Telemedicine has taken healthcare by storm. This virtual exam room option provides a new way for patients and providers to interact outside of the office. While this is the more convenient way to see individuals who may struggle to make it to your practice, it may also pose more issues for your organization when it comes time for billing. Truth be told, billing for virtual visit still has some “shaky” rules and often varies from payer to payer.
Here are some tips to help your billing office navigate telemedicine…
Be Aware of Private Payer Coverage
Most of the major insurance payers cover telemedicine. What billers need to be cognizant of is ensuring that an individual’s policy covers it. Make note of this as you move forward – some policies include virtual visits under their “exclusion list.” Different levels of plans from the same private payer may not include telehealth. In order to eliminate any issues moving forward, make sure your office reviews the patient’s insurance plan.
Some of the private payers that state they cover telemedicine include the following: Anthem Blue Cross Blue Shield, Aetna, Human, Cigna, and United Healthcare. It is hopeful that, moving forward, this process of determining eligibility for virtual visits coverage will be more simplistic.
Guidelines by Payer
This tip requires a lot of work on behalf of your practice. Knowing how the bill for telemedicine for the major types of payers, Medicare, Medicaid, and Private Payers will make it easier for your practice to move throughout billing for processes.
In order to start the process of compiling guidelines for each payer, you will need to know what the right questions are to ask. From Capture Billing, the following questions can help you to begin asking questions of the different types of payers…
- Which healthcare providers can bill for virtual visits?
- What healthcare services can be done via telemedicine?
- Do you specifically cover live video telemedicine?
- Are there any restrictions or conditions that need to be met before a patient qualifies for virtual visits (i.e. distance from provider, established provider-patient relationship, informed patient consent in writing)?
- Are there any restrictions on the number of virtual visits patients can have in a given year?
Also, ensure that you verify which CPT code should be used when billing for a virtual visit. The telemedicine specific CPT code is 99444, however, this will vary depending on the payer and which state you live in.
Decide How to Handle Telemedicine Charges
If your practice chooses not to seek out reimbursement for telemedicine charges, you can opt to charge patients a convenience fee for these types of “visits.” eVisit states that many patients don’t seem to mind paying a convenience fee in lieu of not leaving their house for a doctor’s appointment. This also can save your billing office a headache later when it comes time to actually bill for a telemedicine. If this is the route you choose to go, patients should sign a waiver agreeing not to use insurance for virtual visits at your office. These convenience fees typically cost between $30-75 per visit.
Billing for telemedicine comes with a lot of undefined rules, and not many streamlined solutions. For now, the best way your practice can prepare is by making phone calls and remaining vigilant to ensure reimbursement is possible for each e-visit.