Medical billing for telehealth during COVID-19

May 1, 2020

How to ensure practice success.

COVID-19 is changing the way we practice medicine. Social distancing measures have led to a surge in demand for telemedicine, while practices around the country are seeing a reduced number of in-office patient visits.

While the regulatory environment has not always been favorable towards telehealth, federal and state legislations have recently loosened in an effort to enable healthcare providers to more easily treat patients virtually during this time. This allows practices to meet the unprecedented demand for telehealth, and to maintain the safety of physicians, staff and patients. The changes have been positive; however, many practices are still facing challenges.

In addition to navigating the rapidly changing regulatory environment, many medical practices are facing a negative financial impact. Some practices have had to reduce staff down to “essential” employees only in order to manage costs, and others have had challenges maintaining financial security due to the variances in patient volume, as well as billing staff absences because of personal or family illness.

Whatever the case may be, the burden on providers is high. Understanding the options for maintaining medical billing during the pandemic can help alleviate financial interruptions and pressures.

Telemedicine and Your Healthcare Practice: Understanding the Basics

At this point, the majority of non-urgent health issues are being addressed by physicians virtually. There are three main types of telemedicine services:

  • Telehealth Visits: This is defined as a patient visit with a provider via a telecommunication device, usually a phone or video conference.

  • Virtual Check-Ins: This check-in can be conducted over the phone or other secure communication portal to decide whether an office visit or other service is needed.

  • E-Visits: These are classified as communication between a patient and provider through a secure online portal.

Each type of visit is coded and billed differently. And regardless of physical location for appointments, medical professionals must still go through the general workflow for billing services, which is why it’s crucial to understand the key differences between each type.

Telehealth Visit

Telehealth visits should be made available to both new and established patients.

Different payers require different Place of Service (POS) designations for telemedicine, and carriers are changing their requirements on a near daily basis. Prior to coding a telemedicine appointment, check the carrier’s website for POS updates to ensure the claim is not rejected.

Practitioners also need to confirm that video restrictions have been lifted for any non-Medicare payer in order to avoid issues further down the road, as well as to verify the type of non-public facing video options patients may be using are approved.

Virtual Check-In

Both established and new patients can schedule a virtual check-in with a practitioner. Consider this type of appointment as a follow up or introductory appointment – it must be patient-initiated, and a recommendation of care is not necessarily the end goal.

A physician or other qualified non-physician provider is required to conduct a virtual check-in. While these visits may not always be a billable event, by having a billable provider conduct the call, a recommendation of care can be provided to the patient as needed, thus turning it into a billable event.

Virtual check-ins can also include both asynchronous and synchronous media exchange between the patient and provider. If the patient submits a video or image for interpretation outside of the appointment (i.e., before or after), it is classified as an asynchronous event. If it is shared in real-time (i.e., during the check-in), it should be classified as a synchronous event when billing. The exception to the rule for asynchronous and synchronous events is if it arose from a service performed in the past seven days or is provided within 24 hours of the next available appointment.

E-Visit

This patient-initiated virtual appointment must be conducted through a secure patient portal in real-time. Patients, both new and established, can schedule an e-visit with their preferred provider.

Physicians, physician assistants or nurse practitioners are able to conduct these appointments and code them based on practicing status. Clinicians may also conduct e-visits, but must include G codes. E-visits require time-based coding in 10-minute increments and should be submitted within a cumulative seven-day timeframe.

There are two important commonalities between the different types of telemedicine appointments. First, many payers are requiring disaster related coding to be included in all billable events. Check the carrier’s website prior to submitting the services.

Second, prior to conducting the appointment, providers should obtain written consent. While this requirement varies across state lines, obtaining consent in areas that do not have this requirement adds an extra layer of protection to the practice.

Our healthcare and medical professionals are fighting COVID-19 on the front lines. For many, it means visiting hospitals in need to provide support in hot spots. For others, it means taking care of those who still need day-to-day routine care. In order to maintain financial success during and following the current healthcare crisis, it’s important to have the tools and resources for proper billing and coding for remote visits at your fingertips. Partner service providers, industry associations and insurance providers are here to help with real-time updates and resources on the business side, so providers can focus on patient care. We’re here to help.

About the AuthorAt Greenway Health, a leading health information technology and services provider, Marvin Luz serves as senior director, Greenway Revenue Services. With more than 13 years of experience in the ambulatory EHR and practice management market, he oversees the daily billing operations of revenue services for customers, ensuring compliance with divisional established policies and protocols, adherence to government and insurance payer policies and assurance of customer conflict resolution. In addition to his daily responsibilities, he also leads the Patient Call Center and Patient Accounts Receivable teams at Greenway.