5 Things You Should Know When Billing Telehealth and Telemedicine Services

Though telemedicine was introduced decades ago for connecting patients and doctors in remote locations with specialists somewhere else, the gadgets required to conduct such remote visits remained complicated and expensive. But today, with the introduction of affordable, high speed internet and smartphones with high-quality video transmission, telemedicine has evolved as practical solution for providing remote healthcare to patients in their homes, workplaces or assisted living facilities. This alternative to in-person visits, for both primary and specialty care, improves patient engagement while saving money and time for patients.

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Telemedicine refers specifically to remote clinical services while telehealth refers to a broader scope of remote healthcare services including telemedicine and non-clinical services such as provider training, administrative meetings, continuing medical education and so on. Telemedicine technology uses patient engagement software for specialist consultations, follow-up visits, medication management and many other clinical services. Though telemedicine is becoming quite popular, the billing and payment for telemedicine services are still a confusion for many doctors as well as their patients. Here are 5 things to keep in mind while dealing with telemedicine bills:

1. Telemedicine Coverage can be Policy Dependent

Coverage for telemedicine bills depends on which state the patient is located in and the kind of medical insurance they use. Though most private payers do cover telemedicine, it's important to read the insurance policy carefully to ensure its not listed under their policy exclusions list.

The major commercial payers such as Blue Cross Blue Shield, Cigna, United Healthcare, etc. cover telemedicine in their healthcare policies. Some of these companies are running telemedicine pilot programs to find out more about the care and cost benefits of telemedicine.

Though Medicare does pay for telemedicine services under certain circumstances, their goal is to cover for telemedicine services only in places where an in-person visit may be difficult for the patient or the care provider. To be eligible for this coverage, the patient has to be located in a Health Professional Shortage Area and receive care from an eligible provider. If all their conditions are met, Medicare covers 80% of the physician fee while the remaining 20% has to be paid by the patients themselves. Medicare will also pay a facility fee to the originating site. Medicare covers store-and-forward telemedicine services in Hawaii and Alaska.


2. Verify Coverage Before the 1st Telemedicine Visit

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The best way for doctors to ensure they get paid for their telemedicine services is to call up and verify the coverage options with the patient’s insurance. This should be done before their first telemedicine visit, rather than after it. It's usually worth the extra effort as it needs to be done only once for a policy while there may be several telemedicine visits from the same patients regarding consultations, medications and further follow up. When calling up the payer, the doctor should document the representative’s answers regarding the payment along with the call reference number. If the claim is later denied, the doctor can use the call reference number to fight for the payment as everything said over the phone is recorded and the company has to honor their promises.

Nowadays, more private companies are coming forward to pay for telemedicine services as this is turning out to be in quite popular in terms of value based care. The evidence in cost-savings of virtual care is another motivating factor for payers like United Healthcare which has expanded coverage for telemedicine in their employer health plan offers. But for which telemedicine services and how much such private payers can pay vary from state to state. Telemedicine parity law has been passed by 29 states and Washington, DC that direct private payers in those states to pay for telemedicine services at the same rate as in-person visits.

3. Telemedicine Guidelines May Vary for Each Payer

There are basically three types of payers for medical care and telehealth solutions, namely Medicare, Medicaid and Private payers. As they may all have different guidelines concerning their telemedicine coverage, it is essential for service providers to understand them, to ensure they get paid for the use of their modern patient care software. Such guidelines may be different from payer-to-payer and state-to-state. While contacting their customer care representatives, it's important to ask the right questions to each payer and document the responses as well as the reference number for the phone calls made:

  • Who are all allowed to bill for telemedicine?

  • Which healthcare services are permitted for telemedicine?

  • Is live video telemedicine covered?

  • Any conditions to ensure a patient qualifies for telemedicine coverage?

  • Any restrictions regarding the distance from the provider?

  • Is informed patient consent required in writing?

  • Any restrictions regarding the number of telemedicine visits in a given period?

4. Direct Payments from Patients

There are many occasions where patients pay directly for their telemedicine visits. Some online telemedicine services offer monthly or yearly subscription rates for accessing their services. There are websites with telehealth software that provide 24/7 on-demand access to virtual doctors and patients are charged a per-visit fee. Such payments are paid from the patient’s pocket, rather than by insurance companies.

Some doctors offer virtual visits to their patients as part of concierge practice model where the payment is direct. The concierge practice or boutique medicine is a system where patients pay an added fee in exchange for more personalized care and better access to their doctors. Though such patients pay yearly fees to have the doctor on retainer, they usually keep a high-deductible insurance plan for emergencies. An additional convenience fee may be charged at every virtual visit. Extra charges may also be levied for access to telemedicine visits as they may not be included in the basic subscription fees of the concierge practice.

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5. CPT Codes for Billing Telemedicine

Once the insurance company's guidelines for billing telemedicine is confirmed, the service providers can start coding the visit in question. The CPT code commonly used for in-person visits can usually be used for telemedicine visits also but be wary as there are certain exceptions to the rule. Codes for billing may vary based on the payers and the state they reside in.

Telemedicine providers have to bill for their services using the right CPT codes and GT modifiers. Medicare has a long list of CPT codes while some private companies require providers to use the telemedicine specific code 99444 for billing. To find out which codes are appropriate, its best to just call up the payer and confirm their list of covered codes. If they are not able to provide a full list, ask if 99444 is covered and whether the E&M CPT codes can be used with a GT modifier. Errors on claims give insurance companies the grounds to deny payment. To avoid the denial of telemedicine claims it's vital to understand CPT codes and GT modifiers in telemedicine billing.