What Are Telehealth Billing Codes?

Telehealth billing codes is a code for telehealth services provided by the health care provider to the patient. These codes are used to set reimbursement rates for certain services, track telehealth services, and facilitate payment by insurance. Telehealth billing codes used include Current Procedural Terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS) codes. Providers use the codes to submit claims to Medicare, Medicaid, private insurers, and other payers.

As new telehealth billing codes have been created, modified, and adjusted with telehealth’s rapid adoption, the updates will continue for the calendar year 2024. This complex billing environment leaves healthcare providers scrambling to keep up with the latest telehealth billing codes.

Key Telehealth Billing Codes 2024

In 2024, several telehealth billing codes 2024 expected to see updates and new modifiers have been introduced to improve accuracy in billing. Let’s review the most relevant codes for telehealth services:

1. CPT Code 99421 – 99423: Remote assessment of patient-initiated, recorded health data. They are commonly used when a provider reviews patient data and renders medical advice through electronic means. An online consultation, for example through a secure patient portal.
2. CPT Code 99201-99215: These are the usual codes for in-office visits, but they can be used during telehealth consultations as long as the consultation is conducted via a real-time interactive audio and video communication system. These codes remain valid for telehealth visits in 2024 as long as certain requirements are satisfied.
3. CPT Code 99457 – 99458: These codes can be billed for remote monitoring with corresponding services. They encompass services that include reviewing and analyzing patient data remotely, usually in the context of chronic care management, like checking blood sugar levels or monitoring conditions of the heart.
4. HCPCS Code G2010: A brief telehealth consult, such as a remote evaluation of recorded patient information, like an image, video or other data. This code is best used for follow-ups or assessments when the provider does not need to conduct a direct, real-time consultation.
5. HCPCS Code G2012: Remote evaluation of patient information transmitted by the patient through a telecommunications technology system (telephonic or other electronic means).

The Role of Modifier 93 in Telehealth Billing

One of the biggest changes coming to the telehealth billing landscape in 2024 is the arrival of Modifier 93. It is used to show that a service was performed using real-time audio and visual technology (telehealth) but a telecommunications technology that is usually needed for telemedicine services is not used.

Telehealth services, especially ones using synchronous audio-video interactions, are reimbursed differently from standard face-to-face visits. Modifier 93 indicates that a telehealth service that has been rendered via technology is not normally considered telemedicine.

For instance, if the provider provided a telemedicine consultation through a video conference, but the service itself does not meet all telemedicine standards due to a low bandwidth of the device or if it is not HIPAA-compliant, Modifier 93 can be added to the CPT or HCPCS code to add that the service was still performed through telehealth.

This modifier lets cab rides be billed as just remote services for which providers were meeting the requirements, allowing for a smooth reimbursement process.

Medicare Billing Codes for Telehealth

Medicare has specific guidelines for telehealth services, and the Medicare billing codes for telehealth differ from those used by private insurers like Aetna. For 2024, Medicare is expanding its coverage to enhance access to healthcare, particularly for beneficiaries in rural and underserved areas.

These expanded Medicare billing codes for telehealth allow for a broader range of services, including virtual consultations, remote monitoring, and mental health services. Providers must use the correct Medicare billing codes for telehealth to ensure accurate reimbursement. Staying up-to-date with these codes is crucial for compliance and optimizing the claims process under Medicare’s evolving policies.

Medicare Telehealth Codes typically include:

CPT Codes 99421 — 99423: Online digital evaluation and management (E/M) services (for services when a provider reviews patient data submitted digitally, e.g., via patient portals, without real-time interaction, typically used for ongoing care or follow-ups)

CPT Codes 99201-99215: These are the CPT codes for telehealth consultations, and feature a variety of evaluation and management, ranging from new to established patient visits, and requiring simultaneous audio-visual communication between healthcare provider and patient.

G2025 (HCPCS Level II): Utilized for telehealth visits related to virtual check-ins for services in which a provider reviews patient symptoms remotely, generally through a telephone or video connection, and assesses whether additional care is warranted or if an in-person visit is required.

HCPCS Code G2012: Remote evaluation of patient generation health data, including images or recordings, submitted by a patient to be reviewed by the provider with the aim of addressing the condition and a plan for care.

Medicare also reimburses for telehealth services related to mental health, behavioral health, and physical therapy, making it an essential program for providers who treat these conditions remotely.

Aetna Telehealth Billing Codes

Other private insurers have also established their own policies and billing codes for telehealth services, but Aetna telehealth billing codes are known to set its own guidelines that clinicians must adhere to in order to receive payment for telehealth visits. This is a signal that Aetna will continue to the extent possible to cover the full range of telehealth services, including not only behavioral health, but also chronic disease management and other types of virtual healthcare. However, it is also vitally important for providers to be aware of Aetna’s specific billing needs for telehealth in 2024.

In many ways, Aetna operates similarly to Medicare, but there are more requirements for some services. For example, the Aetna telehealth billing codes might be:

CPT Code 99421-99: These codes are used for online digital evaluation and management of patients. They are relevant for services where providers asynchronously review patient-submitted data (such as health records, images, or text messages) using secure online platforms. These services are typically for low-acuity conditions or follow-up visits that do not require real-time interaction.

CPT Code 99201-99215: These codes are used to bill for office or outpatient consultations and for in-person or telehealth visits. They range from the 99201 for initial consultations to the 99211-99215 for established patients and include comprehensive evaluations, follow-up care, and preventive care. These codes cannot be used with any other types of care and telehealth visits using these codes need to meet documentation requirements and the type of platform used.

HCPCS Code G2012: This code was for virtual check-ins, or remote evaluations by phone or video. It is used when a provider evaluates patient symptoms remotely to decide, based on that assessment, whether in-person care or further consultation is needed.

G2012 is generally for short visit, G2012 allows for reimbursement for short, non-visit, face-to-face interactions.

Aetna, too, has specialty telehealth billing codes for mental health services, such as psychiatric consultations and therapy sessions. Providers need to be careful of the mental health telehealth guidelines because the need for services flows differently than physical health visits. Appropriate and comprehensive use of Aetna’s telehealth billing codes is critical to avoid claim denials and confirm correct reimbursement.

Common Telehealth Billing Challenges and How to Overcome Them

Billing for telehealth services can be complex, and providers often face several challenges in navigating the reimbursement process. Some of the most common issues include:

1. Code Confusion: So many codes for so many telehealth services it can be difficult to know what code to use for what service. Healthcare providers need to stay current with coding changes and guidelines for Medicare, Aetna and other insurers.
2. Eligibility Criteria: Medicare and Aetna and others set certain eligibility criteria for telehealth services. Every code does not always fit every case; some codes are registered only to some rural regions or specific diseases. Each provider must verify the eligibility of each patient prior to billing.
3. Telemedicine Technology Requirements: In some cases, insurers may require telehealth services to be delivered via certain technologies or platforms. Not complying with these requirements could cause the claim to be rejected. Check the technical specifications, and always do so before any telehealth visit and even before you make an appointment.
4. Modifier Use: It can be tricky to track the proper use of modifiers, including Modifier 93. Providers need to make sure they are properly applying the appropriate modifier to their claims, based on the type of telehealth service performed. Modifier 93 is used for telehealth services rendered through synchronous audio and video tools.
5. Documentation: Telehealth claims must be properly documented and comprehensive. Be sure to document the telehealth service, being sure to include information such as the method of communication, type of service, and the patient’s condition as appropriate.

Best Practices for Telehealth Billing

Stay Informed

Telehealth billing codes and regulations are consistently evolving as telemedicine advances with new technologies being developed. Stakeholders in the healthcare industry must stay abreast of these updates so they remain compliant with the latest billing requirements. Providers can subscribe to the new coding resources and updates from reputable professional organizations, such as the American Academy of Physical Medicine and Rehabilitation (AAPM&R), to keep abreast of new guidelines and code changes.

Verify Insurance Coverage

With the exception of Medicare, reimbursement will vary widely between insurance plans, which is why it is so important to check patient insurance coverage before implementing telehealth services. The rules vary widely by insurer from which services qualify for telehealth coverage to what technology is acceptable for consultations to whether the patient’s specific plan has telehealth benefits. Verifying insurance coverage before the consultation can help avoid potential claim denials and misunderstandings on the road.

Use the Right Codes and Modifiers

Billing codes and modifiers for telehealth are both important to get reimbursed successfully. Any telehealth services must be separately billed using applicable CPT (Current Procedural Terminology) or HCPCS (Healthcare Common Procedure Coding System) codes, along with applicable modifiers (i.e, Modifier 93 [service delivered by real-time audio and video communication]).

Final Thoughts

To conclude, telehealth billing codes can be cumbersome to maneuver through, but healthcare providers must know how to navigate the latest changes in the 2024 updates, including Modifier 93, Medicare billing codes numbered 94 and 95, and Aetna’s telehealth billing codes. Providers can optimize reimbursement for telehealth services by clarifying the various billing codes associated with each service and submitting these codes with their claims. With telehealth continuing to expand and evolve, it’s critical to keep abreast of current guidelines if billing errors are to be avoided and access to care for patients is to be ensured.

The decision to use temporary policies, then more permanent policies, then back again, amid the public health emergency is still playing out and has created confusion among everyone involved. However, a recent CMS transmittal provides other guidance and assurances regarding billing Telehealth services.

CMS Transmittal 12671 (Change Request 13582), dated June 6th, provides Medicare Administrative Contractors (MACs) with guidance on how to adjudicate claims for covered telehealth services billed with POS 10. Telehealth services are those on the CMS List of Telehealth Services and are therefore “covered.” Effective Jan. 1, 2024, such claims will be paid at the Medicare Physician Fee Schedule non-facility rate, and the transmittal continues. This special rule does not apply to facilities at the origination site that bill a facility fee.

POS – Point-of-Service Medical Definition

One of the integral parts of the healthcare billing process is Point of Service. Which means that the place in which a healthcare service or procedure is being performed for a patient. The POS 10 in medical billing is used on medical claim forms (e.g., CMS-1500 form) to indicate where a service was performed. The codes are critical as they influence the reimbursement rates and how providers submit claims for payment to insurance companies or government healthcare programs such as Medicare and Medicaid.

POS 10 in medical billing codes are included in the standard codes used by healthcare providers for billing purposes. These code assists in determining what kind of service was performed and in what type of setting (for example, in a hospital provider’s office or nursing facility, etc.). The reason for this distinction is that reimbursement rates are often dictated by the location of service, and various rules and regulations apply depending on the care setting.

Key Purpose of POS Codes

Payment Location: Insurance companies and government programs typically pay for the same service differently, depending on where the service is provided. As an illustration, a procedure done in a hospital tends to have a higher reimbursement to a procedure in the office, reflecting the difference in facility overhead and resources.

Correct Billing: POS codes make certain that service providers are reimbursed correctly. The error in POS code assignment can result in a rejection of the claim or an improper reimbursement amount, which can halt payment cycles or result in a loss to the healthcare provider.

Compliance: Healthcare providers should be using the appropriate POS code in order to stay compliant for billing purposes. Coding or billing something wrong could lead to an audit or even penalties, or in some cases, an investigation into fraud, where the wrong code is being charged in order to obtain a higher reimbursement or where the Point of services is being misrepresented (URAC).

What is code 10 POS?

Payment for services provided is a crucial function in our healthcare system, also called medical billing. One of the most recently announced updates that has been creating a huge buzz is the addition of POS 10 in medical billing documentation. The new regulatory label of point of service is significant, particularly for telehealth services. Now, let us get into the details of POS 10, what its uses in medical billing, and how it is different from the other codes, especially POS 2.

What does POS 10 mean in medical billing?

POS 10 is a Point of service code that indicates a telehealth visit to a patient in their home. POS 10 in medical billing is different from the codes used previously in that it more accurately indicates remote care provided to a patient who is not located in a medical facility. As for CMS directives, POS 10 is used to bill and pay for telehealth services provided to a patient in their homes.

This code was released to meet the urgent need for telehealth as people seek treatment from their homes. Breaking out home-based Telehealth into its own bucket from other types of remote care sets up a structure for making claims processing more efficient while legitimizing the payer’s capacity to independently assess the nature of service delivery. And it fits neatly into the broader movement in the medical industry toward patient-centered designs, which focus on convenience and access.

Since payers will look at logs for proof of where services were provided, providers billing under POS 10 must keep complete logs as proof that eligible digital care was indeed delivered as intended. Further, POS 10 in medical billing recognizes telemedicine as a pivotal element of modern medicine that indeed enhances access but reduces costs. It also serves to keep legislators and stakeholders up to date with relevant developments by monitoring emerging practices.

POS 10 in medical billing is used when the patient is receiving Telehealth service while in their own home; visiting the patient services may be documented by the provider. With in-home virtual care versus over-the-phone virtual care, you will be able to differentiate location-based reimbursement closely, as this will be a line of demarcation that payers will be able to classify. With Code 10 POS, providers can ensure treatment settings match their claims, resulting in an increase in payments and fewer denials.

What Insurances are using POS 10?

Now, healthcare delivery is rapidly shifting to Telehealth, and in connection with that, we see more and more insurers using POS 10 for medical billing. They are not able to differentiate between home-based virtual visits and non-home-based virtual visits through the use of POS 10. The substance and tone of any one session can be radically different.

Unlike Medicare, private insurance companies have vastly different telehealth payment policies, but a trend developed over the past few months, one that recently reported more and more people without government insurance are realizing the benefits of virtual therapy. Real-time as well as delayed appointments with healthcare providers are meant to enable you to manage chronic illness and other aspects of your care — providing increased access to Telemedicine.

What is the difference between POS 2 and POS 10?

POS Workgroup is updating the description of POS code 02 and establishing a new POS code 10 to cater to the comprehensive industry requirements, as mentioned below:

POS 02: Telehealth Other Than in Patient’s Home

The setting in which health care and related services are delivered or transmitted, via telecommunication technology when patient is not at home.

POS 10: Home Telehealth

Where health services and health-related services are delivered or received through telecommunication technology. The patient is at home (which is somewhere other than a hospital or other facility where the patient receives care in a private home) when receiving health or health-related services or goods through telecommunication technology.

POS 10 and POS 2 The customers have POS invoices POS 2 and POS 10 invoices, and GRANCE identifies the gaps, yet they will never be created without GRANCE, so if you want to get paid through POS and your invoices will be correct, GRANCE is the solution. Indirectly, both are connected to telehealth, just in another way. POS 2 facilities provide remote assistance to patients being treated in a medical institution, such as a clinic or nursing home. In 2022, POS 10 will only look at whether Telemedicine improves outcomes from home. The big difference was the places where patients were treated.

What modifier to use with POS 10?

POS Code 10 refers to a Telehealth (Telemedicine) Service provided in a patient’s home. When submitting claims for telehealth services provided at home, it is important to use the correct modifier to ensure proper reimbursement and compliance.

The modifier commonly used with POS 10 is:

• Modifier 95: This modifier is used to indicate that a service was provided via real-time interactive audio and video telecommunication technology, which is necessary for telehealth services.

For example, if you’re submitting a claim for a telehealth consultation provided in a patient’s home, you would use:

• POS 10 (Telehealth provided in the patient’s home)
• Modifier 95 (Real-time telehealth service)

Together, these codes indicate that the service was provided remotely via telemedicine, allowing insurance companies and payers to understand that the service was delivered through telecommunication technologies.

Conclusion

Finally, using POS 10 in medical billing reflects the growing role of telehealth in modern medicine. Since the majority of insurance companies that know about POS 10 understand it, clinicians can adjust their practice. Well-implemented Code 10 POS offers not only financial sustainability but also promotes patient-centered care delivery. As telemedicine broadens its reach, the industry has embraced increased innovation. POS 10 is a tool for clinicians. An indicator, a metric, and a guidepost for billing as care continues to change.

With a focus on precision, compliance, and flexibility, providers can manage complications and broaden treatment pathways. Distinguishing between traditional office visits vs virtual care and using the appropriate modifiers to ensure both compliance and maximization. This means that the practitioner should accommodate the changes in the demands and the payment system as well as the establishment of telehealth, which recast the traditional approach of how medical service was delivered. Also learn more about how to ask for and understand billing codes.

FAQs for POS 10 in Medical Billing

1. What is POS 10 in medical billing?

POS 10 in medical billing refers to a Point of service code that identifies telehealth services provided to patients at their home. It is used when healthcare providers deliver services remotely through telecommunication technology, such as video calls or phone consultations, to patients who are in their homes. This code was introduced as part of the changes made to accommodate telehealth during the COVID-19 pandemic.

2. What is the point-of-service medical definition?

The point-of-service (POS) in medical billing refers to the location where a healthcare service is provided. It is a standard code used to identify whether the service was provided in an office, hospital, outpatient facility, or remotely (e.g., telehealth). POS codes are critical in determining reimbursement rates and ensuring proper billing for services rendered in different locations.

3. What is the difference between POS 2 and POS 10?

• POS 2 refers to telehealth services provided by a healthcare provider to a patient located in a different setting, such as a hospital or clinic. It is used when the service is not delivered in the patient’s home.
• POS 10, on the other hand, specifically refers to telehealth services provided to a patient in their home, where both the patient and provider interact remotely through telecommunication technologies.

4. What is code 10 POS?

Code 10 POS represents telehealth services provided in the patient’s home. It is part of the Point of service coding system, which is used to indicate the location where a service was rendered. Code 10 allows healthcare providers to bill telehealth services appropriately when the patient is not in a healthcare facility but is receiving care from home.

5. What insurances are using POS 10?

Many insurance companies, including Medicare and Medicaid, as well as private insurers, have adopted POS 10 for telehealth services provided to patients in their homes. The adoption of this code has become more widespread due to the increased use of telehealth services, particularly during the COVID-19 pandemic. Insurers have expanded telehealth coverage to ensure access to care while maintaining social distancing guidelines.

6. What modifier to use with POS 10?

When billing for telehealth services using POS 10, it is recommended to use modifier 95. This modifier indicates that the service was provided via real-time interactive audio and video communication. Modifier 95 is required to distinguish telehealth services from in-person services and ensures that the claim is processed correctly by insurance payers.

We will learn the basic concept of how telehealth billing works; we know CMS telehealth billing guidelines 2023, but the new CMS telehealth billing guidelines 2024, telehealth reimbursement policies, regulatory changes, and best practices to ensure accuracy and efficiency.

Understanding Telehealth Billing

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Telehealth is the provision of opportunity to distant or remote areas people to the healthcare practitioners. This system was introduced during the pandemic time when patients were restricted or afraid to visit the doctors, and healthcare was provided to them through video calls and live calls using innovative technologies. But now the question comes to how they are billed for the services provided. Three models handle the billing process.

1.  Subscription-based model

There are many subscription plans available in which specific medical services are given to the patient. Patients can choose their subscription plan according to their needs and enjoy telehealth services when needed.

2.  Medicare and Medicaid

Medicare and Medicaid are government programs, and people who are part of these models can get medical services from the doctors registered with this model. Healthcare practitioners can get reimbursement for the services given by the government health department.

3.  Fee for service

In this model, there are no subscription criteria, and the patients must pay each time for the services they get. This model can be expensive, and patients may receive unexpected bills. It is recommended for that doctors to provide every bit of detail to the patient before providing any medical service to make the whole process transparent.

Telehealth Billing Updates

CMS has decided to extend telehealth coverage in the US, and they have also introduced new updates regarding billing protocols. They have changed the scenario of sending bills for the reimbursement rate. Following are some CMS telehealth billing guidelines:

• According to the current line of updates, hospitals will now include the modifier “95” along with the hospital place of service code to bill for telehealth medical services.
• Audiologists are restricted from using the modifier “95” from now on, and they can use POS “02” for services rendered at satellite offices and POS “10” for services conducted at patients’ homes.
• Therapists, including the SLPs, can use the modifier “95,” and they are not supposed to use the POS code. They can mention POS if they want to indicate the area of service provision.
• Telehealth service provided at a patient’s home billed with POS “10” will be imbursed at a higher rate by the CMS. The CMS will reimburse Telehealth service billed with POS “02” at a lower rate.

Telehealth Reimbursement Updates 2024

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CMS telehealth billing guidelines 2024 are concerned with the new reimbursement policies under the Physician Fee Schedule (PFS) for Medicare payments. These updates bring changes regarding the telehealth and remote patient monitoring:

1.  Established patient requirement

This rule concerns new patients seeking RPM services. As opposed to established or previous patients, new patients have to undergo evaluation and management (E/M). There are a few exceptions to this rule, including patients who received services during a public health emergency (PHE). This update also does not apply to remote therapeutic monitoring (RTM) reimbursement.

2.  16-Day Data Collection for Remote Monitoring

• Healthcare practitioners are now supposed to collect data for CPT codes 99453 and 99454 for 16 days within 30 days of care. This indicates continuous monitoring all the time.
• This 16-day data collection rule is not applicable for time spent codes 99457 or 99458. This denotes the difference in billing protocols for different telehealth services.
• The two-day rule during the public health emergency has also come to an end.

3.  RPM/RTM “Time Spent” clarification

• Billing guidelines for the 30-day calendar month will be followed for time spent codes 99457, 99458, 98980, and 98981.
• 16-day data collection is not applicable for time spent codes.

4.  Concurrent billing rule

RTM and RPM cannot be billed for similar services together in the same month. These can be billed together for specific services, which include Chronic Care Management (CCM) and Behavioral Health Integration (BHI), Transition Care Management (TCM), and Chronic Pain Management (CPM).

5.  RPM billing and Global surgery period

It is a rule that a physician during the global surgery period cannot bill for office visits. But the question arises: what is the global surgery period? If the patient has gone through some surgery and is billed for that treatment, then we will not pay for visits he will make during that period. This time duration is called the global surgery period.

However, there is a condition that if a patient is receiving RPM service prior to surgery procedure or from a physician different from the physician receiving global surgery payment, then CMS will pay for RPM services.

6.  Single provider billing restriction

There is a change in CMS telehealth billing guideline 2024, which states that multiple providers are not eligible for the claim for RMP/RTM services, contrary to previous rules. Now, only one provider will get the reimbursement for RPM codes, including 99453 and 99454, or RTM codes 98976, 98977, 98980, and 98981. The practitioner who will submit the claim first will be imbursed only.

7.  Updated cost structure

To make the telehealth service easily accessible and practical to the people, CMS has updated the cost fee structure for the services. There is a decrease in overall reimbursement rates for many codes for the services, including Chronic Care Management (CCM), RPM, and RTM. Providing complete details is separate from the subject of this article, but the previous and new costs for RPM are given below for quick assessment.

Remote Patient Monitoring (RPM) Reimbursement Rates:

Conclusion

Telehealth medical billing is complex, and policies are being updated to make the process effective and valuable for patients. Three models, including fee for service, subscription model, and Medicare and Medicaid model, are present to cover telehealth billing. The new regulatory policies should be adopted to optimize the process for enhancing patient experience, generating more revenue, and minimizing telehealth billing complexities.

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Physicians who want to enjoy the privileges of telemedicine must get complete knowledge of telehealth billing to get the reimbursement rates on time. Its billing process is quite different from the common billing processes. Regulatory authorities have policies and standards for telemedicine billing, and medical practitioners must comply with these policies. The Affordable Care Act has recently introduced some regulations in telehealth billing, and it is mandatory to understand these regulations.

In this article, we will learn about the telehealth billing models, legal considerations for billing, and the telemedicine billing software and tools. This will give us a complete understanding and clear our queries related to the telehealth billing process.

What is Telemedicine Service?

Telemedicine provides healthcare services to remote patients utilizing telemedicine software and applications. Telemedicine service is used when distance is a major factor behind no access to healthcare facilities. Consultation for the specific disease is done through video calls, secure messaging, or email networks or by getting the patient’s data from various sources and analyzing the health-related issues. Diagnostic test reports, X-rays, or CT scans can be sent to the medical practitioners to judge the disease best. Telemedicine billing is necessary for the revenue generated for the given services and to comply with the terms and conditions set by regulatory authorities.

Telemedicine Billing Models

There are different telehealth billing models, and the healthcare provider has the choice to select the model of his interest. They have to comply with that specific model, and they can only provide healthcare services to those patients who come under that particular model. Here are four known models for the telemedicine billing:

1.  Fee-for-Service

This model doesn’t have any subscription criteria. However, the medical practitioners get the service fee each time after providing the service. This is like a fee-per-encounter billing model. The medical practitioner should know the accurate coding. He needs to document all the services to get the reimbursement. Before providing any service, they should determine the patient’s insurance status and whether his health insurance company covers the telemedicine service. Many insurance firms cover it, but it is wise to be sure. While providing the telemedicine service, the billing staff is supposed to let the patients know every detail, like the healthcare services and the billing methods.

2.  Subscription-based Models

It is the package model for providing healthcare services to the people. In this model, patients pay a specific amount per annum or per month to enjoy healthcare services when needed. The extent of coverage of healthcare facilities is different in different subscription models. These services in subscription should comply with the healthcare standards. Getting the reimbursement in this telehealth billing model is done with the help of software or a third party. In case of the provision of healthcare service out of subscription, the medical practitioner must obtain the consent of the patient before providing the service.

3.  Direct-to-employer

There is a payment method in which employers pay the medical bills for the services rendered to their employees. In this case, employer-sponsored health insurance is provided to the employees. Physicians offer the telemedicine service to the employees, and the medical bill is sent to the employers. The payment, number of medical services, and other terms and conditions are decided between the healthcare provider and the employers. It is also necessary for physicians offering telemedicine services to comply with healthcare laws such as HIPAA to get reimbursement. Privacy rules should also be kept under consideration while providing employees with personal and medical information.

4.  Medicare and Medicaid

Medicare and Medicaid are the healthcare programs started by the government, and the state also bears all the expenses. This program also covers telehealth services and bills. Physicians must provide healthcare services to the eligible population for the Medicare and Medicaid programs. Physicians should have complete knowledge and understanding of medical billing and coding to claim for the services. Medical bills are sent to the regulatory authority of this program for reimbursement rates.

Telehealth Billing Software and Tools

Many tools are useful for the telemedicine billing process. These tools streamline all the processes involved, from making the medical bills to getting the reimbursement. All the steps are followed efficiently to increase the output. Some software and tools are described below:

●        Practice management system

This system is responsible for making the telemedicine billing process smooth from start to end. The practice management system helps in scheduling the appointments of the patients with the doctor, and it also notifies the patients about their meetings. It also helps in generating accurate medical bills and mentions all the necessary codes and patients’ information. After this, it submits the claims to the insurance companies and tracks the status of the claims. The patient’s information and the history of his online visits and interactions are also recorded.

●        Telemedicine-specific Software

This type of software coordinates with other telemedicine tools like the video conferencing tool for accurate exhibition of remote consultation. It has another great feature as it sends the digital prescription directly to the pharmacies to send the medicines to the patient. It keeps a record of information about online consultations, payment methods, and personal data of patients.

●        Telehealth Platforms

It is not always necessary for physicians to have all the tools and digital equipment for providing the telemedicine service. There is another third-party system in which the telehealth platforms connect the healthcare providers and the patients. These platforms maintain the schedule for appointments and handle the telehealth billing process.

Legal Considerations for Telehealth Billing

Healthcare regulatory authorities have set some rules and regulations for the legal practice of telemedicine, and every provider must abide by the rules. Legal actions will be taken in case of any violation of the healthcare policies and laws, and claims for services will also be denied. There are some important considerations described below:

●     HIPAA compliance: The Health Insurance Portability and Accountability Act (HIPAA) focuses on patient data privacy and confidentiality. Healthcare providers must take steps to maintain the privacy of the patient’s data. Safe communication tools should be used. There should be no leak of data like video recordings and ailment descriptions.

●     State licensure: Telemedicine service is provided across the border. That’s why the providers need to have a license to practice across the border. Some states have reciprocity agreements, and physicians just need approval for telemedicine practice without any additional licenses. For some states, getting a state license is necessary.

Conclusion

Telemedicine is an emerging healthcare opportunity for both healthcare providers as well as for patients. It provides healthcare services remotely and has different billing standards. There is a need to understand telehealth billing rules and regulations to get the reimbursement on time without any objections from the insurance companies. It has many payment methods like fee-for-service, subscription-based models, direct-to-employer, and Medicaid and medicare models. Providers and patients need to select the method according to their requirements. Providers must understand the medical coding system for the successful submission of claims. Telemedicine tools like practice management software and telemedicine-specific software help streamline the process. Providers can also use telehealth platforms to provide telemedicine services to patients. Compliance with government health-related policies and laws should also be practiced to avoid any kind of obstacles in the way of completion of the telehealth billing process.

Decoding these terminologies is challenging not only for providers but originating sites that ensure eligibility and complete Medicare telehealth reimbursement.

According to the guidelines shared by CMS, telehealth services are subject to be provided using an internet-based telecommunication system with interactive audio and video which enables direct communication between beneficiary and provider. In the CMS telemedicine demonstration program, the exceptions of asynchronous technology in Hawaii and Alaska that are defined as the transfer of medical information and reviewed by practitioners are permitted.

The place where the transmission of services to the beneficiary takes place is an originating site. Medicare would cover the telehealth service if the originating site is;

• Hospital
• Practice office
• Rural health clinic
• Skilled nursing facility
• Renal dialysis center
• Critical Access hospitals (CAHs)
• Federally qualified health centers (FQHCs)
• Community mental health centers
• A jurisdiction outside Metropolitan Statistical Area (MSA)
• Medicare telehealth CPT codes for medical billing guidelines

A distant site is a location where the services from the provider are delivered. Providers from distant sites and centers eligible to obtain payments from Medicare telehealth reimbursements include;

• Nurse practitioners
• Physicians
• Nurse-midwives
• Physician assistants
• Certified anesthetics
• Clinical nurse specialists
• Nutrition professionals
• Registered dietitians

Medicare telehealth billing guidelines

If telehealth services are not delivered according to the requirement mentioned above and according to the site and equipment, telehealth services cannot be reimbursed.

Also, if a provider renders telehealth services to a beneficiary at a site that is not eligible for Medicare reimbursement, then the services will not be billable or payable. (For instance, visit a beneficiary in a provider’s office that does not meet Medicare guidelines).

This is essential to understand that not all practices and services are not eligible to be paid by Medicare telehealth reimbursements. For CY 2018, 96 Current Procedural Terminology-CPT and Health Common Procedure Coding System (HCPCS) codes are designated for different services.

In addition, claims should be submitted according to eligible distant location and origin site requirements mentioning applicable and correct HCPCS and CPT codes.

What should you look for when applying Telehealth CPT Codes?

To ensure that healthcare providers are appropriately reimbursed for telehealth services, using the correct Current Procedural Terminology (CPT) codes when billing insurance companies is important. Here are some important things to note when using telehealth CPT codes:

Choose the correct code:

Several CPT codes are specifically designated for telehealth services, such as 99201-99215 for evaluation and management services, 99421-99423 for online digital evaluation and management services, and 99441-99443 for telephone evaluation and management services. Be sure to choose the code that best describes the service provided.

Document the telehealth visit:

Just like an in-person visit, it is important to document it thoroughly. This includes the reason for the visit, the patient’s medical history and current medications, and any diagnoses or treatment plans discussed. Be sure also to document that the visit was conducted via telehealth and the platform used.

Use the appropriate modifier:

When billing for telehealth services, it is important to use the appropriate modifier to indicate that the service was provided via telehealth. The most commonly used modifiers are GT (via interactive audio and video telecommunications systems) and GQ (via asynchronous telecommunications systems).

Verify insurance coverage:

Before providing telehealth services, be sure to verify that the patient’s insurance plan covers telehealth services and what the reimbursement rates are for each CPT code. This can help avoid billing errors and ensure that the provider is reimbursed appropriately.

Follow state and federal regulations:

Telehealth regulations vary by state and are subject to federal guidelines, so it is important to know any applicable regulations when providing telehealth services. This includes ensuring that the provider is licensed in the patient state and location and that the telehealth platform used meets HIPAA requirements.

CPT codes for Medicare telehealth reimbursement

Ending notes

A provider can be reimbursed efficiently for the services rendered if they avoid making mistakes in reimbursement claims such as not using correct/applicable billing codes, not focusing on maintaining post-visitation documentation, not training practice staff according to the telehealth billing process, and in some cases, not outsourcing billing service. Ensuring that claims are according to provided guidelines will reduce the delay in Medicare telehealth reimbursement and help improve revenue cycle management.