Managing the Blind Spots

Telehealth services have quickly become the primary means of communication between providers and patients since COVID-19 caused a public health crises. The Healthcare industry as we know it, is shifting. Telehealth services come with there own unique attributes when it comes to providing services and billing. Whether your entity has billed for telehealth services or not, your practice needs to be prepared to navigate and manage common “blind spots” to ensure that you receive proper payment.

Common Telehealth Billing “Blind Spots”:

  • Patient Consent – this must be documented in the patient’s medical record prior to initiating Telehealth services. Providers may document “verbal” consent in their note or you may already have the patient’s signature on file per your existing consent forms obtained at registration. Double check and/or update existing consent forms as needed.
  • Documentation – must support the level E/M visit billed. It is important for documentation to prove medical necessity for certain services as well as stand up against payer retro-audits
  • Common Denial Trends:
    • The patient is no longer covered by their insurance policy – it will be important to continue to verify patient eligibility and update patient demographics prior to seeing the patient. This is very important to complete prior to seeing new patients via telehealth, since there is no existing/former provider-patient relationship.
    • Incorrect Patient Demographics – such as patient’s name, date of birth, or policy ID number.
    • Place of Service codes and modifiers – ensure you are following your payer’s guidelines.
    • Claim lacks necessary information to bill.

Medicare typically reimburses for the following types of telemedicine visits: telehealth visits, virtual check-ins, and e-visits.

Commercial payers often times have different billing requirements for submitting these types of telehealth visits, including timely filing guidelines. It is imperative to stay informed and continually monitor regulatory changes, also, check your payer’s websites for routine updates to ensure billing compliance.

Dean Dorton has experts available to assist you in all Telehealth matters including: compliance, billing, coding, and documentation. Please do not hesitate to reach out to our experienced team with any questions you may have. We are committed to serving any of your healthcare needs.

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