Telehealth refers to medical services like diagnosis, treatment, and monitoring provided remotely using technology like video chat instead of in-person clinic visits. Telemedicine is a broader term including related offerings like online patient portals.
Recent Updates to Telehealth Policies
Several temporary Covid-era telehealth policies are changing in 2023:
• The public health emergency ended May 11, 2023. So commercial insurers may change coverage.
• Medicare can reimburse for telehealth regardless of patient location through 2024. Previously patients were restricted to certain originating sites like clinics.
• Audio-only visits can still be billed in 2023. Video will not be required.
• Telehealth visits for mental health do not require an initial in-person exam until January 2025.
• Providers cannot waive patient cost-sharing for telehealth after the emergency ends. Copays will be enforced again.
• Enforcement of privacy and fraud/abuse laws will resume for telehealth services.
What Providers Can Bill for Telehealth
Many types of providers can deliver and charge for telehealth services like:
• Physicians
• Nurse practitioners
• Physician assistants
• Certified nurse midwives
• Clinical nurse specialists
• Registered dietitians for diabetes education
• Physical therapists
• Occupational therapists
• Speech therapists
Where Patients Can Be Located
The “originating site” refers to where the patient is located during the visit. This used to require clinical settings but now patients can be anywhere like at home.
The “distant site” is where the provider is located delivering remote services via technology. Providers can be in office or home.
Live Video vs. Store-and-Forward Telehealth
Synchronous or live video visits allow real-time interaction visually and verbally. Asynchronous or store-and-forward transmits recorded health data like images to providers to evaluate later. Different codes apply.
Telehealth Service Codes
Common telehealth visit codes billed like comparable in-person care:
• 99201-99215 for physician office and other outpatient visits
• 99231-99233 for subsequent hospital care
• 99307-99310 for nursing facility care
• 99341-99345 for home visits
• 99495-99496 for transitional care management
Different codes are used for e-visits, virtual check-ins, telephone calls, online assessment, and remote physiologic monitoring. Know requirements for each code.
Documentation for Telehealth Claims
Key details to note in visit documentation for telehealth:
• Consent obtained to conduct visit remotely.
• Telehealth modality used, patient and provider locations.
• Normal medical history, exam, decision-making process
• Total time spent if billing based on time instead of complexity.
• Compliant platform verifying privacy and security.
Telehealth Parity Laws
Some states have parity laws requiring private insurers to cover and pay the same for telehealth as equivalent in-person care. But there can still be restrictions around providers, services, technology, and sites covered.
Strategies for Telehealth Success
• Check payer policies in your region for coverage details.
• Obtain appropriate patient consent and document it.
• Use correct codes and modifiers like -95 for live video.
• Audit documentation and coding regularly
• Update enrolment forms with telehealth location info
Conclusion
With rapid changes in telehealth regulations, it can be challenging for busy medical practices to keep up with billing requirements like appropriate codes, modifiers, and documentation. The billing experts at BMMS stay on top of the latest telehealth rules and policies across all major payers. Our trained staff audit your telehealth documentation and claims to ensure correctness before submission. We identify any issues early and make recommendations to strengthen compliance. BMMS appeals denials and underpayments related to telehealth services by highlighting clinical evidence and regulatory details payers may have overlooked. Our dedicated telehealth billing team handles the complexity so you can focus on delivering excellent virtual care. Let BMMS optimize your telehealth revenue and prevent rework through our up-to-date expertise.
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