Compliance Traps to Avoid When Billing for Virtual Services
When the COVID-19 pandemic swept around the world, and as it continues to impact day-to-day life for individuals and businesses, many business owners had to pivot and adapt to remain open and to continue providing services for customers. This is also the case for the healthcare industry.
Even though people needed to shelter in place and practice social distancing, they still need healthcare services. While the pandemic did not invent virtual healthcare and telemedicine, it has grown significantly since this occurred.
If your practice has begun offering telemedicine and virtual services, it may be new territory. There are several compliance risks you must understand to ensure issues do not occur. Keep reading to learn more about the most common problems related to billing for virtual health services. If you know what these issues are, you can take steps to avoid them.
Not Knowing the Right Codes to Report
There are specific codes to use for reporting virtual services. For example:
- Telehealth services for Medicare: With Medicare, the POS (place of service) code must match the CPT code entered. For example, the home services code, which is 99341-99350, would coordinate with the POS 12. Some codes specify nonphysician and physician professional cares, while others are Medicare specific.
- Online digital E/M services: For this, you report codes G2061-G2063, 98970-98972, or 99421-99423.
- Telephone services: With these, you report G2012, 98966-98969, or 99441-99443.
Assuming That all Commercial Payers Follow Medicare
Be sure to get in touch with all commercial payers to determine if they cover all or some of the virtual services offered. With telehealth, be sure to ask if the payer requires audio or audio and visual. Usually, commercial payers will have policies available on their websites you can access.
Relaxing the Required Documentation for Telehealth Services
Just because you are providing virtual services, it does not mean you can skimp on the documents required. For example, if you are submitting a bill for telehealth, you must continue to document the relevant details to show they met all the code requirements.
Because of the existing PHE – public health emergency – doctors can bill the codes 99201-99215 for telehealth based on medical decision making (MDM) or time. Time or MDM will be used by physicians starting January 1, 2021, which means it is essential to have documentation that reflects all these elements.
Billing an Online Digital or Telephone Visit that Lasts for Under Five Minutes
These medical services require you to provide service for a minimum of five minutes. If this does not happen, then it is not billable – at all.
Ensuring Your Practice is Compliant
In the healthcare industry, compliance is essential. If you are non-compliant, you may face several consequences. If you need help ensuring everything is handled correctly, consider putting your practice’s coding and billing needs into the hands of a third-party service provider. In the long run, these professionals can provide you with the solutions needed to ensure ongoing compliance.
Recent Comments