Medical Billing Expert

The outbreak of Covid 19 has let loose endless hardships on healthcare providers. The one boon that has emerged out of these hardships is the emergence of telehealth as an alternate platform for health care delivery. The huge success of this mode of healthcare service delivery signals that telehealth is here to stay and grow with each passing day. This is likely to have a profound impact on RCM services, because telehealth has so far not found a serious place in the billing process, and with the sudden relaxation of rules in favour of telehealth, billers have a lot on their plate – rather a lot more than they can ask more.   

In the aftermath of the pandemic, the worldwide telehealth service is predicted to grow from $25 billion in 2020 to $56 billion by 2025 with an annual growth rate of 16.9%  
Success Rate of Telehealth Services   Chronic Health Management – 65%, Acute Care Management – 55% High-Risk Patient Management – 50%

Telehealth is Here to Stay and Grow 

However, the rapid advancement of high-quality video equipment including Smartphone, and faster Internet connections will make it easier for providers to grow their business with more patients. Insurers will have no objections to this because telehealth interactions presumably will prevent patients from making duplicative in-person visits. Furthermore, as more people begin to value telehealth, they will purchase plans from an insurer only if the plan covers telehealth visits thus prompting insurers to introduce better telehealth coverage.

How Telehealth Solutions are Improving Service Delivery

The Technology Barrier 

Another key challenge is to integrate telehealth service billing with revenue cycle technology. This is of more importance to billers because it would apply the same workflow to telehealth visits as is applied to coding, billing, and reimbursement processes. An integrated workflow helps to spot the disconnect in the process on the go and undo errors before it gets too late.  

About 84% of telehealth users resolved their medical concerns with a virtual visit, and 73% had a seamless experience.

Here’s What Needs to be Done 

Given the variance of laws across borders and rules amongst payers, it is important for billers to cross check rules with insurance companies at every step. This way they can avoid denials and maximize reimbursement during these trying times. Medicare, for instance, restricts telehealth payment only for seniors living in rural communities.

Medicaid, on the other hand, has no such restrictions. So, cross checking for coverage is very important for billers. Yet another reason is the continuous change and updates that telemedicine policies are undergoing almost every day. Committing after checking for the latest rules saves the day for billers. 

So, as far as payer guidelines on telemedicine are concerned, you need to have a clear answer to the following queries:  

  • Which specialists does the payer recognize for telemedicine billing?  
  • What types of healthcare services does the payer acknowledge for telemedicine?  
  • Does the payer pay for live telemedicine services?  
  • What are the conditions or restrictions that patient has to meet before making claims for telemedicine?  
  • Is there any capping on the number of video consultations that can be availed annually?  

Getting all these questions answered is not the end of your job. There is another important task to complete and that is going to the company’s website and validating the answers. Any variance, and you can call them up to draw their attention. Also, seal the matter by sending them a mail. This will help nip issues in the bud.   

As billing for telemedicine is a new concept using accurate CPT codes along with GT or 95 Modifiers is very important. Sometimes it is difficult to be accurate because despite the exhaustive number of CPT codes listed by Medicare, some private payers would insist on code 99444. This again varies with payers and state. There is another easy way to confirm the eligibility of the codes – dial the payer up and enquire upfront.

Medical Billers should also be mindful of the GT modifier. This modifier is used to convey to the payer that the provider delivered appropriate telehealth services. As per Medicare recommendations, claims for telemedicine services should be accompanied with correct GT modifier with precise E/M CPT Codes. If the bill is for commercial insurance, then it’s compulsory to apply regular E / M CPT code and 95 modifiers. Even in this case, it’s safe to get it confirmed with the insurance company.

Other things to take care of is facility fees, patient demographic details and the place of the service code. Any slip ups in this can lead to delays. In case of facility fees through Medicare, billers must bill HCPCS code Q3014.  

Conclusion 

We are soon moving towards an age where there will be full payer coverage for telemedicine.  This will be primarily driven by baby boomers and employees who have already used the services and hence will be demanding more. It’s just a matter of time before the restrictive rules of Medicare disappears because the trade groups are stepping up their lobbying efforts on the government to pass legislation that would grant full financial support for the service. Likewise, states are moving quickly to establish standards to bring telehealth at par with normal treatment.  






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