Telehealth Billing Practices: What Medical Providers and Practice Managers Need To Know

Telehealth has become a vital part of healthcare delivery, offering convenience, accessibility, and continuity of care. However, telehealth billing presents unique challenges that differ significantly from traditional in-office billing. For medical providers and practice managers, understanding telehealth billing practices is essential for ensuring compliance, minimizing claim denials, and optimizing revenue.

This article breaks down key aspects of telehealth billing, common pitfalls, and how leveraging professional billing solutions can save your practice time and money.

1. Stay Updated on Telehealth Billing Codes

Telehealth billing codes, such as CPT codes and modifiers, are frequently updated to reflect changes in technology and policy. Common telehealth-specific codes include:

• CPT Code 99441-99443: Telephone E/M services.
• Modifier 95: Indicates synchronous telemedicine services.
• POS 02 or 10: Designates telehealth encounters.

Failing to use the correct codes or modifiers can lead to denied claims. Staying updated on coding guidelines ensures compliance and streamlines reimbursements.

How It Impacts You: Misusing codes can result in revenue loss and administrative headaches. A knowledgeable billing partner can keep your claims accurate and compliant.

2. Understand Payer Policies

Insurance companies, including Medicare and Medicaid, have specific rules regarding telehealth coverage. For example:

• Medicare requires the patient-provider interaction to meet specific criteria for reimbursement.
• Commercial payers may differ in their requirements, coverage, and reimbursement rates.

Policies can vary based on location, provider type, and service. Keeping track of these variations is a time-intensive task for in-house teams.

How It Impacts You: Lack of awareness of payer-specific guidelines can delay reimbursements. A billing company can navigate these complexities, ensuring maximum revenue for your practice.

3. Track Telehealth Waivers and Policies Post-Pandemic

The COVID-19 pandemic introduced emergency telehealth waivers, many of which temporarily expanded access and reimbursement for telehealth. While some waivers remain, others have expired or been modified.

What To Watch:

• Expanded provider eligibility.
• Relaxed HIPAA requirements for specific platforms.
• New restrictions or requirements for originating sites.

How It Impacts You: Understanding which waivers apply to your practice ensures you don’t miss out on reimbursable services while maintaining compliance with evolving regulations.

4. Verify Patient Eligibility and Coverage

Before every telehealth appointment, verify a patient’s insurance eligibility and coverage for telehealth services. This step prevents claim rejections and ensures that patients understand their financial responsibility.

How It Impacts You: A robust eligibility verification process reduces the risk of unpaid claims and enhances patient satisfaction. A billing partner can integrate eligibility checks into your workflow for seamless operations.

5. Embrace Technology for Accurate Billing

Many practice management systems now include telehealth billing functionalities. These tools can help:

• Streamline claims submission.
• Reduce manual errors.
• Integrate telehealth scheduling and billing processes.

How It Impacts You: Investing in telehealth-compatible systems ensures smoother operations and higher claim approval rates. Working with a billing company experienced in telehealth billing can help you maximize the benefits of your technology.

Why Partnering With a Billing Company Is Essential

Managing telehealth billing in-house can be overwhelming due to the complexities of coding, policy variations, and payer-specific guidelines. Partnering with a medical billing company offers:

• Expertise in telehealth-specific coding and payer rules.
• Reduced claim denials and improved cash flow.
• Time saved for your team to focus on patient care.

At Quest National Services, we specialize in telehealth billing and practice management solutions. Our team stays up-to-date on the latest industry changes to help your practice succeed in an ever-evolving healthcare landscape.

For informational purposes only.