A s a result of the COVID-19 Pandemic, the Trump administration has announced broadened access to telehealth services to provide improved telehealth access to beneficiaries – without having to travel to the doctor’s office. Centers for Medicare & Medicaid Services (CMS) extends their services to help citizens fight the COVID-19 impact.

Effective for services from March 6, 2020, Medicare will cover a broader range of telehealth services. The healthcare program will pay for telehealth visits and include an array of providers, including hospital outpatient departments, nursing homes, clinical psychologists, social workers, and more.

The U.S. Department of Health & Human Services (HHS) has also set out to relax some of the HIPAA policies and copay structures to facilitate doctors to offer telehealth services (for instance - using their phones) at a more affordable cost. The healthcare administration also recommends Medicaid agencies to provide telehealth services since federal approval is not required. Administrators believe in increased use of telehealth services to limit beneficiaries’ exposure to Coronavirus, which will also slow down the spread of illness.

Care providers can offer a broad range of telemedicine services to the beneficiaries that include:

• Telehealth visits – for real-time audio and video-based interaction between providers and patients (similar to in-patient visits)
• Virtual Check-ins – using email and text messaging for brief doctor-patient communications
• E-visits – to deliver care through patient engagement solutions and portals.

For Providers

While telehealth services are broadening their horizons to offer remote care to beneficiaries, telemedicine billing guidelines are changing to meet the evolving and emergency needs of the COVID-19 pandemic. Here are the top updates that healthcare providers need to know on Telemedicine Billing

1. Top private payers cover telemedicine

The regulations and policies have expanded, and top payers, including Medicare as well as private commercial payers, all include telemedicine, with the current scenario of Coronavirus.

2. New Telehealth policies rolled out daily

New Telehealth policies are announced every day by Medicare and insurance companies with the latest updates. Check out the Medicare Telemedicine Services summary updated on March 17, 2020.

Also, note that Medicare allows telehealth visits for new patients now.

3. Ensure Eligibility Verification on telemedicine in Advance

It’s recommended that you verify the patient’s insurance coverage before their first telehealth visit to ensure a smooth billing and reimbursement process. Also, have a telemedicine insurance verification form handy to help you fight denied claims later.

4. Understand the varying Telehealth guidelines

Telemedicine guidelines differ with payers, and you must be aware of their policies. Here are the quick questions to ask your payers to make the most out of your Telemedicine reimbursement.

• Which care can providers bill for telehealth?
• Which healthcare services can be offered through telemedicine?
• Is live video telehealth specifically covered?
• Are there more restrictions or guidelines to be met for patients to qualify for telehealth (for instance – provider-patient distance, patient consent in writing, established relationship between patient and provider)?
• Are there any restrictions on a patient’s number of telehealth visits in a year?

5. Check with the Payer on the Eligible CPT Codes for Telemedicine Billing

Most recommended CPT codes by payers to providers billing telemedicine include Codes (99201 – 05, 99211-15) with GT or 95 modifiers.

The simplest way to identify the eligible CPT codes is to enquire with the payer directly, and if they are unable to provide the list of covered codes, you can always ask if 99444 is covered and if E&M CPT codes can be used with a modifier.

Also, check out Medicare’s list of eligible CPT codes.

To get the latest updates on the COVID-19 impact on healthcare providers and how to rise above the challenges, stay tuned to our blog section.