Tackling Telehealth Reimbursement Issues

1. Tackling Telehealth Reimbursement Issues

2. Tackling Telehealth Reimbursement Issues • Telehealth has been considered as a revolutionary innovation in healthcare delivery. However, its adoption has been limited, with one of the main barriers being reimbursement issues. Despite its potential to save costs, there is limited evidence of managed care organizations (MCOs) using telehealth to control costs. Furthermore, Medicare reimbursement in the fee-for-service system is not generous, with restrictions based on location, institution type, and CPT codes. These restrictions are in part due to concerns that telehealth may lead to overutilization and abuse of the healthcare system. In this article we discussed, how healthcare providers can tackle telehealth reimbursement issues by following best billing and coding practices. • Tackling Telehealth Reimbursement Issues • Telehealth reimbursement issues can be complex and vary depending on the specific circumstances and location of the healthcare provider. However, there are some general steps that can be taken to tackle telehealth reimbursement issues. • Understand the reimbursement policies of Medicare and managed care organizations (MCOs): To effectively tackle telehealth reimbursement issues, it is essential to understand the policies of Medicare and MCOs. These policies can vary significantly, and it is essential to know what services are covered, what requirements must be met to qualify for reimbursement, and what the reimbursement rates are. • Verify patient eligibility: Before providing telehealth services, verify that the patient is eligible for telehealth services under their health plan. This may include verifying that the patient is located in a geographic area that is covered by the health plan, and that the health plan covers the specific telehealth service being provided.

3. Tackling Telehealth Reimbursement Issues • Use appropriate codes: When billing for telehealth services, it’s important to use the appropriate CPT (Current Procedural Terminology) codes. These codes are used to describe the services provided during the telehealth visit. The Centers for Medicare and Medicaid Services (CMS) has specific codes for telehealth services, which can be found on their website. It’s important to note that some codes may be different for telehealth services than for in-person services. • Use modifier 95: When billing for telehealth services, it’s important to use modifier 95, which indicates that the service was provided via telehealth. Modifier 95 should be added to the CPT code for the service provided. • Document care appropriately: Documentation is key to successful reimbursement for telehealth services. Providers should document the same information as they would for an in-person visit, including a description of the services provided, any diagnoses, and the patient’s response to treatment. • Work with payers to negotiate reimbursement rates: Telehealth reimbursement rates may be lower than in-person visits, which can discourage providers from offering telehealth services. It is important to work with payers to negotiate reimbursement rates that are fair and reflect the costs of delivering care via telehealth. Reimbursement requirements for telehealth services are constantly changing, so it is important to stay up-to-date on any changes to regulations or billing requirements. • Comply with regulations: Telehealth services are subject to federal and state regulations, and failure to comply with these regulations can result in denied claims or even legal consequences. It is important to understand and comply with all applicable regulations, including those related to privacy and security of patient information.

4. Tackling Telehealth Reimbursement Issues • Monitor and track telehealth usage: Telehealth can be a cost-effective way to deliver healthcare services, but overutilization can lead to higher costs. Providers should monitor and track telehealth usage to ensure that it is being used appropriately and that the costs are justified. • Overall, tackling telehealth reimbursement issues requires understanding the reimbursement policies, verifying patient eligibility, using appropriate codes, proper documentation, complying with regulations and tracking telehealth usage. If you are having trouble with telehealth reimbursement, consider seeking assistance from reliable medical billing company like Legion Healthcare Solutions. We can help you navigate complex reimbursement issues and ensure that you are billing appropriately for telehealth services. • Legion Healthcare Solutions is a leading medical billing company providing complete billing and coding services. As a reliable telehealth billing company, we specialize in helping healthcare practices optimize their billing and collections processes, reduce claim denials, and increase revenue. We ensure accurate insurance reimbursements whether you are billing for Medicare, Medicaid or any commercial insurance company. To know more about our telehealth billing and coding services, contact us at 727-475-1834 or email us at info@legionhealthcaresolutions.com