Due to a surge in patients due to COVID-19, billing for telemedicine can be complicated. Telemedicine is changing almost every day due to the coronavirus pandemic, which makes your team hard to keep up to date with policies. Though CMS has already issued guidelines for telemedicine, they are still getting new updates from authorities to make the process smooth. Actually, rules for billing telemedicine are not only changing fast but also vary from payer to payer.
Your medical billers need to answer some questions to their billing and coding questions. For example, how should they bill telemedicine? Which codes they should use? How does telemedicine reimburse? Is there any restriction should they watch for?
Almost all major private payers provide cover for telemedicine. Some major commercial payers like Blue Cross Blue Shield, Aetna, Humana, Cigna, and United Healthcare cover telemedicine. Medicare also covers telemedicine and with the current pandemic situation, the rules for telehealth have expanded. There are some incidents found like the treatments were not allowed in last week and are allowed in the current week.
According to the CDC, there are several telehealth modalities allow provider and patients to connect using technology to provide health care treatment:
Synchronous Modal includes a direct call or live audio-video interaction with a patient. This interaction can happen using a smartphone, tablet, or computer.
In some special cases, peripheral medical equipment (e.g. ultrasounds, otoscopes, digital stethoscopes) can be used by another provider or healthcare person (e.g. medical assistant, nurse) physically with the patient, and the healthcare conducts a remote evaluation while consulting.
Asynchronous Modal includes “store and forward” technology where images, messages, or data are collected at one point in time and interpreted or responded to later. Patient portals can enable this type of communication between providers. But these patient portals should be HIPAA compliant and use secure messaging.
Remote patient monitoring Modal
In this remote patient monitoring modal, providers are allowed direct transmission of a patient’s clinical measurements from a distance (may or may not be in real-time) to their healthcare provider.
Payers and Medicare are revising and changing telemedicine policies almost frequently. Here is an important link of the new United Healthcare telemedicine policies. You will get the most recent updates about telemedicine policy updates at United Healthcare Provider Telehealth Policies.
Verify Patient Insurance
Your practice might have a process in place to verify patient insurance. But now onwards there is one more check added to this verification i.e. is the payer going to pay for telemedicine? Your biller or outsourced medical billing company must verify a patient’s insurance before their first telemedicine visit to avoid claim denial.
When you are calling a payer, you should document everything with a call reference number, you can use this information later to resubmit denied claims if any.
CPT Code verification
Most of the time payer’s advice providers bill telemedicine with the appropriate evaluation and management CPT codes (99201 – 05, 99211-15) along with a GT or 95 modifier.
Medicare covers a long list of eligible CPT codes, and some private payers may prefer that provider can use the telemedicine specific code like 99444. It can be vary based on your location. Medicare telemedicine code details.