How to Maximize Billables From Telehealth Visits
Telehealth visits have exploded in popularity since the COVID-19 pandemic, with post-pandemic utilization holding steady at a higher rate than pre-pandemic levels.1 What began as a stop-gap measure to continue providing care during nationwide lockdowns has quickly become a mainstay in the U.S. healthcare system. However, practices offering telehealth now face a new challenge: driving proper reimbursement for these services. The widespread adoption of telehealth required payers to quickly pivot and update their billing guidelines for a new type of care delivery, with different and evolving rules creating unprecedented challenges for in-house billing teams.
The Latest Telehealth Billing Guidelines for 2024
To match demand, the Centers for Medicare and Medicaid Services (CMS) continue to update billing requirements and reimbursement rates for telehealth visits. For Calendar Year (CY) 2024, the four most important changes to telehealth billing include:2
- New CPT and HCPCS codes. The new CPT codes 0591T-0593T temporarily cover health and well-being coaching services, and HCPCS code G0136 permanently covers Social Determinants of Health Risk Assessments.
- New and expanded services. CMS is temporarily expanding its definition of: telehealth originating sites (to include any location where the patient receives the telehealth services, including their own home), telehealth practitioners (to include occupational and physical therapists, speech-language pathologists, and audiologists), and distant site practitioners (to include mental health counselors and marriage and family therapists).
- Extended use of modifier 95. Modifier 95, which specifies a synchronous telemedicine service conducted in real-time with both interactive audio and video, now applies when the clinician is in a hospital and the patient is at home, as well as when the patient receives outpatient telehealth therapy services.
- Clarified service codes for professional billing. CMS now provides two Place of Service (POS) codes to differentiate between telehealth provided in the patient’s home and telehealth provided in a location other than the patient’s home.
Outsourcing: The Key to Maximizing Telehealth Revenue Capture
The rise of telehealth is great news for healthcare providers, as these appointments are easier to stack and allow clinicians to see more patients in one day. Capitalizing on these new revenue opportunities, however, requires a comprehensive understanding of the nuances of telehealth revenue cycle management (RCM). Even the most experienced billing office faces a learning curve when implementing new billing rules, leading to inevitable errors and missed billables. Issues like incorrect modifier usage, coding for in-person visits instead of telehealth, and insufficient provider documentation can drive up a practice’s denial rate and diminish reimbursements.
For many practices, training every billing staff member on the ins and outs of telehealth billing compliance consumes time and resources that simply aren’t available. That’s why more providers in the post-COVID era are turning to a specialized telehealth RCM partner like Med USA — an expert team of telehealth coders and billers offers the best of both worlds: accurate and timely claim submission and a lower cost to collect.
At Med USA, our team brings a wealth of telehealth billing experience to the table, helping providers get the most out of their telemedicine offerings, all while making your practice workflow more efficient and cost-effective. Our scalable, customizable, and business intelligence-based RCM solutions can rapidly optimize your revenue cycle operations to make telehealth a revenue-generating machine for your healthcare practice.
Ready to Learn More About How Outsourcing Telehealth Billing Can Improve Your Bottom Line?
Talk to a Med USA representative today!
Sources
- Bartlet, K., Piff, A., Allen, S., Barkley, E. (2023, November 21). Telehealth Utilization Higher Than Pre-Pandemic Levels, but Down from Pandemic Highs. Epic Research. https://www.epicresearch.org/articles/telehealth-utilization-higher-than-pre-pandemic-levels-but-down-from-pandemic-highs
- Telehealth Services. (April 2024). MLN Fact Sheet. https://www.cms.gov/files/document/mln901705-telehealth-services.pdf
