The COVID-19 pandemic accelerated the adoption of telemedicine, with virtual visits rapidly becoming commonplace. Providers and patients alike experienced a transformation in how healthcare is delivered because of this shift. With telemedicine now firmly entrenched, the billing processes supporting it need to evolve as well. Indeed, the experts at Find-A-Code.com (icd code lookup) tell us that medical billing for telehealth continues to be shaped by changing regulations, payer policies, and coding guidelines. To keep up with this evolving landscape, it is critical for providers to get paid properly for virtual care delivery.
During the pandemic, temporary waivers removed many of the barriers to telemedicine by enabling remote care for new patients and across state lines, expanding coverage by Medicare and private insurers at the same time. The use of audio-only visits also increased access for patients that lacked video capability. Nevertheless, as waivers expire and restrictions return, billing remote visits gets more complicated again.
The Complexities of Telemedicine Billing
The codes and rules for telemedicine billing vary widely, depending on factors such as:
- it being a new or established patient.
- the type of visit being provided.
- it being live video, audio-only, or asynchronous.
- whether the patient is in a rural or urban setting.
- the technology platform being used.
- which payer is being billed.
All of this results in a patchwork of requirements that billers need to navigate. For example, different payers may cover different codes and modalities, have their own telemedicine consent protocols, or require additional documentation like video logs. To maximize revenue, then, billers must understand exactly what each payer allows.
Common billing errors like using incorrect place of service codes or applying codes not covered for telehealth result in avoidable claim denials. This ties up valuable operating capital while facilities wait for payments. Compliance is also essential as fraudulent billing risks severe penalties.
Keys to Successful Telemedicine Billing
In response, medical billers advise providers on key steps to telehealth billing success:
- Verify coverage for the expected virtual services for each payer contracted with. Create a telemedicine billing reference sheet or matrix to ensure codes adhere to the payer’s policies.
- Gather proper patient consent and clearly document it prior to visits. Consent often must include the right language acknowledging telehealth use.
- Closely follow coding rules to accurately reflect services such as telemedicine. For example, append modifier 95 to show synchronous video visits.
- Include additional details like time spent and technology used to support codes if required by payers. Avoid vague or incomplete documentation.
- Confirm visits meet requirements such as the use of HIPAA-compliant platforms and licensed providers at both ends. Payers may audit documentation.
- Submit claims promptly as some payers still only reimburse live video telemedicine. Lags could jeopardize payment.
- Resubmit rejected claims after fixing errors like wrong codes versus allowing denials. Persistence pays off.
- Compare tele-visit revenue to targets regularly to identify any billing issues before they escalate.
Adapting to the Future Landscape
Many practices find outsourcing telehealth billing to specialized external companies is the best way to keep up. These experts handle everything from credentialing with payers, to platform integration, coding, claim submission, audits, and denial management.
Longer term, advancing technologies and pressure for expanded access will continue reshaping medical billing for telemedicine. Remote patient monitoring, AI assistive tools, data analytics, and mobile capabilities will open new frontiers. With value-based care also gaining momentum, billing may shift from volume of visits to improving patient outcomes cost-effectively.
Conclusion
The temporary flexibility granted during the public health emergency proved the possibilities of barrier-free telemedicine. Though the road forward has obstacles, the destination justifies the effort. Expanding access and improving outcomes through telehealth are noble goals worth fighting for, and aptly evolving the supporting medical billing framework is a key battle in that fight.
