Telemedicine, which was once considered a mere part of the healthcare industry, is now one of the rapidly growing healthcare segments that brands are rushing to adapt and embrace, possibly as a permanent service offering.

According to a survey by McKinsey and Company, when compared to the pre-COVID-19 figures, telehealth services have seen a 38 times growth! 

When the healthcare industry adapts to a change, it becomes necessary for the medical billing and coding companies to follow suit quickly! That is, if they want to retain their clients and offer the same SLAs.

While experts believe that there are still a few challenges to telemedicine services that need to be addressed, including technological security, tech availability, and government regulations, this is a trend that is here to stay. 

Telehealth – before and after COVID-19

Before COVID-19, you could access telehealth in the United States only if you were a rural patient. However, telehealth was opened up to all patients during the pandemic, and Medicare coverage was made available.

With the pandemic slowly getting manageable, healthcare providers worry about not getting reimbursed enough for their telemedicine services while patients worry they may not get access to telemedicine, which has become a more convenient way to reach out to medical practitioners. 

Here are some facts for you!

  1. According to the Future Health Index report in 2021, 64% of healthcare providers globally are investing heavily in telehealth, assuming it is going to stay. 
  2. The same report states that up to 24% of these healthcare providers hesitate to adopt telehealth because of certain limitations in the reimbursement models.
  3. According to a McKinsey Report, compared to 2017, the number of investors investing in digital health segments has tripled. 
  4. Since April 2020, about 50% of all psychiatry treatments have been handled virtually. Similarly, about 30% of substance use disorder treatments and 17% of endocrinology and rheumatology treatments were virtually conducted. 

Right now, CMS has proposed to extend telehealth flexibility up to 2023 and has come up with a complete list of services and their HCPCS/CPT codes for 2022. However, keep looking out for possible changes that may affect you as a medical billing and coding service provider. 

Factors to keep in mind by medical billing and coding companies

If you are a service provider looking to serve clients who offer telemedicine services, then here are certain things you should focus on in 2022.

  • Be aware of the regulatory changes post-COVID-19

CMS and insurance providers are coming up with new regulations, and there are a lot of pending bills with Congress that can change things for the US healthcare providers, payers, and the medical billing and coding companies.

Right now, most CPT codes have telehealth coverage, thanks to Public Health Emergency state. So the first thing you need to do is constantly be aware of the regulatory changes. It may take some time for things to settle down. 

  • Understand the telemedicine guidelines for different payers

The guidelines for telemedicine vary depending on the payers your client deals with (Medicare, Medicaid, or private). As a result, their coverage will also vary. If you are a new service provider handling telemedicine claims, then you may have to check the guidelines thoroughly to ensure your reimbursement rate suddenly doesn’t drop down.

  • Do not hesitate to get in touch with the payers

Medical billing and coding companies that handle billing for large healthcare providers may be required to process hundreds of bills a day. Knowing the right codes and the modifier to bill telemedicine is something your staff needs to get used to. The easiest way to do this, explains experts in the field, is to get in touch with the payers anytime there is confusion. When in doubt, confirm with both the payer and the provider.

Since telemedicine is a new forte for many, delays, process lags, and errors may bring down the efficiency of RCM services when not dealt with right.

  • Make sure you have access to the right information

Now, reimbursements for telehealth services will depend on the time spent for each session, and this has to be documented right, so you can claim appropriate reimbursements. This means that the medical billing and coding companies have to find a way to get proper documentation of the time spent during the session. 

RCM service providers will understand the challenge of getting quick information from the client to process claims with clarity. Quintessence’s Doctor Portal is designed to exactly handle this challenge.

This is a free-to-use portal for all our clients and helps you raise tickets and connect to the specific service provider to get the right information. The portal also keeps track of delays and helps get resolutions quickly.

  • Get familiar with the service codes

When you are billing a payer for telemedicine services, then you may have to bill evaluative and management codes in place of the service codes. This will ensure the payer actually accepts the claims and processes reimbursements. 

If you don’t do this, it gets easy for the insurance providers to keep denying bills, and your reimbursement rate will go for a toss.

As a medical billing and coding company, confirm with the payer whenever needed and use E & M CPT codes at the right places. 

Avoiding denials 

Here is a gist of all you can do as a service provider to keep reimbursement rates high and denial rates low while handling telemedicine services.

  • Always double-check the policy coverage in advance for telemedicine claims.
  • Make sure every step of billing, coding, and reaching out to the payer and the client are documented to handle delays and denials better.
  • Codes change with telemedicine, and the quickest way for a provider to deny a claim is because of the use of wrong codes. So make sure to use E & M CPT codes in the right places.
  • When in doubt, reach out to the payer. This may seem cumbersome, but it helps learn and avoid unnecessary denials.

Takeaways

The expansion of telemedicine during the pandemic has shown patients what a boon it can be. It has also helped healthcare providers offer their services to people across geographies, touching more lives and making a more significant difference.

While we don’t still have clarity on what will be the future of telemedicine in the USA, there is no doubt that many experts and lobbyists are pushing towards making it the new normal, even after the pandemic.

As a medical billing and coding company, start investing in L&D programs and training to process telemedicine bills. If your client is handling large volumes of virtual sessions, then tweak your processes, double-check, verify, and bill these claims the right way to maintain your SLAs.