Introduction
The COVID-19 pandemic has accelerated adoption of telehealth services, with virtual doctor visits via video, phone and patient portals becoming commonplace. As telehealth utilization grows, medical practices must understand how to properly code, document, and bill for these remote care services to get reimbursed.
This comprehensive guide provides best practices and step-by-step advice on telehealth medical billing, including using appropriate CPT and HCPCS codes, filing claims, documenting encounters, verifying payer policies, and appealing denials. Read on to optimize your telehealth revenue cycle management.
Defining Telehealth and Virtual Care Services
Telehealth refers to a broad scope of remote healthcare services leveraging telecommunications technology:
Synchronous or live telehealth involves real-time audio-visual interaction between the provider and patient via videoconferencing or telephone. This virtual face-to-face connection allows vital services like diagnosis, treatment, prescription, and monitoring.
Asynchronous or virtual check-in telehealth refers to services like online patient health assessments, review of recorded health data, and physician consults done via online patient portals outside of a live encounter.
Remote patient monitoring refers to collection and transmission of patient health data like blood pressure, glucose levels and other vitals captured by devices for provider assessment and care recommendations.
mHealth or mobile health are healthcare services delivered via smartphones, tablets, and mobile apps, including medication reminders, digital health coaching, symptom trackers and more.
Telehealth allows providers to deliver timely, convenient quality care to patients wherever they are located. It expands access to care and saves costs through avoided ER visits and hospital readmissions. Healthcare systems, insurers, clinicians, and patients have all embraced broader telehealth utilization, especially for routine primary care along with services like telepsychiatry and telerehabilitation.
CPT Codes for Billing Telehealth Professional Services
Medical practices must use the proper CPT (Current Procedural Terminology) and HCPCS (Healthcare Common Procedure Coding System) codes to bill for telehealth services and receive proper reimbursement from payers.
Some of the main telehealth billing codes include:
Evaluation and Management Codes:
99201-99205 - Office or other outpatient visit, new patient
99211-99215 - Office or other outpatient visit, established patient
99241-99245 - Office or other outpatient consultation, new or established patient
These are billed for telehealth exactly as they would be for in-person visits. The level selected depends on medical decision-making complexity and/or total time spent on the virtual encounter.
Telephone Services:
98966 - Telephone assessment and management, 5-10 minutes
98967 - Telephone assessment and management, 11-20 minutes
98968 - Telephone assessment and management, 21-30 minutes
Use these codes for diagnosis, treatment, and care delivered over the phone without video. Time increments must be met.
E-Visits or Virtual Check-ins:
G2061 - Qualified non-physician healthcare professional online assessment, 5-10 minutes
G2062 - Physician or other qualified healthcare professional online assessment, 5-10 minutes
G2063 - Physician or other qualified healthcare professional online assessment, 11+ minutes
Bill these for brief patient assessments, review of data, and consultations conducted via online patient portals.
Interprofessional Consults:
99446 - Interprofessional telephone/internet/electronic health record referral service
99447 - Interprofessional telephone/internet/electronic health record assessment and management service
99448 - Interprofessional telephone/internet/electronic health record MCM service
Use when providers collaborate with other health professionals via phone, internet portal, or EHR.
Make sure to append telehealth modifiers to the CPT codes:
95 - Synchronous telehealth service rendered via real-time audio and video telecommunication system.
GQ - Asynchronous telehealth service for store and forward applications.
GT - Interactive audio and video telecommunications system.
Billing for telehealth requires staying up to date with the latest codes and modifiers, as these are continually evolving to accommodate virtual care.
HCPCS and Place of Service Codes for Telehealth
In addition to CPT codes, telehealth claims require accurate billing with:
Place of Service (POS) code 02 to indicate the location where health services and health related services were rendered via telecommunication technology.
HCPCS code Q3014 for live telehealth services rendered by a physician or other qualified health professional using interactive audio and video technology.
Proper use of POS codes and HCPCS codes like Q3014 validate that remote telehealth services took place for payers.
Documenting the Telehealth Patient Encounter
Thorough medical record documentation is vital for substantiating telehealth encounters and successfully getting claims paid. Providers should record the following in their notes for telehealth visits:
Informed Consent - Documentation that the patient verbally consented to receiving virtual telehealth services after risks and benefits were explained.
Telehealth Medium - Note the technology used such as video conferencing, telephone, remote patient monitoring device, mobile app, patient portal or other digital platform.
Location of Patient and Provider - Document the physical location of both parties during the virtual visit.
Medical necessity and nature of the visit - Detail the patient's condition, evaluation methods, diagnosis, medical decision making, treatment plan and follow up.
Time spent - Record total time spent providing telehealth services, especially for telephone and E/M codes where time determines the proper code level.
Complete medical record notes validate to payers that a quality telehealth visit was conducted. Sparse documentation can trigger claim audits and denials.
Utilizing Modifiers for Telehealth Coding
Along with selecting the proper CPT and HCPCS codes, using modifiers appropriately is imperative for delineating telehealth services on claims. Here are some of the common modifiers:
95 - Synchronous telehealth service rendered via real-time interactive audio and video. Appended to E/M or psychotherapy codes.
GT - Interactive audio and video telecommunications system used for real-time telehealth encounter. Paired with Q3014.
GQ - Asynchronous telehealth service involving store and forward transmission of recorded health information for physician review. Used with online assessment codes.
G0 - Telehealth service delivered directly by a physician or other qualified healthcare professional. Designates they provided the telehealth service versus supervised ancillary staff.
Modifiers provide additional information to describe the telehealth care services delivered. Payers monitor modifier use closely to identify inappropriate billing. Stay updated on proper telehealth modifier protocols.
Checking Patient Telehealth Benefits and Eligibility
Because telehealth policies differ among payers, practices should verify a patient's telehealth benefits and eligibility prior to a virtual visit. Confirm details such as:
Does the plan cover telehealth for the requested service type and CPT codes?
Is the patient's diagnosis eligible for telehealth treatment?
What telehealth delivery methods are covered - video, telephone, apps?
Is prior authorization needed from the payer first?
Are in-network providers required, or can the patient use an out-of-network telehealth provider?
Are cost-shares waived for telehealth during the public health emergency?
What proof of telehealth delivery does the payer require?
Documenting that telehealth benefits were verified improves clean claim submission and reimbursement rates.
Filing Telehealth Claims with Payers
When filing claims for telehealth services:
Use the proper telehealth CPT codes with applicable modifiers
Include the place of service 02 code
Provide supporting medical documentation
Identify rendering provider along with billing provider
Verify enrolment status of servicing providers
Submit claim promptly to avoid timely filing penalties
If denied, appeal with documentation of medical necessity
Provide additional details requested by payers to complete processing
Keeping claims submission processes running smoothly facilitates faster payments for telehealth services.
Developing Telehealth Policies and Procedures
Healthcare organizations should develop and regularly update telehealth-specific policies and processes encompassing:
Consent protocols - how patient informed consent for telehealth services is obtained/documented
Platforms and technology - approved video, telephone, app and online portal options
Documentation standards - what clinical, technical, administrative details must be captured in telehealth visit notes
Billing and coding procedures - instructions for providers on selecting proper codes/modifiers
Compliance protocols - measures to prevent fraud, overbilling, prescribing violations
HIPAA and privacy - how patient data on virtual platforms remains secure and confidential
Formal policies/procedures ensure consistency, maximize legitimate reimbursement, and reduce compliance risks.
Staff Training for Telehealth Operations
For successful telehealth program implementation, practices must train both clinical and administrative staff on key processes including:
Scheduling telehealth visits - how to identify appropriate virtual care opportunities, obtain consent, arrange technology
Conducting patient assessments and education on connecting via various telehealth modalities
Delivering clinical services like diagnosis, treatment, prescription and follow up coordination through telehealth
Proper documentation practices for in-person vs. telehealth encounters
Coding and billing protocols unique to telehealth claims
Utilizing EHR, video platforms, patient portals and other technology
Telehealth compliance best practices
Regular competency assessments help identify any additional staff training needs related to telehealth.
Billing Challenges with Telehealth
Despite its advantages, telehealth billing comes with obstacles, including:
Inconsistent payer policies - Coverage varies plan to plan for types of telehealth services covered, approved modalities, eligibility, authorization requirements and reimbursement rates. Requires provider diligence to identify and adapt.
Documentation shortfalls - Lack of details on telehealth delivery, consent, functional outcomes open claims to denial and fraud allegations.
Unfamiliarity with telehealth coding - Newer providers may use incorrect codes or modifiers leading to payment issues. Upfront education helps prevent this.
Technology gaps - Lack of integration between telehealth platforms and EHR/billing systems hampers back-end workflows.
Higher denial rates - Common reasons include insufficient documentation, inappropriate CPT codes, outdated policies. Denials must be reworked and appealed.
Patient financial responsibility - Plans passing more telehealth costs to patients via copays and high deductibles that lead to bad debt.
Awareness of these telehealth billing problem areas allows providers to take steps to avoid roadblocks that delay or disrupt revenue.
Appealing Denied Telehealth Claims
Despite proper coding and submission, some payer claim denials for telehealth services still occur. Providers should be prepared to appeal denials through these steps:
Review the reason for the denial – attachment needed, improper code, unapproved service etc.
Gather documentation to justify the billed services – office notes, policy approval forms, coding rationale.
Draft an appeal letter highlighting evidence the services delivered met medical necessity and payer billing requirements.
Include specific telehealth documentation – technology used, consent obtained, mode of communication.
Submit the appeal promptly within the payer’s filing timeframe.
Follow up aggressively on pending appeals. Escalate to a supervisor if needed.
Consider in-person appeals, peer-to-peer review or arbitration for repeatedly denied claims.
Persistence usually results in successful claim payment on appeal. Quantify appeal success rates to identify payers needing education on telehealth policies.
Pursuing Telehealth Reimbursement Beyond the PHE
The Public Health Emergency (PHE) has brought about temporary telehealth policy expansions increasing coverage and reimbursement rates. However, as the PHE winds down in early 2023, payers may pull back some expanded telehealth benefits.
To sustain telehealth access long term, providers should:
Analyse utilization to demonstrate positive patient outcomes and cost savings under telehealth.
Have patients share direct feedback on their telehealth experience and impact.
Advocate to government and commercial payers for permanent telehealth policy reforms.
Promote legislation mandating pay parity between telehealth and in-person services.
Leverage data and patient testimonials to prove telehealth value.
Educate payers on the merits of telehealth using quantifiable results.
Proactive advocacy helps cement telehealth among standard care options after COVID-19 flexibility dissipates.
Partnering with Telehealth Medical Billing Specialists
Given the intricacies of telehealth billing rules, providers can benefit from partnering with specialized medical billing firms like Telehealth Billing Partners to optimize their revenue cycle management. Outsourcing offers valuable advantages:
Expert coders understand complex telehealth coding nuances
Specialists continuously monitor changes to telehealth rules and payer policies
They enhance charge capture by spotting missed billing opportunities
They relentlessly appeal denials and maximize collection of every dollar earned
Billing data analytics identify areas for telehealth billing improvement
Allows providers to focus on delivering quality virtual patient care
Conclusion
As telehealth becomes further ingrained into routine medical practice, optimizing the revenue cycle is crucial for fiscal sustainability. Thorough documentation, accurate coding, robust payer verification, efficient claim submission, and persistent denial appeals are the best practices providers should adopt to master telehealth medical billing. This telehealth billing guide provides an all-encompassing overview of the steps and knowledge needed to receive optimal insurance reimbursement for virtual care services.
FAQs
Q: Do I need separate telehealth consent forms?
A: Yes, it is best practice to have patients sign a consent form specifically for telehealth services to document their agreement to virtual visits.
Q: Can I bill for telehealth services if the patient is out of state?
A: It depends on individual state laws, but often you can bill for out-of-state patients if you hold an active license in that state.
Q: How should I document a telehealth visit in the medical record?
A: Document it the same way you would an in-person visit and include details like date, time, telehealth modality used, consent obtained, evaluation and treatment delivered.
Q: Do I need a separate tax ID to bill for telehealth services?
A: No, you can bill telehealth services under your existing tax ID if you are already enrolled with payers. Add location/service information as needed.
Q: Can patients use health savings or flexible spending accounts to pay for telehealth visits?
A: Yes, many of these tax-advantaged accounts can be utilized to cover out-of-pocket costs for telehealth services.
How BMMS Can Help
Outsourcing telehealth billing to a trusted medical billing company like BMMS can optimize revenue cycle management through:
Coding expertise to ensure you receive the maximum appropriate reimbursement
Staying up to date on the latest telehealth rules and payer policy changes
Conducting telehealth benefit verifications for patients before their visits
Providing staff training on proper telehealth documentation and coding
Appealing unfair or erroneous telehealth claim denials
Supplying telehealth billing reports and analytics to identify areas for improvement
With telehealth claim rules differing widely among payers, having a seasoned billing partner like BMMS ensures your practice accurately captures all revenue earned from virtual care services.
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