Addressing Billing & Coding Challenges Of Telehealth During COVID-19

Telehealth_It was once a minor part of the healthcare industry. But due to the COVID-19 outbreak, this minor part has now become mainstream. The trend of alleviating the sufferings of the patients through remote medical checkups is now the new normal. Particularly in the United States. It has been estimated that up to $250 Billion of U.S healthcare expenditure witness a shift to virtual care in 2020. Moreover, in the second quarter of 2020, the healthcare providers recorded over 35 million telemedicine visits. The statistics show that the trend of telemedicine sees a remarkable rise i.e. 38X times compared to pre-pandemic. Due to its immense benefits, experts have predicted that telemedicine is here to stay even after the pandemic will be over.

The healthcare providers and patients find remote healthcare services as the best solution to all the medical-related complications. Because it allows both parties to get mutual benefits by avoiding in-person interactions. In this way, patients don’t need to pay physical visits to the medical facilities. They can get the much-needed healthcare services even by staying at home.

As we all know the fact that telehealth is the process of treating patients via remote communications. Such as; computers systems, mobile applications, smartphones or other digital means. However, this rapid shift has also brought a lot of challenges for both small and large scale practices. Because it has been observed that_physicians who were at the beginning of their career faced immense challenges to ensure the successful shift to telehealth services. They were running short on cash reserves and weren’t prepared to invest a hefty amount in purchasing cutting edge tools. Which is required to provide quality medical care services to the patients.

It was just a single aspect! Practices of all sizes are still facing medical billing and coding challenges associated with submitting medical claims for telehealth services. These both financial aspects of providing remote basis care undergo several changes. It has become extremely challenging for the practitioners to receive constant education about all the necessary changes, along with busy schedules. However, the Centers for Medicare and Medicaid Services (CMS) issued a waiver (1135 waiver) in early March, this year. Which gives relaxation in virtual visits to both patients and providers. These flexibilities came in order to ensure the care delivery_and encourage the patients to avoid visits without any concerns about the quality of the medical services.

Types of Virtual Services

According to the new relaxed rules, i.e. 1135 waiver paves the way for the expanded virtual services such as;

Telehealth: Medicare beneficiaries are required to use audio/visual (AV) telecommunication to offer healthcare services to the patients. It will ensure real-time communication between the patients and providers, which ultimately builds a trustworthy relationship. Healthcare providers should keep in mind that the delivery of telehealth services requires a robust AV connection. Furthermore, practitioners who are eligible to get the reimbursements for covered telehealth services (subject to state law) can include_registered dietitians, nutrition professionals, physician assistants, physicians, nurse practitioners, nurse midwives, certified nurses anaesthetists, clinical psychologists & clinical social workers.

Virtual Check-Ins: According to the CMS, virtual check-ins are not limited to rural or underserved areas. This allows healthcare providers to get in touch with their patients by using devices. Such as; mobile phones, integrated audio/video systems, text, email or captured video images from any corner of the country or even the world. These visits are reimbursable via a series of G codes.

E-Visits: Medicare patients can get access to the care services in all types of settings e.g. patients’ homes, rural or urban areas_without visiting the healthcare facilities. For this purpose, they can use patient portals.

Things To Know About Telehealth Billing

As I have earlier mentioned, complications involved in the medical billing and coding for the viral healthcare service have become a major headache for the providers. However, if you are facing the same situation. Don’t worry. While keeping in mind the challenges, the majority of the providers are facing. We have compiled all the basic and necessary information to prepare comprehensive medical claims and get timely reimbursements.

1. Most Commonly Used Medical Codes

In order to ensure the successful translation of patients’ diagnoses, treatments and medical procedures into standard medical codes. Make sure that your coding and billing staff has complete knowledge about the_Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes used for telemedicine billing.

HCPCS/CPT CodeType of servicesWhat are the services?Patient Relationship with Provider
99201-99215 (Office or other visits)A visit with a provider that uses telecommunication systems between a provider and a patient.For new or established patients.
G0425-G0427 (Telehealth consultations, emergency department or inpatient)(To the extent the 1135 waiver requires an established relationship, HHS will not conduct audits that such as prior relationship existed during this public health emergency)
G0406-G0408 (Follow-up inpatient telehealth consultations furnished to beneficiaries in hospital or SNFs)Medicare Telehealth visits
HCPCS code G2012Virtual Check-InA brief (5-10 minutes) check with your practitioner via telephone or other telecommunications device to decide whether an office visit or other service is needed. remote evaluation of recorded video and/or images submitted by an established patient.For established patients
99431
99422
99423
G2061
G2062
G2063
E-VisitsA communication between a patient and their provider through an online portalFor established patients

2. Medicare Payment Policies During COVID-19

In order to improve the patients’ lives by providing them quality remote-based care services. The Centers for Medicare & Medicaid Services has increased the payments for the medical providers_who are delivering the telehealth services during the public health emergency, caused by the COVID-19.

3. Telehealth Policy Changes

Here are the following changes to Medicare coverage and reimbursements for telehealth services.

Location: patients and providers are free from any type of geographic restrictions.

Eligible providers: Medical care providers who are enrolled in Medicare, can bill for telehealth services, including Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs).

Cost-sharing: Providers are allowed to waive patient cost-sharing i.e. out of the pocket expenses, high deductibles and copays for telehealth visits.

Licensing: Healthcare providers can benefit from the enrollment flexibility and temporary billing privilege programs_and can render their services outside their state of enrollment.

Modality: Some telehealth services only require a telephone.

4. Reimbursements for Providing Care to Uninsured Patients

The U.S. The Department of Health and Human Services (HHS), has decided to spend approximately billions of dollars_for testing, treating and administering vaccinations (through telehealth services) for the individuals who aren’t insured for COVID-19. Moreover, medical care providers and healthcare practices, that are providing the services like testing of the uninsured people, are eligible to submit the medical claims for the reimbursements.

Furthermore, medical practitioners, administering the COVID-19 vaccines, will also get reimbursements. Moreover, the federal government has also announced additional bonus patients for those_who continue to treat patients even on thin margins and tight budgets. They will be reimbursed on the basis of revenue loss and expenditures associated with vaccinating people.

It’s pertinent to mention here that: the U.S. Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), has announced relief funds for the providers. Who are being financially affected by the COVID-19. For this purpose, the authority has allocated $8.5 billion in American Rescue Plan (ARP) resources for providers_ who provided the care services to the Medicare patients, rural Medicare and Children’s Health Insurance Program (CHIP).

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