During the COVID-19 public health emergency, telemedicine offers medical practices the ability to continue caring for their patients both with and without COVID-19. In order to mitigate exposure of patients who are sick or at-risk due to other conditions and to protect the healthcare workers and community, practices are strongly encouraged to use telemedicine and telehealth services whenever possible.
They are also encouraged to consider establishing protocols and procedures for use by practice staff and clinicians. Now in a full state of emergency, Medicare, Medicaid and many private insurance restrictions related to telemedicine have been lifted.
Patients can be at home and non-HIPAA compliant technology is now allowed.
There is no cost-sharing for COVID-19 testing. In addition, to encourage use by patients, Medicare, Medicaid, and some private insurances are allowing practices to waive cost-sharing (copays and deductibles) for all telehealth services. Many prior authorization activities are being paused.
There is one caveat here. It seems patients who have been tested for CORVID-19 and have a diagnosis code related to CORVID-19 will have their co-pays, co-insurance, and deductibles waived. With this said there are payers who are waiving all patient cost-sharing but it is on a plan by plan basis.
The Basics of Billing for Telemedicine Services
Telemedicine billing seems to change from day to day, by payer and by state. While all payers have some form of formal policy in place for how to bill for telemedicine, the COVID-19 impact on insurance is changing almost daily to meet the needs of so many specialties that normally would not need to use these services.
There are a few items to discuss what to expect from different payers, regardless of the state they are in.
How Are Self-Funded Plans Affected?
These are plans where the employer pays for the medical services provided to their employees. These plans are administered by a third-party administrator and currently have full discretion on which services they will allow. Currently, most are not reimbursing providers for telemedicine services.
What Services Are Covered and How Is This Determined?
Many payers will only pay for the services under the patient’s current insurance plan. If it is not a covered service, the payer will not cover the cost and the cost will defer to the patient. The verification of the patients’ eligibility to ensure telemedicine services are covered is essential and begins at the provider’s office.
How Are Private Payers Affected?
Private payers may have their own manner of billing for telemedicine services. For instance, modifiers, procedure codes, and the place of service may be different from that of Medicare and Medicaid.
How is Payer Reimbursement Seen on an Individual Level?
Each payer reimbursement has to be looked at individually. There is not a standard reimbursement rate across the board. Some pay at a reasonable and customary rate or a fixed rate. A few payers will pay at the provider’s contracted rate and of course many will deny your claim. In every one of the aforementioned scenarios, the billers working on the claims will place the claim in a queue for further investigation with the payer to determine if additional funding will be forthcoming.
Updates to Insurance Information
Insurance companies are updating their websites almost daily, so we have a team solely dedicated to finding the answers. Of course, the providers and their teams are also receiving insurance direct correspondence. By working together we can keep everyone updated.
Steps You Can Take
Many doctors aren’t being fully compensated for their telemedicine services. This is largely in part due to the complexity of medical billing for telemedicine services.