Tackling Telehealth Reimbursement Issues

1
Tackling Telehealth Reimbursement
Issues
2
Tackling Telehealth Reimbursement Issues

• Telehealth has been considered as a revolutionary
  innovation in healthcare delivery. However, its
  adoption has been limited, with one of the main
  barriers being reimbursement issues. Despite its
  potential to save costs, there is limited
  evidence of managed care organizations (MCOs)
  using telehealth to control costs. Furthermore,
  Medicare reimbursement in the fee-for-service
  system is not generous, with restrictions based
  on location, institution type, and CPT codes.
  These restrictions are in part due to concerns
  that telehealth may lead to overutilization and
  abuse of the healthcare system. In this article
  we discussed, how healthcare providers can tackle
  telehealth reimbursement issues by following best
  billing and coding practices.
• Tackling Telehealth Reimbursement Issues
• Telehealth reimbursement issues can be complex
  and vary depending on the specific circumstances
  and location of the healthcare provider. However,
  there are some general steps that can be taken to
  tackle telehealth reimbursement issues.
• Understand the reimbursement policies of Medicare
  and managed care organizations (MCOs) To
  effectively tackle telehealth reimbursement
  issues, it is essential to understand the
  policies of Medicare and MCOs. These policies can
  vary significantly, and it is essential to know
  what services are covered, what requirements must
  be met to qualify for reimbursement, and what the
  reimbursement rates are.
• Verify patient eligibility Before providing
  telehealth services, verify that the patient is
  eligible for telehealth services under their
  health plan. This may include verifying that the
  patient is located in a geographic area that is
  covered by the health plan, and that the health
  plan covers the specific telehealth service being
  provided.

3
Tackling Telehealth Reimbursement Issues

• Use appropriate codes When billing for
  telehealth services, its important to use the
  appropriate CPT (Current Procedural Terminology)
  codes. These codes are used to describe the
  services provided during the telehealth visit.
  The Centers for Medicare and Medicaid Services
  (CMS) has specific codes for telehealth services,
  which can be found on their website. Its
  important to note that some codes may be
  different for telehealth services than for
  in-person services.
• Use modifier 95 When billing for telehealth
  services, its important to use modifier 95,
  which indicates that the service was provided via
  telehealth. Modifier 95 should be added to the
  CPT code for the service provided.
• Document care appropriately Documentation is key
  to successful reimbursement for telehealth
  services. Providers should document the same
  information as they would for an in-person visit,
  including a description of the services provided,
  any diagnoses, and the patients response to
  treatment.
• Work with payers to negotiate reimbursement
  rates Telehealth reimbursement rates may be
  lower than in-person visits, which can discourage
  providers from offering telehealth services. It
  is important to work with payers to negotiate
  reimbursement rates that are fair and reflect the
  costs of delivering care via telehealth.
  Reimbursement requirements for telehealth
  services are constantly changing, so it is
  important to stay up-to-date on any changes to
  regulations or billing requirements.
• Comply with regulations Telehealth services are
  subject to federal and state regulations, and
  failure to comply with these regulations can
  result in denied claims or even legal
  consequences. It is important to understand and
  comply with all applicable regulations, including
  those related to privacy and security of patient
  information.

4
Tackling Telehealth Reimbursement Issues

• Monitor and track telehealth usage Telehealth
  can be a cost-effective way to deliver healthcare
  services, but overutilization can lead to higher
  costs. Providers should monitor and track
  telehealth usage to ensure that it is being used
  appropriately and that the costs are justified.
• Overall, tackling telehealth reimbursement issues
  requires understanding the reimbursement
  policies, verifying patient eligibility, using
  appropriate codes, proper documentation,
  complying with regulations and tracking
  telehealth usage. If you are having trouble with
  telehealth reimbursement, consider seeking
  assistance from reliable medical billing company
  like Legion Healthcare Solutions. We can help you
  navigate complex reimbursement issues and ensure
  that you are billing appropriately for telehealth
  services.
• Legion Healthcare Solutions is a leading medical
  billing company providing complete billing and
  coding services. As a reliable telehealth billing
  company, we specialize in helping healthcare
  practices optimize their billing and collections
  processes, reduce claim denials, and increase
  revenue. We ensure accurate insurance
  reimbursements whether you are billing for
  Medicare, Medicaid or any commercial insurance
  company. To know more about our telehealth
  billing and coding services, contact us at
  727-475-1834 or email us at info_at_legionhealthcares
  olutions.com

5
(No Transcript)