Sidestepping Common Telehealth Billing Errors for Improved Accuracy

With the rapid expansion of telehealth services, tele-providers have embraced this innovative approach to deliver care remotely, especially during the COVID-19 pandemic.

According to recent data, telehealth utilization surged by over 30% in 2020, with millions of patients accessing medical services virtually across the United States.

However, telehealth has introduced unique challenges in billing and reimbursement processes alongside the benefits of increased accessibility and convenience. In fact, common telehealth billing errors have emerged, leading to significant financial losses and compliance issues for providers. Therefore, it is essential to understand and address these challenges to ensure accurate reimbursement and maintain the integrity of telehealth services.

Common Telehealth Billing Errors

• Billing for Multiple Telehealth Services 

Healthcare providers may inadvertently bill for multiple telemedicine or telehealth services for the same client within a short period. This includes scenarios like billing for follow-up calls shortly after a telemedicine visit, performing both telemedicine and in-person visits for the same diagnosis, and billing for unsolicited “check-up” calls. Such practices can lead to overbilling and improper reimbursement, raising concerns about compliance and potential audit scrutiny.

• Impossible Hours Billing

Billing for more than 24 hours a day using timed procedure codes can trigger flags for tele-providers. While there are legitimate reasons for exceeding 24 hours per day, such as services rendered by assistants, tele-providers must ensure compliance with each Managed Care Organization’s (MCO) policy. In fact, the failure to do so can result in billing discrepancies and potential audits, highlighting the importance of accurate telehealth billing services and adherence to regulatory guidelines.

• Telephone-Only Services

Incorrectly billing multiple Evaluation and Management (E&M) codes on a patient in a single day, along with using modifier 25, can lead to improper reimbursement. Tele-providers must understand that telephone services may be considered part of an office or video visit. In fact, billing separately for them can result in billing errors, potentially leading to financial loss and reputational damage for the practice.

• Billing for Excess Time

Audits have revealed instances where clinics billed for more time than actually spent with clients for telemedicine services. Healthcare providers must ensure that claims for time-based services accurately reflect the service length to avoid overbilling and potential audits. As a result, implementing robust processes for documentation and billing validation is crucial to maintaining billing accuracy and compliance with regulatory standards, safeguarding the practice’s financial integrity.

• Lack of Upfront Administrative Checks

In telemedicine, the absence of upfront administrative checks increases the risk of claims denials due to reasons such as service coverage issues, changes in policy status, out-of-network providers, and incorrect details. Without proper administrative checks, providers face challenges in preventing denials and ensuring accurate reimbursement, necessitating the implementation of streamlined administrative processes and thorough verification protocols to mitigate common telehealth billing errors and optimize revenue capture.

• Potential Lack of Patient Relationship

Unlike traditional healthcare settings where providers develop ongoing patient relationships, telemedicine may involve interactions with new or one-time patients. This lack of continuing relationships can hinder reimbursement efforts, making obtaining necessary patient information for claims processing difficult. Providers must establish effective communication channels and engagement strategies to foster patient-provider relationships in telemedicine, facilitating the exchange of essential information and enhancing reimbursement outcomes.

• Confusion About Coverage

Navigating reimbursement in telemedicine is complicated by inconsistent coverage policies among payers. Not all commercial insurance plans and Medicaid programs cover telemedicine visits, while Medicare has specific requirements for billing telehealth services. Providers must ensure compliance with payer policies and accurately document telehealth visits to avoid reimbursement challenges, necessitating continuous monitoring of policy updates and proactive communication with payers to address coverage uncertainties and optimize reimbursement opportunities.

• Difficulty in Selecting the Right POS and Modifier

During Public Health Emergencies (PHE), coders should use the appropriate Place of Service (POS) and modifiers as outlined by CMS guidelines. Providers must understand the correct usage of modifiers such as 95, G0, GT, and GQ to accurately bill telehealth services and avoid coding errors, emphasizing the importance of comprehensive training and adherence to regulatory guidance to mitigate billing discrepancies and ensure compliance with payer requirements.

• Incorrect Documenting Telehealth Visits

Accurate documentation of telehealth services is crucial for receiving correct payment. Providers must appropriately label telehealth encounters based on the type of communication used (audio-only or video), include the date and platform used, and ensure compliance with coding guidelines. Thereby, continued coding education can enhance coding team efficiency and accuracy in documenting telehealth visits, enabling providers to optimize reimbursement outcomes and maintain financial viability.

What about the Solution?

OUTSOURCING TO 24/7 MEDICAL BILLING SERVICES!!

Outsourcing emerges as a comprehensive and one-stop solution to deal with the complexities and mitigate the challenges associated with telehealth billing errors. By partnering with experienced outsourcing providers specializing in healthcare revenue cycle management, hospitals can leverage their expertise to address the various billing errors discussed. These outsourcing partners bring a wealth of knowledge in navigating payer policies, ensuring accurate documentation, and adhering to regulatory guidelines, thereby minimizing the risk of denials and optimizing reimbursement.

Moreover, outsourcing offers scalability and flexibility, allowing tele-providers to adapt seamlessly to changing regulatory requirements. By entrusting their medical billing processes to competent outsourcing partners, practices can streamline their operations, enhance billing accuracy, and focus on delivering high-quality patient care, ultimately fostering financial sustainability and operational efficiency in the telehealth sector.

See also: Telehealth Billing Essentials: What You Need to Know