Telemedicine seems to be part of the “New Normal” and seems like it’ll stay that way. This is thanks to an impressive success rate for helping to provide a wide range of patients with basic care and information without having to come into the clinic.
Though getting reimbursed for telemedicine or telehealth visits presents a little bit more of a challenge for practitioners. Especially solo or small practices that might not have a large administrative staff to rely on. Adding to this concern is that some insurance companies might not have clearly defined policies on what types of telehealth services are covered, or to what degree they are covered.
Fortunately, there are some things you can do to decrease denied or rejected claims while streamlining the reimbursement process for telemedicine claims.
Determine The Type Of Telemedicine You Offer
Telemedicine or telehealth services can vary widely, and many solo practitioners are finding creative ways to connect and provide their patients with the basic care they need. This might include things like:
Live Video Appointments
With timely scheduling this is a great way to connect with patients, assess their symptoms and needs. In some cases, this might be all that’s needed to provide them with a necessary prescription or to properly administer some basic self-care. Live video appointments are also popular for mental health and behavioral professionals.
Remote Monitoring Software
With some medical conditions and devices like a pacemaker, or a glucometer, remote monitoring software can be used to track a patient’s status, and assess the need for in-person care.
Most states have telemedicine reimbursement systems in place with Medicare coverage.
With Medicare-covered services, the level of usage or the treatment directives is often defined for specialty services or general health assessments. Though with other practices you may need to define in advance the way you will use telemedicine. This can also be filtered through insurance provider requirements to reduce the risk of claim rejections and claim denials. This might include things like:
- Virtual check-ins with a patient after they are discharged from the hospital
- Outpatient follow up care
- Determining the risk of infection
- Counseling services
- Instructing patients on self-performed rehab exercises
In all but two states Medicare has some level of defined coverage related to telehealth or telemedicine appointments. While they do their best to be clear-cut about what is and isn’t allowed, there are still some details about the location of the physician and the patient that need to comply.
Technically, Medicare reimburses for telehealth or telemedicine services that are provided by a healthcare provider from a “Distant Site” or clinic directly to a Medicare beneficiary/patient at what is defined as their “Originating Site.” By their regulations, the Originating Site must be in a “Health Professional Shortage Area” of HPSA.
This includes things like:
- Critical Access Hospitals
- Rural Health Clinics
- Solo Practitioner Offices
- Federally Qualified Health Centers
- Renal Dialysis Centers Based In A Hospital
- Skilled Nursing Facilities
- Community Mental Health Centers (CMHC)
By law, the patient in question must be in an approved HPSA for Medicare to reimburse the cost of care, and the patient needs to be receiving virtual care in an approved clinical setting. That setting must be located within a previously defined Health Professional Shortage Area.
It’s also worth noting that only certain CPT and HCPCS codes are eligible for telemedicine reimbursement. Medicare maintains a specific list of CPT and HCPCS codes that are covered under telemedicine services.
Medicare will also pay the “Originating Site” a reimbursement known as a “Facility Fee” for hosting the telemedicine visit. This is according to HCPCS code Q3014.
Set Up Protocols For Handling Private Payers
Some medical insurance providers do not offer claim reimbursement for certain telemedical services or treatments. If the pre-qualification process reveals a situation like this, the patient might still choose the treatment via private pay. This might also include things like private copays.
It’s important to set up steps in advance to determine if the telemedicine treatment in question is covered by the patient’s medical insurance policy. If it isn’t then you, the practitioner needs to communicate the coverage problem or the degree of coverage to the patient in advance of providing treatment.
Set Up Protocols To Deal With Medicaid
Once again, Medicaid has its own regulations in play that can increase the risk of claim denials and claim rejections. This process is often slower than dealing with a medical insurance company, as Medicaid’s requirements are set up to protect the public trust. They can also vary from state to state, with some counties being understaffed to handle the Medicaid processing volume they are currently experiencing.
If possible, try to set up all claims and applications far in advance for all telemedicine reimbursement through Medicaid. This includes doing your research on things like Looking up the Medicaid telemedicine reimbursement rules for your state via websites like the National Telehealth Policy Resource Center or visiting your state Medicaid agency’s website.
Provide Your Administrative Staff With Extensive Training
Any in-house administrative staff you employ will bear the brunt of the responsibility for coding, filing, and handling the medical billing for telehealth services. Make sure to provide them with all the training you need and take steps to verify that they are fluent in the details of the process to reduce the risk of rejected claims, denied claims, or failure to pay by private payers.
Consider Charging Patients A Convenience Fee
Some telemedicine practitioners will charge a convenience fee to patients in lieu of filing a claim to their insurance company. This is more common with things like virtual follow-ups for private payers. This could include a simple flat fee of $30 to $75. In some cases, the convenience fee might even be covered by a patient’s medical insurance as more and more insurance providers are embracing the benefits of telehealth appointments. Just make sure that your patient agrees to it in some form of documentation.
Accurate Coding For Telemedicine Reimbursement
Accurate medical billing codes are critical for being reimbursed for telemedicine appointments. This often includes the use of an appended GT or GQ modifier added to the end of the CPT code.
You will need to use a GQ modifier for asynchronous telecommunication system visits.
The GT modifier is used for interactive audio and telecommunications system visits.
Consider Outsourcing Your Medical Billing Needs
There are many medical billing firms out there, with on-staff professionals who are well-versed in the codes and compliance requirements associated with telemedicine reimbursement. If you are a solo practitioner or a small practice with a limited administrative staff, you might want to consider outsourcing your medical billing to a professional third party service.
Not only can they help you navigate the relatively new waters of the telemedicine process, but their experience helps reduce claim denials and rejections while providing you with a more consistent revenue stream. All at a small percentage cost.