Support   1.800.840.9152   |   Sales   1.801.383.0388   |   OneTouch Login

How to Maximize Telemedicine Billing

Telemedicine is not a passing trend. It’s the future of healthcare, with 60 percent of millennials supporting telehealth options and 71 percent desiring a mobile app from doctors as of 2015. There is no stopping the train that is telehealth – there is only acceptance and adaptation. One facet of telehealth that will need to change is billing. As the field of telemedicine continues to grow, insurance companies and healthcare providers will need to upgrade to claims processing software to optimize modern billing.

Tracking Telemedicine’s Recent Growth

Telemedicine, or telehealth, has come into its own in the last several years. As patients become increasingly busy, they vastly prefer the convenience of a telephone and/or video consultations when they have minor medical concerns. The “connected patient” values online reviews from other patients, the ability to book appointments online, and the ability to pay bills digitally. Millennials report interest in technologies such as mobile devices, wearables, 3D printing, and telehealth when it comes to their healthcare experience.

The federal government is also supporting telehealth. The Health Resources and Services Administration (HRSA) recently named two medical centers in Mississippi and South Carolina “Telehealth Centers of Excellence,” turning them into research facilities focused on telemedicine. Each center received $600,000 in grants with the opportunity for $2 million in funding for two years of telehealth research. This development coincides with the Senate’s recent approval of new Medicare coverage of telemedicine for people with chronic illnesses.

With support from the federal government, millennials pushing for a change, and advances in telecommunications technologies, it’s only a matter of time before telehealth becomes the new normal for the modern patient. Utilization of telehealth services is expected to increase from 250,000 in 2013 to 3.2 million in 2018, with the value of the industry in the U.S. reaching $1.9 billion in 2018. Forecasts of the global telehealth industry place its value at $48.99 billion by 2021. Telemedicine is only increasing in importance and demand around the world.

Telemedicine for Patients of All Ages

Although millennials are some of the greatest supporters of telehealth in the form of apps and wearables, it is not just the younger generation that supports the transition of healthcare to digital. As older patients move away from primary care doctors, enter into retirement, and find it more difficult to get around, they too could benefit from digital alternatives to traditional doctor’s office visits. Telemedicine could break down common barriers to healthcare for senior citizens.

One study of 646 senior patients found that at least 38 percent of acute care episodes were appropriate for telemedicine care, and 27 percent of emergency department visits were eligible. Transitioning to telehealth for acute care and other visits could increase the efficiency and effectiveness of senior citizen healthcare. Getting the help they need, when they need it, right from home could make all the difference to seniors with injuries or illnesses. The trend toward telehealth will only increase in the coming years. It’s up to providers to stay up to date.

The Impact of Telehealth on Medical Billing

Telemedicine will make significant changes to the way providers handle medical bill processing. Since the Medicare, Medicaid and Benefits Improvement and Protection Act of 2000, Medicare
payments for telehealth services expanded to include a variety of telecommunications between doctor and patient. Coverage includes office visits, consultations, psychotherapy, and more, all delivered through telecommunications in lieu of an in-person encounter. The list of covered telehealth services later expanded further to include emergency visits, nursing care, and more.

For Medicare to make a payment for telehealth services, the patient must have used an interactive audio/video telecommunication system to communicate in real time with a remote practitioner. The patient must have been present during the virtual visit. The medical practitioner (if eligible) will then bill the insurance company for the telehealth services. For an optimal patient experience, the billing process for telemedicine must work as seamlessly and intuitively as possible. Medical billing had to undergo a transformation to keep up with the tech of telehealth.

Today, medical billers must understand Medicare’s telehealth regulations, determine the type of telehealth service the patient needs, learn the laws in the state, and know how to accurately bill patients for these services. The process can be tickly and complex. Guidelines for billing are still in development as new telehealth methods continue to emerge. Furthermore, the rules can vary
from payer to payer. Until clear guidelines exist across all payers, billing providers must obey a few best practices for successful services.

What to Know About Billing for Telemedicine

Telemedicine comes with its own rules and regulations, completely separate from typical medical billing. While all major private insurers cover telemedicine, the coverage may depend on the patient’s policy. Some providers, such as Blue Cross Blue Shield, put telemedicine services on exclusions lists. Billers must pay special attention to the patient’s insurance policy to verify that it covers telemedicine beforehand. Call and verify the coverage before the patient’s first telehealth visit to avoid billing and collection issues down the road.

Next, recognize that each payer will have its own telemedicine billing guidelines. If you’re dealing with multiple payers, this can seem overwhelming. You will need to call each payer and ask whether or not healthcare providers can bill for telemedicine, as well as which services the payer covers and if there are any restrictions. Most insurers request that providers use proper CPT codes and GT modifiers when billing telemedicine. This may vary based on the payer and your state. You may need to request a list of covered codes.

Finally, find out about any applicable facility fees you may be able to charge to payer. Telemedicine programs that bill through Medicare may request facility fees to cover hosting the patient as a telehealth site. The healthcare provider can charge using bill HCPCS code Q3014. When billing for telemedicine, best practice is to double-check everything with the payer before sending the bill. Each payer’s policy may differ, and you may find yourself tangled in a web of red tape to bill a single telehealth visit. Luckily, there are systems to make telemedicine billing much simpler.

Benefits of Software for Telemedicine Billing

Simplified claims processing for telemedicine can streamline the process to save time, effort, and money. Investing in the right medical billing software can make all the difference when it comes
to complex billing procedures for telehealth services. As the telemedicine industry continues to bloom and evolve, it’s more important than ever for healthcare providers and others to keep up with changing trends. A medical billing clearinghouse can ensure efficient, ethical, and accurate claims processing. Here are some compelling benefits of telemedicine billing software:

• Cutting edge technology. Medical establishments of 2017 and beyond need the latest software and technology to stay ahead of burgeoning trends. Falling behind can be devastating to the company and the patients, as it can result in reduced productivity, higher costs, and detrimental billing errors. Investing in current software ensures a business is up to date.
• Revenue cycle management. Billing and collections revolve around the management of a provider’s revenue cycle. In the medical industry, there are often long gaps between billing the payer and receiving the money, as well as receiving the rest of the payment (if applicable) from the patient. Efficient revenue cycle management can make reduce gaps in payment and keep a company on its feet.
• Direct claims processing to payers. The right billing software can send telemedicine service claims directly from your software to the payer, cutting out the traditional in- between actions. This system is easier for you and it saves time. With Apex EDI, you’ll see your real-time claim status and have the power to manage your web-based claims from your software.
• Real-time claims support and customer service. Telehealth claims can be confusing, and require the verification of patient eligibility, rules, and guidelines fro payers. A software system can make these communications easy, offering unlimited technical support and customer service.
• Online access to patient medical records. Many services also offer patients access to their health records and information, all securely online. This can lead to better-informed patients, as well as take the load off of nursing staff in gathering records. Fifty-seven percent of patients say they’d be more involved in personal healthcare if they had access to their medical records online.
• More attention on the patients. Telemedicine is all about optimizing the patient experience. When you adopt telemedicine billing software, you give your facility the ability to focus on the patients. Software makes billing a breeze, allowing you to receive payments faster and spend more of your time and energy on the patients.

The power to create and manage email lists, create health apps, offer virtual physician visits, become mobile-compatible, and efficiently bill for telemedicine services is at your fingertips. Apex EDI medical claims processing software is a simple yet powerful way to manage telehealth billing in the modern medical industry. It uses state-of- the-art software, yet integrates seamlessly with existing processing systems for easy adoption. It is a software system that can help you master telemedicine billing without any missteps. Contact us for more information about how claims software can help your establishment.

Sources: expands-telehealth- centers/ access-hospital/how-bill- medicare-telehealth- services of-the- connected-patient- 2015-infogrpahic.html about-telemedicine- healthcare shortage-to- spur-2-billion-telehealth- market/#64a5d68c2abe US-Telemedicine- Industry-Benchmark- Survey-REACH-Health.pdf bill/5661 tips/ Education/Medicare-Learning- Network-MLN/MLNProducts/downloads/TelehealthSrvcsfctsht.pdf sets-telehealth- site-facility- fee-payment/

Share on Social!

Share on facebook
Share on twitter
Share on linkedin
Share on email
Apex EDI, Inc.
556 E Technology Ave
Orem, Utah 84097
Support: (800) 840-9152
Sales: (801) 383-0388
Fax #: (801) 642-0333
Follow Us

Start saving time and money today. Let us show you with a personalized demonstration how APEX EDI can benefit your practice.