Billing Guidelines for Tele-Health Clinics

Out of numerous changes in the healthcare industry, CMS has added another one by including Tele-Health services in the Medicare Payment Protocol as part of the healthcare emergency services during the COVID-19 pandemic.

As a result, Tele-Health clinics and healthcare providers have been facing a few challenges. And, the biggest concern is relating to the accurate Tele-Health billing and coding to get no or less denials. Moreover, it adds on more immense problems for the practices to stay afloat especially when Tele-Health clinics are struggling with the telemedicine services. Hence, it is essential to know how to code and bill the telemedicine services accurately.

But have you ever analysed the reasons for such challenges?

The challenges faced by the Tele-Health clinics are arising usually due to the drastic changes occurring in the Tele-Health policies. It is combined with the staff lacking the experience in keeping up to date with these changes and documentation.

If you are also one of them facing similar challenges with your Tele-Health practice, here are the brief three guidelines to mitigate them.

1. Know the Codes for Billing in Tele-Health Services

CMS has approved a list of correct codes for billing the Tele-Health services. They are:

  • G2010 for evaluating the patients’ images or videos that do not originate from or lead to an E/M service.
  • G2012 is used for virtual check-in or other communication with the healthcare provider using some technology.
  • G2061 – G2063 is established for services like assessment and management provided by a professional healthcare qualified non-physician online.
  • 99421-99423 offers an online evaluation and management service to an established patient for seven days.
  • 99441-99443 is to be used when Tele-Health services are provided only via telephone.

2. Selecting the Right POS and Modifier

There has been a change in the CMS interim final rule where the coders during the PHE should not use the POS 02 Tele-Health. Instead of using the CMS-1500 form, the coders must enlist POS, which would be used when there is no PHE.

For example, the coder is to use POS 11 if the beneficiary was seen at the clinic by the provider.

According to the CMS, the correct modifiers for the Tele-Health billing amends are:

  • 95 – Use of audio and video technology to provide Tele-Health service
  • G0 – In case of symptoms of acute stroke, there is the diagnosis, evaluation, and treatment with a Tele-Health service
  • GT – Interactive audio/visual technology is used to offer telemedicine services
  • GQ – Services in telemedicine are provided through an asynchronous telecommunication system.

3. Correct Documentation for Reimbursements

One of the reasons Tele-Health clinics find themselves in loss of revenue is inaccurate and incomplete documentation. 

Several factors are in play when it comes to correct coding and documentation for the reimbursement of the services. For instance, the codes differ in the audio and visual telecommunication tools used during the service. Also, the provider’s diagnosis, findings, and treatment can change the coding of the service.

Any video consultation that offers a face-to-face visit with the clinic must include the billing document apart from the codes, the platform used, and the date. Likewise, any patient consulting and getting service via telephone, email, or other audio tools must be categorized into non-face-to-face services. It should also mention the platform through which such service was provided, like whether it was on a patient portal or only audio communication along with the date.

Winding It Up!

To ensure all these guidelines are followed correctly, the Tele-Health clinics should outsource their medical billing services to a Tele-Health billing and coding company. An experienced medical billing company can conduct periodic and focused audits to warrant the clinic about filing its documentation correctly and compliant with the Medicare Tele-Health revised guidelines.

Also, sometimes it is best to find additional guidance of expert billers and coders with updated knowledge of Tele-Health billing rules and codes upcoming in the healthcare industry. They can help you to select the right POS and modifiers while filling the claims to ensure complete reimbursement and higher revenues. Therefore, the best way to ensure efficiency with the coding and documentation while keeping up with the revised Tele-Health guidelines is by outsourcing Tele-Health coding and billing system to a knowledgeable partner like 24/7 Medical Billing Services.

Read more: Medicare Payment Rules For Telehealth Billing Services

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