Billing for Telemedicine: The Tips You Need to Know

April 20, 2020 by Antonio Arias, MBA, CHBME

Topics: Medical Billing, Practice Management, Medical Billing Company

Telemedicine is an excellent advancement for the healthcare system at large, since it helps underserved communities get the medical attention they deserve even when a local physician is unavailable. This has proven especially important during the COVID-19 crisis because telemedicine allows healthcare providers to deliver essential medical services without placing an additional burden on medical infrastructure or compromising social distancing requirements.

COVID-19 and the Role of Telemedicine

Although telemedicine services have been available for many years now, hospitals and other providers have been slow to embrace the technology. That’s disappointing because there is substantial evidence that it can greatly increase the overall availability and efficiency of healthcare services. For instance, hospitals with telehealth tools not only see a larger volume of patients each day than hospitals without them (110.1 patients per day compared to 88.1 patients), but those patients also tend to have much shorter stays (4.7 days compared to 7.0 days).

The COVID-19 coronavirus outbreak has forced many healthcare providers who were either hesitant to provide telemedicine services or lacked the HIPAA-compliant IT infrastructure to reliably deliver them to greatly ramp up their telehealth capacity. In the span of a few weeks, demand for virtual medical services has grown exponentially, creating a tremendous opportunity for healthcare practices that have made investments in telehealth.

Following the Centers for Medicare & Medicaid Services (CMS) announcement in late March that a waiver would be used to expand Medicare reimbursements for telehealth and telemedicine services, that demand has only increased and could eventually lead to significant changes in the way patients interact with the healthcare system even after the COVID-19 crisis passes.

Tips for Telemedicine Billing

But despite the growing prominence of telehealth in the midst of the coronavirus pandemic, medical billing for it is still tricky business.

Medicare, Medicaid, and commercial payers all have different rules when it comes to billing for telemedicine. Many providers who offer telehealth services rely on a cash-pay-only approach. As such, there’s no set of one-size-fits-all advice for providers looking to grow their telehealth services list. It’s also important to remember that the recent CMS regulatory waivers are still only temporary and do not apply to all forms of telehealth services

That means that sorting out the details of telemedicine billing will continue to be a challenge for healthcare practices. Here are a few essential tips that can help them navigate the evolving reimbursement environment without incurring issues.

Get Friendly with the GT Modifier

Medicare covers telemedicine services and reimburses it on the standard fee schedule. Use the appropriate CPT code with a “GT” modifier to indicate the “interactive telemedicine” component. Don’t let the similar GQ modifier, for “asynchronous communications,” trip you up – that one’s only intended for providers in demonstration projects in Hawaii and Alaska.

Similar for Medicaid… but Different 

To identify, track, and reimburse for telehealth services, providers can select from a variety of HCPCS codes (T1014 and Q3014), CPT codes and modifiers (GT, U1-UD), but medical billing and coding guidelines depend on their states’ rules. At present, 48 states and the District of Columbia now provide some form of Medicaid reimbursement for telehealth services.

For Private Payers, It’s a State-by-State Basis 

States have had to create their own requirements when it comes to telehealth, and at last count, 32 states and the District of Columbia have some kind of private payer policy. Research whether your state is one of 29 with a “telemedicine parity law,” which mandates commercial coverage of telehealth services the same as in-person ones. But as always, read the fine print – some states have restrictions.

The Big Five Have You Covered 

Aetna, Humana, Blue Cross Blue Shield, Cigna, and United all offer some degree of coverage for telemedicine, but it’s policy-dependent (meaning many exclusions on lower-tier plans) and varies state-by-state. If you or your patient need specifics prior to a telehealth session, be sure to verify carefully.

When in Doubt, Check

The advice to verify carefully is even more important when it comes to smaller commercial payers. Go beyond a basic eligibility check to asking an actual representative about the telemedicine CPT code in question. If the rep says it’s covered, try to get that statement on record (with a reference number or other form of documentation) to dodge any potential billing disputes down the road.

Stay Informed

Telemedicine is growing in popularity for more than just underserved populations due to the COVID-19 crisis. Thanks to advances in technology and the changing expectations of patients, telemedicine is increasingly being utilized by providers and accountable care organizations to bolster primary care delivery and keep consumer costs down. Watch for pilot programs in your area and stay engaged with the evolving laws; more positive telehealth program results will ultimately lead to stronger coverage and better reimbursement rates across the board.

Maximize Your Telemedicine Services with NCG Medical

Since the regulatory landscape for telemedicine is changing rapidly as the coronavirus pandemic puts more pressure on healthcare providers, having a trusted medical billing service available to guide your practice through those changes is more valuable than ever. By outsourcing medical billing to a third party, you can spend more time focusing on delivering quality care to patients during these difficult times and less time researching and worrying about which telemedicine services qualify for reimbursements.

At NCG Medical, we’ve long been advocates for using technology to streamline and improve healthcare practice management. Our team of medical billing specialists can help you evaluate the current reimbursement options for telehealth services to avoid claim denials and billing errors. Contact us today for a consultation.

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