Telemedicine is being an expert at distinct chronic disease management. No doubt that it has resolved the issues by taking medical practice to next level. Healthcare bpo companies are supporting healthcare professionals by pulling them from hindering revenue problems.
Telemedicine or telehealth is witnessed as best method of medical practice during pandemic difficulties. However telemedicine billing is also tricky!
Telemedicine billing is a budding sector and needs to improve as the billing and coding guidelines are still in process and not constant. So, the entire billing by healthcare bpo companies depends on insurance payers.
Earlier GQ and GT modifiers were very essential for telemedicine billing and coding. Later on, CMS has eliminated the use of modifiers for telemedicine claims. Instead, POS 02 must be used for the telemedicine claims.
Keeping all these in mind, there are certain needs for healthcare bpo companies to polish their way of work with few tips for telemedicine billing and coding.
Tip 1: Telemedicine coverage can be policy dependent
Tip 2: Insurance coverage verification before initial telemedicine visit
Tip 3: Beware of guidelines for major insurance companies
Tip 4: Have conversation with payers regarding CPT codes
Tip 5: Be confident while coding to avoid denials and audits
Tip 1: Telemedicine coverage can be policy dependent:
- Most of the insurance companies offer telemedicine coverage and some of them also provide telemedicine pilot programs in place to have a glance at cost and care benefits of telemedicine services.
- Usually the telemedicine coverage varies according to the insurance company’s policies and regulations.
- Some insurance companies’ gold policy covers telemedicine services while the bronze policy that may not get into the idea of telemedicine services coverage.
- So, it’s important to know the types of policies that insurance companies provide and help in telemedicine coverage services to avoid falling into denials.
Tip 2: Insurance Coverage Verification before Initial Telemedicine Visit
- Telemedicine coverage is very often policy dependent. It’s very essential for healthcare bpo companies to examine patient’s telemedicine policy before their first visit.
- Accurate patient’s information is required to call them and verify regarding insurance policy coverage for particular services rendered by healthcare professionals.
- It might consume time, but it’s only time and processes that healthcare bpo companies do for the policy.
- While having a conversation with insurance companies regarding policy coverage, it’s important to have required documents to verify the information from the insurance payer.
- Document every information along with their phone number. It helps in fighting for the denials in future.
- If healthcare bpo companies hold the proof of the call which tells that they cover telemedicine services, then it should definitely need to be honored.
Tip 3: Beware of Guidelines for Major Insurance companies
- Each insurance company has their own set of different telemedicine guidelines. So, it’s very important to beware of all the guidelines.
- Dealing with major insurance companies for telemedicine billing services can be little tricky and overwhelming too.
- Healthcare bpo companies must ask few questions with insurance companies.
- What kind of telemedicine services is offered?
- Which healthcare professionals are ready to bill telemedicine services?
- Are there any terms and conditions involved before patient qualifies for the insurance coverage?
- Will telemedicine coverage include live video of diagnosis or procedure?
- Are number of telemedicine visits to healthcare providers limited?
Tip 4: Have Conversation with Insurance Payers regarding CPT codes
- Many insurance companies prefer healthcare bpo companies or healthcare professionals using accurate, appropriate and evaluative CPT codes for telemedicine services.
- Those CPT codes may include (99201-05, 99211-15) along with GT modifiers for telemedicine billing services.
- It’s very important and crucial to note that CMS does not allow the use of GT modifiers in many cases.
- Normally, Medicare has a set of codes that’s eligible for telemedicine coverage, though private insurance companies prefer 99444 specific codes for telemedicine services.
- Incase if healthcare bpo companies aren’t aware of the codes to be used and not sure if they can use GT modifiers, it’s always better idea to go on a call with insurance companies.
Tip 5: Be Confident while coding to avoid denials and audits
- While coding telemedicine or telehealth services, it’s vital to bill telemedicine claims with GT, GQ or POS 02 .
- Healthcare bpo companies should be specific and certify if the code specific and broad telemedicine requirements are met accordingly.
- While billing Medicare, make sure all the statutory necessities are met accordingly.
- Avoiding errors and false claims by consuming time to encounter all the necessary requirements are predominant as they might expose medical practice to audits, denials as well as liabilities.
- Changes in CMS billing by leaving GT modifiers are designed in order to reduce the burden on medical billing and coding department.
- Respective steps are to be taken in the beginning to understand telemedicine services completely. Telemedicine services that cannot be covered can help to avoid telemedicine denials in future.
- If healthcare professionals require more attention on telemedicine billing, they will need to approach healthcare bpo companies who are experienced for years in billing and coding services.
- Errors in medical coding and billing will moreover lead to rejections and revenue loss when telemedicine services are not billed appropriately according to insurance guidelines.
- Accurate coding is very essential and rapid changes will require staying informed on changing guidelines and laws concerning telemedicine services.
- As telemedicine services evolve, coding changes continue to grow along with the telemedicine services that have become very crucial in the recent times. Perfect healthcare bpo companies and medical billing and coding teams can guarantee revenue reimbursements.
Things to keep in mind while billing and coding Telemedicine:
- Time spent with documents is crucial. Documentation is as essential as coding for telemedicine.
- It all matters in the time spent for documenting telemedicine billing and coding and also considered to be critical.
- Healthcare professionals must know the way to bill video components. Adding video component is possible with standard CPT codes along with 95 modifiers.
- Better to use documentation peripherals used for telemedicine billing. While using peripherals such as spirometers, glucose and blood pressure monitors, healthcare professionals must know to document them for coding.
- These peripherals are essential to support the CPT specifically used.
- Avoid 95 modifiers for asynchronous services. When 95 modifiers are used for telemedicine when there is a video component, do not use it for asynchronous like ultrasound and radiographs studies etc.
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