Untangling telehealth billing

The utilization of telehealth services has increased significantly over the past few years, as those in the healthcare industry have started to realize the benefits it offers. Telemedicine allows organizations to maximize existing service lines; add new specialties without the associated costs and hassle of hiring full-time, in-house clinicians; and increase patient satisfaction. It also provides better work-life balance for clinicians, helping to alleviate the issues associated with the burnout crisis. However, in retrospect, the growth over the past few years will likely pale in comparison to the dramatic growth the industry is experiencing due to the COVID-19 crisis.

COVID-19 has initiated a major uptick in the adoption and utilization of telehealth services, allowing patients to safely receive care and clinicians to provide it, often from the comfort of their own homes. In March 2020, the global telehealth market was predicted to reach $82.03 billion by 2027, with a forecasted compounded annual growth of almost 18 percent. Now that telehealth has become—and is likely to remain—the new normal, those projections are expected to increase. In fact, LocumTenens.com has seen a 32 percent increase in clinicians working telehealth assignments since the crisis began.

The necessity of telehealth services during the pandemic has caused many in the healthcare industry to realize what so many of its proponents have long claimed: receiving care via telemedicine is not significantly different, and is often preferential, to receiving care face-to-face. A primary differentiation, in fact, lies in an administrative duty rather than a clinical responsibility: billing.

Even before recent legislative changes were enacted to make telehealth services more accessible during a time of crisis, reimbursement for telemedicine had started to improve. And with many healthcare organizations struggling financially due to cancelations of elective and non-urgent procedures, collecting telehealth revenue can be incredibly beneficial.

Billing for telemedicine services doesn’t have to be overwhelming when you understand a few key concepts and take advantage of your available resources.

Get a grasp on GT modifiers

Anyone who has performed medical billing is familiar with CPT codes, but what a lot of them have never worked with before are GT modifiers. GT modifiers are simply added to a CPT code to show that the service was rendered via telemedicine. You can find a list of examples of CPT codes modified for telehealth services here.

Understand your payor mix

One of the most important steps you can take toward successful telemedicine billing is to get to know your payor mix. It’s important to understand what percentage of your patients utilize Medicare, Medicaid, and commercial insurance so you can recognize how to properly bill for each. Don’t be hesitant to reach out to your representatives from each specific insurance entity, either. They’ll be able to provide you with a wealth of information and answers to important questions. For example, is there a cap on the number of telehealth sessions your patient can have per year? Does the telehealth session have to be synchronous? Billing in general is nuanced and complex. These experts can help you get it right.

Always check state regulations

Telemedicine billing and reimbursement laws vary by state. You’ll need to gain a solid understanding of your state-specific telemedicine billing legislation, and it is equally as important to check regularly for updates, especially given the continuous legislative changes that are making telehealth more accessible.

Work with an agency that will provide billing assistance

Although there’s a growing number of telehealth vendors, it’s important to keep in mind that they’re not all created equal. A reputable company will be able to offer you assistance with billing as necessary and might partner with an outside agency to ensure they’re able to provide you with the best service possible.

The growth of the telemedicine industry isn’t slowing down. Don’t let billing for telehealth services hold your organization back from reaping the tremendous benefits telemedicine affords both clinicians and patients.

_{About the Authors}

_{Pamela Ograbisz, DNP, FNP-BC is Director of Telehealth at LocumTenens.com. LocumTenens.com specializes in the temporary placement of physicians and advanced practitioners at U.S. healthcare facilities. Ryan Bush is Vice President, Sales at ARMCO Partners. ARMCO Partners provides high quality forensic billing, clinical abstracting, NCCI edit resolution/denial management, and ICD-10 medical coding services for hospitals, physician networks, and home health/hospice services.}