Billing for Telemedicine Services Guidelines

Overview 

During these challenging times, telemedicine allows medical practices to continue caring for their patients. Healthcare providers are encouraged to use telemedicine and other telehealth services whenever possible to limit physical contact with other people. Patients can stay at their homes, and non-HIPAA compliant technology has been allowed. 

Even though we are in a state of a public health emergency, it is still important to make sure you’re properly compensated for your services. The Centers for Medicare & Medicaid Services (CMS) recently released numerous waivers along with new rules for billing professional telehealth services during the public health emergency of COVID-19. These changes ensure that patients have access to physicians and other healthcare providers when using telemedicine.

Billing for Telemedicine Services During the Pandemic 

Telemedicine billing constantly changes, and each payer has their formal policy on how to bill for telemedicine. But with the impact of COVID-19 on insurance, some changes have to be taken to meet the needs of some specialties that normally don’t need these services. Here are some of the changes you can expect from different payers: 

• Self-Funded Plans

A third-party administrator administers self-funded plans with the discretion of which services they would allow. As of now, third-party payers do not reimburse telemedicine services rendered by healthcare providers.

• Services Covered

Most of the services provided to a patient which are not part of their insurance plan are usually not paid by the payer. The payment of these services usually defers to the patient. That is why medical staff needs to verify whether the patient’s insurance plan covers telemedicine services.

• Payer Reimbursement 

There is no standard reimbursement rate across the state. Some pay at a customary rate, while some pay at a fixed rate. In these instances, the billers working on these claims will still have to check it further and determine whether additional payment is needed. 

• Updates to Insurance Information

Insurance companies are constantly updating their websites and their telemedicine policies to cater to the needs of both the patient and healthcare providers. Medical practices are also making sure that their patient data are updated by receiving insurance-direct correspondence. By working together, insurance companies and healthcare providers keep everyone updated. 

• CPT Codes Available for Billing Telemedicine

Most payers advise providers billing telemedicine to use the appropriate evaluative and management CPT code along with a GT or 95 modifiers. However, Medicare covers a long list of eligible CPT codes, and some private payers prefer that providers use telemedicine-specific codes. To know which codes are eligible, you can call the payer and ask. 

Partner with DrCatalyst

Many healthcare providers are not being fully compensated for their telemedicine services. It could either be because of the complexities of billing telemedicine services or the constant changes in insurance policies during this state of a public health emergency.

If you have more telemedicine billing questions, DrCatalyst can help you. From the front desk to the back office, we offer end-to-end revenue cycle management services. Let us set up a time for you to chat with one of our billing specialists to see how our organization can help with your billing needs.