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Your Guide to Telehealth Billing

The Mayo Clinic defines telehealth as “the use of digital information and communication technologies, such as computers and mobile devices, to access health care services remotely and manage your health care.” Telehealth is often referred to as “telemedicine,” although it encompasses a broader range of services than remote clinical sessions.

Not surprisingly, telehealth has exploded in popularity in 2020, especially in the wake of the COVID-19 pandemic. Of course, even before then telehealth was already an integral part of many health care providers’ service packages, with at least 76% of hospitals connecting with patients and consulting practitioners remotely through advanced telecommunications platforms.

Telehealth has provided key benefits to both end consumers and health care providers. For example, many patients previously enjoyed only limited access to health care services due to a variety of geographical, logistical, or physical factors. Now, they can consult with their primary physician from the comfort and safety of their own home. At the same time, health care providers have been able to diversify and expand their offerings because of the increased flexibility that telehealth mediums enable.

Of course, telehealth providers must adhere to billing procedures that are similar, if not identical to procedures associated with more traditional services. The following overview of telehealth billing discusses the process, codes, and procedures involved in some more detail.

Telehealth Billing Terminology

First of all, it’s important to define key terms that are used in telehealth billing procedures. These include the following items:

  • Practice type. This is a medical billing code that indicates to the payer which type of practice provided the invoiced service. Examples of practice types include hospital-based clinics, private practices, skilled nursing facilities, community mental health centers, rural clinics, and so forth. It is vital that billing professionals list the practice type accurately, since insurers may decide to extend or deny coverage based on the patient’s policy with regard to the practice type utilized.
  • Originating site. The originating site basically refers to the patient’s location during a telehealth session. This is a classification primarily used in relation to Medicare. In order to qualify as an originating site, the location must be approved by the Centers for Medicare and Medicaid Services (CMS), which normally would mean it is located outside of a Metropolitan Statistical Area (MSA), or in a rural Health Professional Shortage Area (HPSA). Of course, the federal government announced a series of policy changes with regard to telehealth coverage during the COVID-19 crisis, one of which included the abolition of geographic restrictions for patients or providers.
  • Distant site. The distant site is the provider’s location during a telehealth session. This term also specifies which provider types are authorized to provide covered telehealth services. These provider types include physicians, physician assistants (PAs), nurse practitioners (NPs), clinical psychologists, registered dietitians (RDs), social workers, and others.
  • Place of service. This segment of a billing code informs the payer of where the originating site and distant site are located. This is a core component of the billing process, since many insurance companies pay different rates depending on the health care provider’s physical location during the visit.

The Telehealth Billing Process

The typical telehealth billing process has many “moving parts,” so to speak, and can become quite complicated. However, the basic process goes something like this:

  • To begin the billing cycle, the health care provider clears the use of telehealth with the patient’s insurance company. This may mean a phone call or email to the payer to confirm coverage, as well as the provider sending a “place of service” code to the insurer to identify both the location and the specific service to be provided.
  • Depending on the coded procedure, the provider may need to meet certain eligibility requirements for the payer to cover the telehealth session. These requirements may include factors like distance, patient consent, provider-patient relationship, and so forth.
  • Once the telehealth service receives a specific code, as mandated by the AMA’s Current Procedural Terminology, the provider’s billing department can send an invoice to the payer either directly, or through a clearinghouse service. This typically involves the electronic submission of an ANSI 837 file on the Electronic Data Interchange (EDI).
  • Once the payer receives the billed claims, an adjuster will determine their validity based on factors like the necessity of the service rendered, and the patient’s eligibility for coverage according to his or her policy.
  • If a claim is approved, the insurance company will provide reimbursement based on a predefined rate. If the claim is denied, it is returned to the provider’s billing department with an explanation of benefits (EOB). The provider must then make any needed adjustments to the claim and resubmit. This process may occur repeatedly until the payer finally reimburses the provider for all of the services rendered, or the provider agrees to a partial payment instead.

Common Telehealth Billing Codes

It seems as though an increasing number of telehealth services are becoming available every year — and each new service must be associated with its own unique CPT code. Still, notwithstanding the proliferation of new procedures, many CPT codes are used quite frequently by health care providers. Such common codes include:

  • G0425 – G0427: Emergency department or initial inpatient telehealth consultations
  • G0406 – G0408: Follow-up visits to inpatient telehealth consultations
  • 99201 – 99215: Office or other outpatient visits
  • 96150 – 96154: Individual and group health and behavior assessment and intervention
  • G0436, G0437, 99406, and 99407: Smoking cessation services
  • 90845: Psychoanalysis

When providers have billing questions, or are not sure which code to list, they can refer to the guidance provided by the CMS. In many cases of claim denial, the root cause is human error and/or inattention to proper billing procedure. Interestingly, even though an average of 63% of claims are recoverable, providers spend approximately $118 per claim on appeals, which translates to $8.6 billion in administrative costs across the United States. This underscores the importance of maintaining accuracy and precision in your billing process.

The Benefits of Outsourcing Your Telehealth Billing

Many health care providers simply don’t have the internal resources or expertise to maintain a high threshold of accuracy when it comes to the telehealth billing process. However, if you want to reduce the number of denied claims from insurance companies and streamline billing procedures across the board, there are many outsourcing options available that would do the trick. Moreover, many companies offer medical billing software as a service (SaaS) solutions to their customers, which have yielded exceptional results.

You will likely gain several advantages from outsourcing your telehealth billing process to an experienced medical billing firm. Such benefits may include the following:

  • Up to date expertise. Since the medical coding & billing profession has experienced many abrupt changes over the past several years — and especially so in light of COVID-19 — the expertise of an industry-leading 3rd party firm can provide invaluable in terms of staying up to date on the latest regulations and procedures.
  • Specialized support. Medical billing companies employ highly trained and experienced coding/billing experts. These professionals are not only familiar with the specific requirements of telehealth billing, but are also comfortable with the technological platforms and specialized software that is used within the industry. Their expertise can prevent many claims from being sent back as “denied,” and boost your practice’s productivity and profitability.
  • Shorter turnaround times. In some cases, it may take days for a claim to be submitted to a payer; and such delays can ultimately result in significant cash flow issues. However, with an outsourced workforce composed of medical billing experts in your service, you could submit the majority of your claims within hours, instead of days.
  • Reduced costs. Maintaining an in-house billing department comes with heavy staffing costs. For instance, think about benefits, workers’ compensation insurance, vacation and overtime pay, and other employee-related costs. The outsourcing route allows you to pay less for expert assistance. The money you save by avoiding the heavy overhead costs associated with unnecessary staff members can be reallocated into growth initiatives, like marketing or IT upgrades.
  • Enhanced focus on patient care. If you outsource your telehealth billing to a reputable 3rd party vendor, then you’ll be able to focus on your core competencies — namely, caring for your patients. By doing so, everyone wins: your reputation will be enhanced, your patients will be happier, and your business will flourish.

The Benefits of Using Telehealth Billing Software

Of course, outsourcing your telehealth billing may not be a viable option for your practice at the moment. Still, you can optimize your process by investing in medical billing software. Such software can help you to:

  • Spot billing errors and fix them before submitting a claim
  • Quickly and accurately input billing codes
  • Submit claims in an intuitive, user-friendly way
  • Save on paper and verification costs
  • Streamline your entire billing process, from one end to the other

If you’d like to learn more about the benefits associated with the use of medical billing software, reach out to our team of friendly experts today to schedule a live demonstration of our software. We guarantee that you won’t regret doing so!

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