drastically expanding the range of solutions they can offer.
However, with this explosion of virtual check-ins and e-visits, it has been increasingly difficult for providers to accurately bill and code for their services or procedures, leading to issues regarding reimbursement, EMR integration, and accessibility.
Fortunately, navigating these challenges is well worth the effort, so it’s important to learn how your healthcare organization can bill and code for your services accurately.
Why Telehealth Is Important
There are several reasons why telehealth has remained popular with both healthcare professionals and patients, even as the pandemic has shifted and waned over the last few years.
- Telehealth reduces the cost of treating health conditions. Virtual check-ins and online appointments are cost-effective for healthcare providers and patients, cutting overhead expenses and prices of visits.
- Telehealth reduces the risk of readmission. Telehealth appointments allow physicians to remotely follow up on their services or procedures, gain immediate clarification, and schedule additional appointments as needed. This allows them to actively monitor the health and wellness of their patients after discharge and can reduce the need for them to return in person.
- Telehealth improves care management and patient satisfaction. Telehealth appointments are a great way to provide care to those who don’t have the ability to meet in person. By tailoring services to the needs of patients, healthcare professionals can quickly satisfy their healthcare needs
- Telehealth helps monitor chronic conditions. Virtual appointments are tremendously helpful for monitoring chronic conditions like diabetes, coronary disease, and more.
What Makes Billing and Coding for Telehealth Visits Challenging?
Although telehealth is a great resource, it comes with several key challenges you need to understand to provide exceptional patient care.
Paperwork (or Lack Thereof)
At in-person appointments, patients typically fill out or double-check their paperwork at the front office. This can include verifying personal information, copying new insurance cards, and completing insurance verifications. If these aren’t correctly inputted and verified, it can lead to payment delays or denials.
Telehealth appointments place more responsibility on the patient to correctly fill out their paperwork online, making typos, confusion, and even deception more of a possibility.
Here are a few more paperwork issues that are easily resolved in the office but are more difficult for the patient to deal with at home:
- Insurance doesn’t cover the service or procedure
- The provider is out of network
- Pre-authorization was necessary
- Incorrect information, such as name or date of birth
Updated CPT Codes
One of the reasons that it can be challenging to bill and code for telehealth appointments is that CPT codes are updated yearly. This can affect how you need to bill for certain services. For example, the telemedicine coding guidelines for 2022 are now outdated, as the 2023 codes went into effect on January 1, 2023.
To bill and code for telehealth services accurately, you need to use the appropriate CPT code and telemedicine modifier. Forgetting the modifier or using an out-of-date code can delay or deny reimbursement.
Insufficient Data for Care Continuity
Billing and coding for telehealth appointments can also be complicated when patients switch providers. If two providers have different operating systems—or if they’re unable to exchange information properly—it can make it challenging for the new provider to offer adequate care. This communication gap can cause confusion in the revenue cycle management, leading to denials or partial reimbursement.
Electronic Medical Records
Integrating new technologies that can exchange medical information in a compliant fashion can be challenging, expensive, and time-consuming. They need to be secure and conform to HIPAA’s regulations regarding the sharing of electronic health information (EHI). As telehealth continues to expand, the use of technology will be highly scrutinized. EMR-integrated systems for telehealth need to be secure for physicians to provide proper care and improve relationships with their patients.
Reimbursement
Briefly discussed above, having the methods and processes in place to maximize reimbursement is an integral part of revenue cycle management. It may seem challenging to navigate the rapid changes in the telehealth industry. Telehealth CPT codes are expected to grow in number and change over the next few years as virtual appointments become a regular part of the healthcare industry. In addition, insurance possibilities will likely continue to expand for telehealth services in the near future.
As the world adjusts to virtual check-ins, online office visits, and e-appointments, medical billing and coding for telehealth will become much less overwhelming.
If you’re unsure how to maximize reimbursements within your revenue cycle management, turn to BSI Medical Billing. Our medical billing and coding experts can assist you in navigating telehealth billing guidelines and help you avoid delays, denials, and partial reimbursements.
Key Points and Best Practices: Telehealth Billing Guidelines
Although several challenges make it difficult to bill and code for telehealth services correctly, you can follow a few best practices to ensure you’re not creating significant gaps in your revenue cycle management.
Here are a few more telehealth billing guidelines to help ensure you’re billing and coding correctly.
- Pay attention to detail. For each patient encounter, ensure you have thorough, accurate documentation, such as the key components of treatment. In addition, know that telehealth CPT codes vary depending on how much time you spend with a patient. Watch your time and use the appropriate code.
- Make sure your qualifying service is synchronous. For your patient encounter to qualify as a telemedicine service, it must occur in real time. You need to have interactive visits over the phone or via video. This telehealth billing guideline helps you avoid delays and denials for inaccurately billing for asynchronous services, such as emails or ultrasound studies.
- Explore your state regulations and payer policies. Telehealth coverage varies widely between states, so make sure you look into the specifics of your geographic region before billing for telehealth.
