An estimated 27.5 million cases of COVID-19 have been reported in the United States as of February 2021. In its wake was a meteoric rise in engagement with telehealth services. According to the Texas Association of Health Plans, 4.5 million patients in the state of Texas alone took advantage of telemedicine since the onset of the pandemic.

For telehealth and telemedicine providers, there remains a layer of complexity to consider when billing for services provided during COVID-19. Telehealth isn’t going anywhere, so it’s important to establish a good understanding of your telehealth billing to avoid costly billing errors down the line.

What Constitutes Telemedicine in Texas?

If you’re not already familiar with what constitutes telemedicine in the state, it’s important to have a good understanding of what it means. The state definition includes more than many Texas healthcare providers realize.

According to state regulations, telemedicine in Texas involves a health care provider’s medical care delivered to patients physically located at sites other than where the provider is located. The same standard of care that applies to an in-person setting applies to health care services or procedures provided by telemedicine. 

Importantly, telemedicine and telehealth services can be delivered synchronously or asynchronously. The delivery of care matters, so here’s what you need to know about each.

Synchronous 

• Real-time, audio-video communication that connects physicians and patients in different physical locations.
• Real-time audio and telephone communications connecting a physician and patient in two different locations.

Asynchronous 

• Store-and-forward technologies that collect images and data to be transmitted and interpreted later 
• Remote patient-monitoring tools such as blood pressure monitors, Bluetooth-enabled digital scales, and other wearable devices that can communicate biometric data for physician review.
• Online digital visits or brief check-in services furnished using communication technology that is used to evaluate whether or not an office visit is needed; via patient portal, smartphone, or a related technology. 

In the state of Texas, practitioners can use any audiovisual telecommunication technology that allows the practitioner to comply with the standard of care described in Section 111.007 of the Texas Occupations Code.

COVID-19 Coding Resources for Telehealth and Telemedicine Providers

There are guidelines available to help you determine how best to avoid coding and billing errors for telehealth and telemedicine services. However, your contract will almost certainly have variables that aren’t reflected in even the most robust “best practices” guides and cheat sheets.

For this reason, it’s crucial that you take the time to review your contracts to understand how you need to bill for telehealth services for specific payers. 

These resources will help you get started with establishing a clear plan of action for your telehealth billing. We know this can be a time-consuming and overwhelming process, so ask our team for help if and when you need it.

General Information

Telemedicine During COVID-19 FAQ

This in-depth resource from the American Medical Association provides plenty of general information regarding telemedicine and telehealth services delivered during COVID-19, including how emergency regulations impact practices nationwide.

Medicare

CMS Telehealth Services Cheat Sheet (PDF)

This booklet is in review with commercial insurers as well, and it affects all site-of-services (POS).

CMS General Telemedicine Toolkit (PDF)

Note that not all links in this toolkit work, but there are helpful resources throughout.

Medicaid

Health and Human Services Provider Information

This resource was most recently updated in January of 2021, and provides up-to-date resources for Texas providers.

Medicaid and CHIP Services Provider Information

This resource provides additional information for providers of Medicaid and CHIP services.

Blue Cross Blue Shield

Telemedicine and Telehealth Services Information

This patient-facing resource provides details about telemedicine and telehealth services through Blue Cross Blue Shield insurance plans, including what is covered and what is not.

Texas Provider FAQ – COVID-19 (PDF)

Download this PDF resource and keep it handy in your office. It includes quick information about COVID-19 testing, treating, telehealth services, and more.

United Healthcare

COVID-19 Telehealth Services

This straight-foward webpage has all the information you need to understand telehealth services covered through United Healthcare plans, including details about remote health monitoring, virtual check-ins and more.

Note – As of January 2021, United Healthcare is temporarily expanding the dates through which they are waiving the Centers for Medicare & Medicaid Services (CMS) originating site requirements for Medicare Advantage, Medicaid and Individual and fully-insured Group Market health plan members.

Aetna

COVID-19 Telemedicine FAQ

This FAQ resource has extensive information and guidelines for Texas telehealth and telemedicine providers, including details about cost share waivers. That said, expect to review your contract for specific details that may impact your practice.

Humana

Telemedicine Information Portal

This site includes a tooltip to use when you have a question or need updates about billing and coding guidelines.

Cigna

Virtual Care Options

This CIGNA member resource for individuals and families provides an overview of virtual care options available through CIGNA telehealth providers.

Coronavirus Information Portal for Healthcare Providers

You’ll find information in a variety of locations across the CIGNA website, but a majority are represented in this coronavirus information portal that includes FAQs and more.

Texas Workers Comp.

Telemedicine Information Page

This robust information page includes details about upcoming webinars, information sessions, and resources/FAQs to help you understand the basics of telemedicine requirements.

Get Help Navigating the Medical Billing Landscape with Our Experts

The medical billing landscape is constantly in flux. Stay on top of these changes and what they mean to your practice with our experts’ help. We’ll streamline the most complex aspects of your practice’s revenue cycle management so you can focus valuable energy on your patients. Contact our team to discuss your billing needs and how we can help.

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