Why Outsourcing Telehealth Billing Services Makes Sense
Once an emerging form of medical care, telemedicine and telehealth services have grown into a viable option for many healthcare providers. In fact, the Centers for Medicare and Medicaid Services (CMS) under the current administration have touted telemedicine and telehealth as a critical part of the current healthcare system in the United States, with over 76% of hospitals in the country engaging in telehealth consultations. Recently, the AMA reported that telehealth is growing faster than any other type of medical care, experiencing a 53% growth in a 2019 study. These changes were triggered by a number of external factors. First, the increasing consolidation and the related centralization of healthcare services has made the task of finding an in-network provider much more difficult for some Americans. It also promoted the diversification of many health organization’s offerings. Now more than ever, individuals with limited access to regular medical care due to geographic, transportation, or physical constraints can receive care through telemedicine.
Telehealth is now a permanent part of modern healthcare. What began as a rapid shift is now standard practice, with Medicare and Medicaid covering a massively extended number of telehealth services. This is fantastic for patients, allowing them to receive a wide range of care—from virus-related or emergent care screenings to regular check-ups—right from home. But this new landscape creates a major challenge: how to bill telemedicine visits correctly. Instead of getting bogged down by complex codes, many practices are choosing outsourcing telehealth billing services to get it right every time.
How Does Telehealth and Telemedicine Billing Work?
First and foremost, while telehealth and telemedicine are often used interchangeably – even by physicians – there are some important historical differences between the two according to the AAFP. Telemedicine was traditionally used to describe any use of technology in a medical setting, whereas telehealth referred to the use of technology to provide patient treatment. Currently, both are used to describe remote interaction with and treatment of patients using technology. Another key set of terms involves the provider’s and the patient’s locations during the telehealth visit as well as the type of practice providing the service are:
- Originating site Primarily used in conjunction with Medicare, this term refers to the patient’s location during treatment. This must be an approved address for the patient to receive health services and for Medicare purposes must be located in a health professional shortage area.
- Distant site This term is used to refer to the provider’s location during a telehealth visit. It is also used to specify which types of providers can provide insurance-covered telehealth visits, including physicians, PAs, NPs, Certified Nurse Midwives, clinical psychologists and social workers, registered dieticians, and clinical nurse specialists.
- Place of service This portion of a medical code for billing purposes informs the payer of the location of both the originating site and the distant site. Since payer rates often depend on the physician’s location during the service, the place of service is a crucial factor to consider when billing for telemedicine.
- Practice type This kind of medical billing code informs the payer what type of practice provided the service. Depending on whether the service originates from a private practice, hospital-based clinic, rural clinic or other, payers may extend coverage or choose to deny claims based on the patient’s policy.
To begin the billing cycle, providers must first clear the use of telehealth with the patient’s insurance company or other payer. In most cases, this involves a phone call to the payer to verify coverage, as well as the specific listing of a code used to identify the place of service as well as the particular telehealth service to be provided. As mentioned, different payers, as well as different legal entities, hold different requirements to determine eligibility; depending on the coded procedure, you may need to meet specific distance, provider-patient relationship, patient consent, and other qualifications for the payer to cover the telehealth visit.
Which Billing Codes Do You Need for Telehealth?
Medical practices in the United States use one primary set of telehealth billing codes designed to assist payers, providers, patients, and patients alike to determine coverage as well as the medical necessity of the procedure. This list, known as the Current Procedural Terminology, is a code set developed by the American Medical Association’s CPT Editorial Panel. These CPT codes, in conjunction with the International Classification of Diseases, or ICD, codes, set up an index of possible services rendered by the practitioner in accordance with the corresponding diagnoses listed by the ICD. Once each telehealth interaction or procedure receives a code, the billing department can bill the payer via a clearinghouse or directly. In most cases, this involves electronically submitting an ANSI 837 file on the Electronic Data Interchange (EDI).
Your Go-To List of Telehealth CPT Codes
While an ever-increasing number of telehealth services are becoming available, there are several common telemedicine CPT codes used by providers. Frequently used telehealth CPT codes include:
- 99201-99215: either new or previously established telehealth office visits for outpatients
- G0406-G0408: follow ups to inpatient telehealth consultations
- G0425-G0427: telehealth consultations as a follow up to inpatient or emergency treatment
- G2012, G2010: brief 10-15 minute check-in for an established patient to determine if an office visit is necessary or to analyze video or photos provided by the patient
- 99431, 99422, 99423, G2061, G2062, G2063: communication between an established patient and a provider through the provider’s online portal, otherwise known as E-visits
- 90832-90828: individual psychotherapy service
- G0108-G0109: group or individual diabetes self-management training
- 90963-90969: end-stage renal disease treatment with home dialysis
- G0396, G0397: alcohol and substance abuse structured intervention and treatment
- G0270, 97802-97804: group and individual medical nutrition therapy
- G0438: annual wellness visit
Additional CPT codes as well as CMS approved CPT codes due to COVID-19 can be found in the CMS guidance. In addition, providers should pay particular attention to code modifiers like G0, GQ, GT and GY to add further specificity to a code and increase its potential for payment.
What Happens After You Submit a Telehealth Claim?
Once the payer receives the billed claims, a medical claims adjuster will determine approval, denial, or a failed claim based on the necessity of the service as well as the eligibility of the patient’s coverage. If a claim is approved, the insurance company provides reimbursement based on a pre-approved rate. Failed and denied claims are sent back to the provider with an explanation of benefits (EOB) who must then make the necessary corrections and resubmit the claim. Sometimes, this process happens repeatedly until the payer agrees to pay the requested reimbursement or the provider accepts a partial payment. Most often, denied telehealth claims stem from improper attention to the originating site, distant site, and codes accepted by payers like Medicare and Medicaid, both of whom assign strict provisions to the reasons behind telehealth procedures. Unfortunately, these denials cost an average of 3.3% of your total revenue each year.
Why Outsourcing Telehealth Billing Services Makes Sense
As mentioned above, ensuring you receive reimbursement for your telehealth procedures can be a tricky process involving CPT code modifiers. To streamline workflow, many practitioners are turning to an electronic management service to provide an electronic health record, or EHR, for each patient. Through the use of EHR software, you can gather a substantial amount of the data necessary to perform analysis on your telehealth billed services. However, simply instituting a software program does not provide you with the in-depth analysis you’ll need to continue to grow your practice. As you know, busy physicians and other practitioners are often hard-pressed to take on administrative duties in addition to other patient-centered responsibilities. As a result, outsourcing telehealth billing to a third-party vendor is a common solution. You’ll glean multiple benefits from outsourcing your telehealth billing to a medical billing firm, including:
- Specialized Teams Telehealth billing firms employ experienced medical coding and billing experts with a focus on telehealth requirements for Medicare, Medicaid, and major insurance providers. A knowledgeable team with sophisticated software can help prevent the $118 spend per claim denial appeal by improving claim accuracy from the outset.
- Medical coding and billing Particularly in the telehealth arena after COVID-19 – is a rapidly changing discipline. A third-party firm is able to focus on ongoing training and certifications in order to keep its team up-to-date and proficient.
- Cost decreases As opposed to staffing your own billing department, outsourcing your telehealth billing allows you to pay less for expertise. Better yet, you won’t take on the additional overhead costs associated with adding an additional workforce to your practice, further increasing your opportunity for revenue.
- Reduced Errors According to legal firm Husch Blackwell, “by far, the most common errors in claims submitted for telehealth services were related to the location of the originating site.” Reducing these errors can help you ensure you receive reimbursement for your services.
- Quicker, more efficient returns With an expert workforce at your fingertips, claims can be submitted in a matter of hours instead of a matter of days. Better yet, through the use of automated EHR software, you could be looking at verification costs under 50 cents instead of the $8 required by the manual billing process.
- More time for patient care Reduced attention to administrative details allows you to place your focus where it needs to be – on your patients. Patient engagement and minimal after-office-hours results in a better standard of care as well as a better reputation.
- Increased revenue potential While each of the above reasons contributes to the increased potential for revenue the majority of physicians see as a result of outsourcing telehealth billing, the true potential lies in the work a telehealth billing firm will put in. A good billing firm will perform a fee schedule analysis and work towards improving your collection rate to make sure you receive your reimbursements.
Lower Operational Costs
Partnering with a third-party billing service can significantly lower your practice’s operational expenses. Instead of hiring, training, and supporting an in-house billing team, you gain access to seasoned professionals without the associated overhead costs like salaries, benefits, and office space. This model allows you to pay for expertise on an as-needed basis, making it a scalable solution as your practice grows. Furthermore, expert billers are adept at preventing common errors that lead to claim denials. By ensuring claims are submitted correctly the first time, they help you secure reimbursements more consistently and quickly, directly improving your practice’s financial health and reducing the costs associated with reworking denied claims.
Gain Access to Specialized Expertise
When you outsource your telehealth billing, you’re not just hiring a service; you’re bringing a team of dedicated specialists onto your side. These professionals live and breathe medical billing. They possess a deep understanding of the intricate rules and regulations that govern telehealth reimbursements. Unlike a general administrative staff member who has to juggle multiple responsibilities, a specialized billing team is solely focused on the financial side of your practice. With over 40 years of experience, firms like Med USA have developed a level of proficiency that is difficult to replicate in-house, ensuring your medical billing is handled with precision and care.
Navigate Complex Telehealth Codes and Modifiers
Telehealth billing is notoriously complex, with a unique set of CPT codes, modifiers, and payer-specific rules that are constantly changing. An expert billing team is always current on the latest requirements from Medicare, Medicaid, and commercial insurance providers. They know precisely which codes to use for different services and how to apply modifiers correctly to prevent automatic denials. This specialized knowledge is crucial for practices in fields like behavioral health or orthopedics, where telehealth services require specific documentation and coding to be reimbursed properly. Their expertise ensures your claims are clean from the start, leading to a more predictable revenue stream.
Manage Multi-State Billing Regulations
If your practice serves patients across state lines, you face an added layer of complexity. Telehealth billing regulations can vary dramatically from one state to another, and keeping up with these differences is a significant challenge. A professional billing company makes it their business to stay informed about these varying policies, as well as federal guidelines from HIPAA and CMS. This diligence protects your practice from compliance risks and ensures that claims are submitted according to the correct jurisdiction’s rules. This is especially important for processes like provider credentialing, which is often a prerequisite for multi-state billing.
Reduce Administrative Burdens
One of the most immediate benefits of outsourcing is the relief it provides to your administrative staff. Managing the billing cycle is a time-consuming process that can pull your team away from core responsibilities like patient scheduling, engagement, and support. By handing over billing tasks to a dedicated partner, you free up your staff to focus on what they do best: creating a positive patient experience. This shift not only improves office morale but also enhances the overall efficiency of your practice. A comprehensive healthcare revenue cycle management service handles the complexities of billing so your team can concentrate on patient care.
Eliminate Constant Staff Training
The world of medical billing is never static. Codes are updated, payer policies change, and new regulations are introduced regularly. Keeping an in-house team proficient requires continuous and costly training. An outsourced billing firm absorbs this responsibility entirely. They invest in ongoing education and certifications for their staff to ensure they are always ahead of industry changes. This means you benefit from the most current knowledge and best practices without having to spend time or money on training sessions, allowing you to focus on other aspects of revenue cycle administration.
Streamline Patient Billing and Data Collection
An expert billing partner brings efficiency to your entire revenue cycle. With a dedicated workforce and sophisticated software, they can process and submit claims in a fraction of the time it would take an in-house team. This accelerated timeline means you get paid faster, improving your cash flow. They also establish streamlined processes for data collection, ensuring all necessary information is captured accurately from the start. This clean data is not only essential for successful claim submissions but also provides valuable insights for your practice. With better data, you can leverage healthcare analytics to make more informed business decisions.
How to Choose the Right Telehealth Billing Partner
If you’re like the countless physicians who have added telehealth to their services list, you may now be experiencing more medical billing uncertainty than ever. Instead of taking on the task of providing training, adjusting to frequent payer regulation changes, and paying your own coding and billing staff, consider hiring an experienced medical billing company. A third-party team can focus on the nuances of your telehealth billing while you continue to focus on your patients. However, it’s important to find the right team to tackle this crucial aspect of your practice. You’ll need a medical billing company with a top of the line EHR software, continuous training and resources, transparency in its collection and claims techniques, and a deep knowledge of the changing industry. Perhaps even more importantly, you’ll need a medical billing company just as dedicated to boosting your revenue as you are.
Verify HIPAA Compliance
Before you sign any contract, your first step is to confirm that a potential partner is fully HIPAA compliant. Telehealth involves transmitting sensitive patient data electronically, so airtight security isn’t just a nice-to-have—it’s a legal necessity. A reputable billing partner will have robust security protocols and be able to provide you with their compliance documentation without hesitation. This ensures that your patients’ Protected Health Information (PHI) is secure from breaches. Outsourcing your medical billing to a compliant expert means you can leverage their security infrastructure, reducing the risk and overhead costs associated with managing these complex requirements on your own.
Ask About Customization and Support
Every healthcare practice has a unique workflow, patient base, and set of challenges. A one-size-fits-all billing solution simply won’t cut it. Look for a partner who takes the time to understand your specific needs and can customize their services accordingly. Ask how they integrate with your current EHR system and what level of support they provide. When claim issues arise, you need a responsive and knowledgeable team you can count on. A dedicated support system helps you resolve problems quickly, preventing costly delays and denials. An expert team can improve claim accuracy from the start, helping you avoid the significant costs associated with appealing denied claims.
Inquire About Reporting and Analytics
Effective billing is about more than just submitting claims; it’s about understanding your practice’s financial performance. A great billing partner will provide transparent, easy-to-understand reports and real-time analytics that give you a clear view of your revenue cycle. These insights allow you to track key performance indicators, identify trends, and spot potential issues before they become major problems. Ask potential partners what kind of reporting they offer. A proactive firm will perform a fee schedule analysis and use data to consistently improve your collection rate, ensuring you’re receiving the maximum possible reimbursement for the services you provide.
Streamline Your Practice with Outsourced Telehealth Billing
No matter the size of your practice, outsourcing your telehealth and other medical billing needs reduces your overhead and allows you to focus on the everyday concerns of running your practice. Meanwhile, increased accuracy and transparency of data enables you to optimize collections and view KPI for future growth. Best of all, as the field of telemedicine continues to change, you can rest assured your medical billing team will adapt, enabling you to reach more patients than ever before.
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Frequently Asked Questions
Will I lose control over my practice’s finances if I outsource my billing? Not at all. Think of a billing partner as an extension of your team, not a replacement for your oversight. A quality firm provides complete transparency through regular, easy-to-understand reports and analytics. This actually gives you a clearer, more detailed view of your financial performance than you might have now. You maintain full control while handing off the time-consuming tasks to a dedicated expert.
My practice is small. Is outsourcing telehealth billing still a cost-effective option for me? Absolutely. In fact, outsourcing can be especially beneficial for smaller practices. Instead of taking on the fixed costs of hiring, training, and paying a full-time in-house biller, you gain access to an entire team of specialists for a fraction of the price. This model is scalable, so you only pay for the services you need, allowing you to access top-tier expertise without the significant overhead.
What is the most common mistake practices make with telehealth billing? One of the most frequent and costly errors involves the location details, specifically the “originating site,” which is where the patient is located. Payers like Medicare have very strict rules about this, and a simple mistake can lead to an automatic denial. An expert billing partner prevents this by staying current on every payer’s specific requirements and ensuring each claim is coded correctly before it’s ever submitted.
How does a billing service work with my practice’s existing EHR system? A professional billing partner is designed to integrate smoothly with your current workflow, including your Electronic Health Record (EHR) system. They work with you to establish a secure and efficient process for sharing information. The goal is to create a seamless connection that reduces manual data entry for your staff, not to force you into a new, complicated software.
Beyond improving my collection rate, what other insights can a billing partner offer? A great billing partner does more than just process claims; they provide valuable financial intelligence for your practice. Through detailed analytics, they can help you track key performance indicators, identify denial trends, and analyze your fee schedule to ensure you’re being reimbursed appropriately for all services. This data empowers you to make smarter, more informed decisions for the long-term health of your practice.
Key Takeaways
- Telehealth billing requires specialized knowledge: Getting paid correctly for remote services means using specific codes, modifiers, and location rules that frequently change. Staying current on these details is essential to prevent claim denials and protect your revenue.
- Outsourcing improves your practice’s financial health: Partnering with a dedicated billing firm helps lower operational costs, reduce claim errors, and secure faster reimbursements, all while freeing up your staff to focus on patient care.
- Vet potential partners for the right qualifications: When choosing a firm, verify its HIPAA compliance, ensure it can customize services to your workflow, and confirm it provides transparent reporting to help you track financial performance.
