Legion Healthcare Solutions

Telemedicine Billing: What every Physician should know?

Telemedicine Billing: What every Physician should know?

Physicians decreasing revenue and patient volume is negatively impacting most practices in the country. Physicians need innovation in practice to fulfill their revenue demands, and one of the ways would be technology. Though the initial cost of investment varies from specialty to specialty and patient diagnosis, this gives the opportunity to the physicians to explore the avenue of increasing revenue.

Telemedicine was initially created to reach remote patients, and it was mostly focused on primary healthcare stage. As the technology improved, the remote patients were given better healthcare facilities using telemedicine leading to the concept of a convenient healthcare system. Telemedicine even gave physicians a chance to provide a 24/7 facility of healthcare without overburdening. Telemedicine gives healthcare providers an edge in the competitive landscape while maintaining a healthy bottom line.

CMS, with a new pandemic situation, is making telemedicine affordable to each of American citizen. It has expanded the benefits on a temporary and emergency basis under the 1135 waiver authority. Using the new wavier, Medicare will be allowed to pay for practice, hospital, and other visits via telehealth across the country. It will include the range of providers such as doctors, nurses, medical practitioners, clinical physiologists, and licensed clinical social worker all can use the new wavier to get paid for telemedicine. In the earlier cases, Medicare could only pay for telemedicine when the patient seeking the healthcare facility resided in a rural area and then they visits the clinic or hospital for medical facility of the service.

Federal authorities have largely looked at telemedicine as used by remote patients, over the years it has changed with need for access to virtual care. In 2019, Medicare understood the need for virtual health checks that didn’t demand in-person checks and started to pay for it. Even for online patient portal Medicare Part B paid clinicians for E-visits that are non-face-to-face. Medicare even specified that patients could receive specific services through telemedicine, including various evaluation and management visits, preventative health screenings, and mental health counseling.

Types of Virtual Services defined by CMS:

Virtual Check-Ins

In all the areas, Medicare patients may have communication with providers using various communication devices. The definition of communication devices is kept broader with the use of synchronous communication devices and exchange of information using video or image. Patients must be first to initiate the virtual service by sending in the requirement, however, the provider must educate the patients about the availability of the service.

Medicare will pay for virtual check-in only under certain condition:

  • Existing or established relationship with the practitioner.
  • The communication between patient and practitioner should not be related to any medical visit for the last 7 days and should not lead to a medical visit in the next 24 hours.
  • Patient consent is required verbally for virtual check-in services. Medicare coinsurance and deductible will be applicable for virtual check-ins.

E-visits

Patients are given an option to initiate a non-face-to-face communication with any doctor by using the patient’s portal. The practitioner can only bill in such a case when they have established a relation with the patient. For this E-visits billing, the patient must generate an inquiry, and communication must occur over the course of the next 7 days. The patient is required to provide verbal consent for the service. Medicare coinsurance and deductible would be applicable for all the e-visits billing.

Medicare Part B pays for e-visits or patient-initiated online evaluation and management conducted using the patient portal. Practitioners will be able to independently bill for such e-visits using:

  • 99421: For established patient, Online digital evaluation and management service, up to 7 days and time period 5 to 10 minutes.
  • 99422: For established patient, Online digital evaluation and management service, up to 7 days and time period 11 to 20 minutes.
  • 99422: For established patient, Online digital evaluation and management service, up to 7 days and time period 21 or more minutes.

Clinicians who are not able to bill independently for evaluation and management visit can even provide the facility of e-visits and bill based on the below codes:

  • G2061: Healthcare professionals who are non-qualified physicians, for established patients, for up to seven days with time period 5 to 10 minutes.
  • G2062: Healthcare professionals who are non-qualified physicians, for established patients, for up to seven days with time period 11 to 20 minutes.
  • G2063: Healthcare professionals who are non-qualified physicians, for established patients, for up to seven days with time period 21 or more minutes.

Medicare telehealth visits

This is developed keeping in mind the current pandemic situation for patients to avoid unnecessary travel to practitioner’s facility or physician clinic where they might be exposed to risks. According to the Department of Health and Human Services (HHS) requires the patient to have a relationship with the practitioner, HHS mentions that it will avoid the conduct audits for such medical bills during public health emergency.

Medicare telehealth visits are based on state laws where the practitioners can be physicians, nurse practitioners, nurse midwives, certified nurses, clinical social workers, registered dietitians and nutrition professionals.

Telemedicine can be regarded as a gateway for practitioners to target patients across the country, though regulations are curbing the growth. Telemedicine is where the future will be held, with technology already disrupting the healthcare system. Physicians can provide a telemedicine option to their patients, and even educate them about its benefits.

Telemedicine can be co-pay, hence prior authorization will assist you in reducing deductibles. Legion Healthcare Solutions (LHS) has a team of billing experts who work with payers and patients before scheduling a telemedicine appointment. Using LHS API-led technology, providers can share info with patients across various channels with HIPAA compliance. LHS believes in providing a world-class patient care in comparison of medical billing; hence our technology experts regularly update on various medical fronts. To get a medical billing quote for a telemedicine claim, please contact us.