Since telemedicine is a fairly new care method for most patients, telemedicine billing can be a bit tricky. The guidelines for billing and coding for telemedicine are still being formed and they’re changing, and how you bill can depend on the payer.
In the past, when billing Medicare for telehealth services, the GQ and GT modifiers were essential. However, in 2018, CMS has largely eliminated the need to use the GT modifier on telehealth claims, although there are a couple unique situations when CMS still wants GQ and GT modifiers used. Instead, “Place of Service POS 02” codes must be used on claims for telehealth services.
As telemedicine continues to grow, it’s important to stay up-to-date on the best billing and coding practices. Here are a top 5 telemedicine billing tips to remember –
Tip #1 – Private Payers Cover Telemedicine but the Coverage May be Policy Dependent
Most of the major private payers like United Healthcare, Humana, Blue Cross Blue Shield, Cigna, and Aetna do offer coverage for telemedicine. Some of these big commercial payers have telemedicine pilot programs in place to look at the care and cost benefits of telehealth services. However, coverage for telemedicine services can vary based on the plan. A private payer’s gold policy may cover these services, while a bronze policy from the same company may list telemedicine as an exclusion.
Tip #2 – Verify a Patient’s Coverage Before the First Telemedicine Visit
Because coverage is often policy dependent, it’s important to do your due diligence and verify the patient’s coverage before they have their first telemedicine visit. Once you have the patient’s insurance information, call the payer and verify that they will cover telehealth services. Although it takes some work on your part, it’s something you’ll only need to do one time for the policy.
When making the call, it’s a good idea to have your telemedicine insurance verification form on hand so you can document the answers you get from the insurer’s representative. Documenting everything on the form along with the reference number of the call allows you to fight any denied claims in the future. If you were told that they would cover telemedicine and you have the call’s reference number, they will need to honor what they told your practice.
Tip #3 – Be Aware of Telemedicine Guidelines for Major Types of Payers
The three major types of payers include private payers, Medicaid, and Medicare. All of these payers have different telemedicine guidelines, so it’s important to be aware of all of them, which can seem a bit overwhelming if you’re dealing with telemedicine billing with all of these major payers.
The best way to learn what every payer wants when you’re billing and coding for telemedicine is to call the payer and ask them a few questions. Some of the helpful questions to ask include:
- What telemedicine healthcare services can be done?
- Which healthcare providers are able to bill for telehealth services?
- Are there conditions that must be met or restrictions before patients qualify to be covered for telemedicine services? (i.e. established relationship with provider, patient consent provided in writing, certain distance from the provider)
- Is live video telemedicine specifically covered?
- Are there limits on the total number of telemedicine visits the patient may have each year?
Tip #4 – Talk to Payers About Which CPT Codes are Eligible
Most payers prefer that providers use the appropriate evaluative and management CPT codes (99201 – 05, 99211-15) when billing telehealth services, along with the GT modifier. However, it’s important to note that CMS no longer requires the GT modifier in most cases. Medicare has a very long list of codes that they will cover for telemedicine, although many private payers may require you to use code 99444, the telemedicine specific code. If you’re not sure when you need to use a GT modifier with your CPT codes, it’s always a good idea to talk to your payer before you bill.
Tip #5 – Careful Coding is Essential to Avoid Liability, Audits, and Denials
When coding for telemedicine services, careful coding is essential. When you bill claims with GT, GQ, or POS 02, you are certifying that code-specific and broad telehealth requirements have all been met. If you’re billing Medicare, this means that all the statutory requirements for telemedicine coverage must be met. Taking time to make sure that all requirements have been met and avoiding erroneous or false claims is important, since these types of claims can expose your practice to liability, audits, and denials.
Recent changes, such as CMS dropping the need for the GT modifier in most cases, are being designed to help reduce the administrative burden on the billing and coding department for telemedicine services. Taking steps in the beginning to fully understand which telehealth services are and are not covered by payers is well worth the time spent and can prevent denials in the future. If your practice needs more help with telemedicine billing, M-Scribe Billing Services is here to help. We have years of experience providing practices with medical claims billing and coding services. Contact us today at 770-666-0470 to learn more and take some of the burden off your practice.