Did you know that the US Telehealth market share is expected to grow to around USD 23 Billion by the year 2025? It was just about USD 8 Billion in 2019! The numbers indicate that the Telehealth market is booming in the USA after the global pandemic hit the country, which means an increasing number of people opt for this service. To maximize the revenue for the providers in this arena, billing and coding teams of healthcare organizations should be on their toes.
The rules of billing are continuously changing with the diverse situations of the country. The billing team needs to know the latest updates to put forward a clean claim on the first move and avoid the issues of denied claim rates going up. This article will tell you about the latest Covid-19 Telehealth updates, as confirmed when the article was published. Read on to see what you should have in mind!
1.Broadening Medicare Coverage:
The public health emergency has left a great dent in the employment scenario with people losing their jobs and their employer health insurance. Medicare changes ensure that it can serve a greater number of people, without hospitals struggling with pending bills:
- Any geographic barriers do not bind providers and patients, thus maximizing the value of Medicare reimbursements.
- Relaxed eligibility criteria for the Medicare-enrolled healthcare providers have allowed them to bill the telehealth services under the same structure.
- The providers can also waive off co-payments and deductibles for the patients.
2.Practicing outside the State of Enrollment:
The healthcare providers can render telehealth services outside the state’s territories, where they are licensed to practice.
- This might be a temporary relaxation. The CMS has approved this rule so that more providers can help to fight the health emergency nationwide.
- The providers can call the Medicare Administrative Contractors (MAC) of their respective areas on the hotline numbers to know the area-specific details.
- You can note the list of telehealth services covered by Medicare from their web portals.
- Make sure you put in the right billable services to enhance timely payments.
3.Medicare Fee for Service Billing in Healthcare:
Changes in Medicare Fee-for-Service claims aim to reduce the burden on the common people by increasing their coverage. Similarly, it is a relief for the billing teams since they have to deal with lesser complexities in payment methods.
- Covid-19 has a separate CPT and HCPCS code list, which has over 100 codes in it. It is available on the CMS portal.
For a comprehensive guide on Covid-19 coding changes, you can read our article here.
- The FFS rate will remain equal for the telehealth visits as they were for the in-patient visits.
- The temporary and permanent codes for billing in healthcare can also be found in the 2021 Physician Fee Schedule.
4.Telehealth Modality for Billing in Healthcare:
The mode of contact for telehealth consultation is crucial for the correct billing and coding. The rate of reimbursements also varies according to these details. Here are a few things you should know:
- Certain services require audio-video visits, while some are done only through telephone calls.
- The CMS has increased the payment rates for these services.
- Reimbursements are similar to the in-person visits for the codes 99441, 99442, and 99443.
- Billing must include modifier 95 to indicate that the service was done via telehealth. On the other hand, a CR modifier is not required.
- The mention of the Place of Service should be the same as the case would have been for a clinic visit.
- Many of these services requiring audio-visual visits have been exempted from this mandate. However, this is a temporary move keeping in mind the global situation.
5.Billing in Healthcare for Out of Network Patients:
The billing for out-of-network patients might be tricky since they are not covered by the insurance carriers. In this case, the reimbursements might get delayed, or the bills might remain pending for an extended period. Keep the following things in mind:
- If a healthcare provider has provided Covid-19 related services to any uninsured patient, then their bills will be reimbursed by the Federal Government.
- Therefore the team can submit such claims separately to the COVID-19 Uninsured Program portal provided by the Health Resource and Services Administration (HRSA).
- The reimbursements rates will be similar to the Medicare rates, though it is subject to fund availability.
- It is important to note that it will also cover the vaccine administration costs.
- This program will cover all telehealth visits regarding Covid-19. Therefore the bills should contain the usual distinguishing modifiers.
6.Private Insurance Billing for Telehealth:
Most of the insurance networks have diversified their cost coverage and are now taking care of various forms of telehealth.
- Even before the pandemic struck, the insurance payers used to cover some specific telehealth consultations.
- Private insurers have changed some of their policies, but all are unique according to the plans.
- Make sure to perform the patient verification eligibility before the services are rendered. This will help to reduce errors while processing claims.
- Prior authorization is a good way to ensure that the services are covered under the insurance plan during a particular period of time.
- Reimbursement rates have changed for telehealth according to modality as well. They might be audio-only consultations or complete digital consultations.
7.Medicaid Coverage:
Medicaid billing in healthcare can be tricky when it comes to telemedicine since the rules vary from state to state.
- In most states, telehealth coverage has increased temporarily for the public health emergency period.
- The Medicaid pay parity for in-patient and telemedicine consultations has been considered by many states.
- The billing team needs to mention the place of service as the home address of the patient.
- Just like other insurance plans, Medicaid is also covering modes of virtual and audio-only consultations.
These were some of the updates in the telehealth arena of billing in healthcare. The rules mentioned keep on changing frequently. The rules mentioned keep on changing frequently. It is advisable to regularly go through the National Telehealth Policy Resource Center to get the most recent picture. For all other updates, please subscribe to our blog.
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