Everything you need to know about billing and coding for telehealth

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It’s no secret that our lives have been transformed with the advent of the internet, modern man has been able to achieve numerous victories. It has even helped our social lives, making it easier to stay in touch with everyone else. One of the things that the internet has boosted is the healthcare industry. It is the easy availability and accessibility of telehealth services and tools that have saved a lot of patients’ lives.

Understanding The Basics Of Telehealth

What is Telemedicine? All You Need To Know

When communication technologies and digital information is used, for instance, mobile devices and computers which leads to having easier access to all of the health care services along with the proper management of all the health care needs, then that is referred to as telehealth. These kinds of telemedicine services can be quite easily used right from the comfort of your own home. 

When it comes to the process of coding and billing for telehealth services, it can be proven to be quite a tricky matter. The guidelines that must be followed during the process of billing telemedicine, are still in the process of being molded. It will not be long before there is a proper guideline book that can be followed by everyone. 

However, a number of medical billers are confused about the key things that must be followed when it comes to the entire billing and coding procedures. Let’s take a look.

1. The private payers tend to cover all of the telemedicine

When it comes to the top-tier commercial payers, they all cover telemedicine. Medicare also tends to cover telemedicine since it has become quite an important aspect these days. In recent times, the rules that are being followed when it comes to telehealth have inflated quite a lot. For instance, if a rule was not allowed last week, it will be allowed this week.

2. Telemedicine rules are changing every day

When it comes to the telemedicine rules, they are ever-changing. Medicare and insurance companies are in the constant process of changing and updating the policies of telemedicine. It is important that telehealth companies remain constantly updated with these changing rules to get the most benefit.

3. It is important to verify your patient’s insurance covers telemedicine

Ensuring that your patient’s health insurance covers the cost of telemedicine will ensure that the bills of your telemedicine get paid. This way you would have a steady flow of revenue without the fear of suffering a loss. Even though this requires a bit of time to do a background check on your patient’s insurance, it is useful for you in the long run.

When you make the call to the insurance company, you have to make sure that you have the required telemedicine insurance verification document. This way you can easily document the necessary information on the form along with the reference number of the call, which gives you an upper hand if you have to fight for denied telemedicine claims.

4. Study the guidelines of telemedicine for each of the insurance payers

It might seem quite intimidating in the beginning, but if you are going to tackle telemedicine billing, it is important to remember that there are three kinds of payers which are private payers, Medicaid, and medicare. Some of the questions you can ask the insurance payers are;

  •  What kind of healthcare services does telemedicine cover?
  • Amongst which of the healthcare providers are eligible for telemedicine?
  • Is there any condition or restriction that must be met before the patient becomes eligible for telemedicine?
  • Do you cover live telemedicine video?
  • Is there any restriction on the number of telemedicine visits a patient can have in a single year?

Many of the insurance payers have proper answers to all of the questions, however, many of the insurance payers tend to cover the telemedicine services for a few medical providers only. These guidelines tend to vary depending upon the payer or the state, therefore it is always wise to call the payer and understand their procedure. 

5. Ask the insurance payer which of the particular CPT codes are allowed when it comes to the process of telemedicine billing

The majority of the insurance payers are always clear about the appropriate use and management of the CPT codes (99211 – 15, 99201 – 05) with the use of 95 modifiers or GT. 

But since Medicare tends to cover a long list of CPT codes that are usable, many of the private insurance payers tend to prefer the use of 99444 (which is a specific code). Again, this all varies for each payer and the state your medical institution is based in.

Therefore, to cut out any doubt that might bug you, it is always wise to call up your insurance payer to know all the eligible codes that can be used. Following CMS telehealth codes provide for a better experience overall.

6. Understanding the use of 95 modifiers and GT

Hierarchical condition categories solution

A GT modifier is used to inform the medicare payer that a medical provider has already delivered the required medical services with the help of telemedicine. It is essential that the GT modifier is used with the proper Management and Evaluative CPT code during the process of telemedicine billing. When telemedicine is billed for an insurance company that is commercial in nature, the use of regular Management and Evaluative CPT code along with 95 modifiers is majorly used.

7. The placement of service codes

During the process of billing all the telehealth services, every healthcare provider should bill Management and Evaluative code along with the 95 modifiers or a GT. if this procedure is not followed then the billed telehealth services get denied by the insurance payer. 

Even though telehealth has provided a number of benefits in healthcare facilities overall, there are some drawbacks to it as well. There is a risk of disrupting health care which leads to many gaps within the industry. Using medicines inappropriately, overlapping or unnecessary use of health care, overusing medical care are some of the disadvantages that come with fragmented health care. Therefore, it is better to outsource your hospital’s entire billing process to a reliable service provider like Synergy HCLS. They can provide you with a number of benefits.