Many medical insurances, Medicare and Medicaid plans included, are now recognizing the need for Telehealth services. This is due to varying reasons including medical provider and patient convenience and even cost efficiencies for the insurance companies. Medical insurances are now paying for this service to accommodate both the medical practice and patient needs. Providers are already taking calls on the phone from patients both on and off hours and now can get paid for these services easily. Basically you may already be doing this work and now you can also be paid for it. This can even help providers expand their service delivery hours and service types while reducing costs. It also allows for patients in remote areas that don’t have locally needed specialists to have access they may not otherwise get as well as to those who are too ill, too elderly, or disabled to travel. There is also a growing need for both psychiatry and psychology services in the market today, often referred to now as Teletherapy.
Recent surveys have shown that over 64% of the population surveyed would be willing to have Telehealth visits with their medical doctor. Studies have also shown that Telehealth visits can reduce cost by over $100 per visit and that 83% of patient issues are resolved during the first Telehealth visit. More than 50% of doctors surveyed are willing to see patients using Telehealth. 78% of emergency, urgent care, and doctor’s visits can be handled safely and effectively over the phone. 74% of patients are comfortable with Telemedicine visits using technology instead of in person visits. 76% of patients care more about access to care than the human connection. 67% of patients say it increases their satisfaction with medical care. 30% of patients already use mobile devices to check test results or other medical information. 21% of patients said not having to travel was the top benefit. 53% of patients said Telemedicine somewhat or significantly increased their participation in treatment decisions.
Challenges include different payers having different compliance requirements which will take research into each payer or plan. Additionally there are new computer systems to navigate, the latest billing rules, different payer parameters, training, and tracking to keep up with. Commercial plans can be more easily handled depending on state regulations and payer policies, and may even allow communication via popular platforms such as Skype or FaceTime. Also certain prescription drugs require an in person visit with the prescribing provider initially or periodically. Basically each state is different and you need to know your own state regulations. Medicaid programs in 48 states and the District of Columbia currently allow Telehealth in some form. Some plans pay a full fee for the service billed, others a reduced fee. Commercial payers will typically have the most flexibility for Telehealth Service delivery.
To bill for Telehealth effective as of January 1, 2017 use POS code 02 Telehealth with your standard CPT coding for services rendered. New for 2018 was that Telehealth modifier GT was eliminated for professional services, being replaced with POS 02 as providing attestation of interactive audio-visual communication. Other plans use modifier 95 which denotes a telehealth system that provides two-way, real time audiovisual conferencing between a patient and the provider. It is extremely important for compliance reasons that a modifier is used when indicated by the payer and to always maintain proper documentation.
For example, there are differences in billing for different insurance companies:
Payer A defines Telehealth as the “use of electronic information and communication technologies to deliver health care to patients at a distance” in which they include “Synchronous telemedicine”, which means that the provider is communicating with the member through a screen (mobile phone, tablet, laptop, etc.) in real time, and is to be billed with the modifier 95; “Asynchronous remote patient monitoring” (RPM) which refers to communicating with a member not in real time but using digital technologies to collect medical data and other personal health information from members and transmitting that information securely to healthcare providers for assessment and recommendations, and is to be billed with the modifier GT; and “Asynchronous store and forward” which is exchanging information with a patient not in real time, through pre-recorded video and/or digital images from one provider to a remote provider regarding a patient’s health, and is to be billed with the modifier GQ.
Payer B states that Telehealth Services are covered only when the patient is located in an HPSA or in a county outside of an MSA. A HPSA is a Rural Health Professional Shortage Area located either outside of a Metropolitan Statistical Area (MSA) or in a rural census tract; – “Originating site”- At the time of service delivery the patient may physically be located in the offices of physicians or practitioners, a Hospital, a Critical Access Hospital (CAHs), a Rural Health Clinic, a Federally Qualified Health Centers, a Hospital-based or CAH-based Renal Dialysis Centers(including satellites), a Skilled Nursing Facility (SNFs) or a Community Mental Health Centers (CMHCs); The term “distant site” means the site where the physician or practitioner, providing the professional service, is located at the time the service is provided via a telecommunications system. Providers may be located in an eligible place of service, although the distant site reimbursement is not an FQHC or RHC service and must be billed outside of the FQHC or RSA rate. This insurance requires use of HCPCS code Q3014, to indicate the separately billable payment for “hosting” the patient and to certify the Telecommunication & presence of the beneficiary at an eligible originating site either POS 11 (Office) or the appropriate TOB & revenue code for the eligible facility location and for processed claims, the “office” place of service (code 11) is the only payable setting for code Q3014.
Some tips that your practices’ medical billing and coding personnel must always keep in mind when billing for Telehealth Services:
To incorporate Telehealth successfully into your practice you must become familiar with the Telehealth and Telemedicine requirements set by the insurances you are planning to bill.
The CPT codes you will bill the insurance will be the exact same CPT codes you would bill as if the patient was seen in the office and will require the same level of support and documentation as you currently provide for that particular code.
Remember to bill the CPT code with the designated modifier and place of service per the insurance company requirements. This is what tells the insurance company that it is a Telehealth visit being billed.
For additional information visit www.bymedicalbilling.com
Information included in this article has been obtained through resources provided by the American Academy of Professional Coders (AAPC).