The Impact of Telehealth on Billing Practices in Specialty Care

Telehealth services have been gaining popularity, especially after the coronavirus pandemic. These services allow providers to conduct virtual consultations, follow-up visits, and remote monitoring, reducing the need for in-person consultations.

As these services evolved they offered great advantages for people who live in rural areas and the ones that have mobility issues. In fact, 89% of Americans have reported being delighted with the recent telehealth services they have taken.

This proves that the shift in transforming how care is delivered has not only made people’s life convenient, but it has also lowered healthcare costs. This blog covers everything medical practices need to know about telehealth billing.

Traditional Billing in Specialty Care

In typical speciality care, the billing process begins with the healthcare provider assessing a patient, performing any procedures needed, and documenting each visit. Each service is given a specific code using systems like CPT (Current Procedural Terminology), which is meant for procedures, and ICD (International Classification of Diseases), which is meant for diagnosis. These codes are of immense importance for billing insurance accurately.

After the consultation, a detailed bill is generated for the services provided. This bill is then submitted to the insurance provider for reimbursement. The insurance company then analyzes the claim, verifies the codes and other details, and decides on the reimbursement amount according to the patient’s coverage plan.

This process is dependent on the accuracy of coding, correct documentation, and timely submission of claims. Since speciality care involves complex procedures and treatments, accurate billing is essential for revenue cycle management.

Challenges in Traditional Billing in Speciality Care

A few common challenges in traditional billing setup in speciality care include:

• Complex coding: As speciality care involves intricate treatments and procedures, precise coding using systems like CPT and ICD is critical. Any errors in selecting these codes can lead to claim rejections and issues with reimbursement.
• Regulatory requirements: Healthcare facilities must comply with the regulatory guidelines, including HIPAA and other billing guidelines. However, these guidelines get changed frequently, requiring the healthcare provider to remain updated at all times. Errors in documentation and failure to meet the compliance requirements can lead to fines, audits, or even legal issues.
• Claim denials: This is something that frequently occurs because of errors in coding, insufficient documentation, or issues with the insurance policies. This often results in delayed reimbursements, making the provider go under the appeal process, and delaying the payments.

The Shift in Billing Due to Telehealth 

Although telehealth services follow many of the same rules and procedures of in-person visits, there are a few differences. A few of those are mentioned here:

• Differences in Service Delivery and Documentation

Unlike traditional care, telehealth services offer virtual consultations and this shift changes how providers document care, as virtual services require comprehensive details of the interaction to ensure accurate billing. In telehealth services, the provider must keep factors such as location, technology used, and duration of consultation in the records.

• New Billing Codes for Virtual Visits

When adapting telehealth services, new CPT codes and modifiers were introduced for virtual consultations. These included different codes for video consultations, remote monitoring, and audio-only visits. Using these codes properly is important to ensure accurate billing as telehealth services are reimbursed differently, varying depending on rules and payers’ policies.

• Integration with Electronic Health Record (EHR) Systems

Many healthcare facilities have now integrated telehealth billings with the existing EHR systems. This integration allows automatic documentation and coding during telehealth visits. It ensures claims are accurate, errors are reduced and compliance with billing requirements, aiding in faster reimbursements.

Impact of Telehealth on Speciality Care

With the evolving medical landscape and telehealth services taking up space, new strategies to ensure accurate billing and reimbursements are important for a thriving healthcare system. Also, it has been found that telehealth services have increased by 7% in 2023 according to FAIR Health’s Monthly Telehealth Regional Tracker. Here are a few ways telehealth has impacted speciality care:

• Coding and documentation

Speciality providers must ensure that the telehealth visits are coded correctly for proper reimbursement and maintaining medical records.

Telehealth-specific CPT and ICD codes are designed to differentiate between in-person and virtual consultations. For example, the new CPT codes are made for remote evaluations of patient-generated data, video consultations, etc.

A common error faced in telehealth services is the incorrect use of codes, failure to document the technology used, and insufficient or incomplete documentation of the services provided during the telehealth visit.

This can lead to claim denials and delays in reimbursements. Specialty providers are required to document all the details including the time spent, technology used, and patient consent, as it is important for legal, reimbursement, and compliance purposes.

• Reimbursement Challenges

The reimbursements for telehealth in speciality care differ across services, states, and payers. Some payers offer parity with in-person visits, while others provide lower rates or limit the type of reimbursable services, this makes revenue unpredictable for the providers.

After COVID-19 the reimbursement policies have fluctuated. It has led to temporary expansions in reimbursement parity, which creates uncertainty for speciality providers.

Other reimbursement challenges include complex services, lack of standardization, technology issues, and documentation burden. These challenges often lead to concussions, potential billing errors, audits, and claim denials.

• Regulatory Considerations

HIPAA ensures that telehealth services use compliant platforms to ensure the patient’s medical data remains secured and is also necessary to avoid legal issues.

Telehealth providers are also required to state and federal regulations. This also includes licensure rules at the patient’s locations. Medicaid, Medicare, and state-specific policies affect service delivery and reimbursement, hence staying updated on these is important.

 Best Practices for Billing in Telehealth Specialty Care

• Accurate coding and documentation

Using correct CPT and ICD codes and maintaining detailed documentation for proper reimbursement.

• Training staff and clinicians

Regular training on documentation standards, billing codes, and payer policies to prevent errors.

• Leveraging technology

Implementing telehealth platforms and integrating EHR systems to improve accuracy and streamline claims.

• Verifying patient eligibility and coverage

Ensuring patient’s insurance plans cover telehealth services to avoid financial loss and denied claims

• Monitoring billing and reimbursement trends 

Tracking billing trends to spot any delays, discrepancies, and denials.

Elevate Your Telehealth Billing with AtlanticRCM

At AtlanticRCM, we have a team of experts who can automate your revenue cycle management to reduce administrative tasks, enhance claim submission, and enhance real-time eligibility verification. We also maintain compliance with evolving regulations, automate engagement tools, and provide detailed analytics for performance tracking.

AtlanticRCM’s revenue cycle management services ensure that its strategies reduce compliance risks and increase reimbursement rates, helping you achieve greater profitability for your practice. Contact us today to simplify your telehealth billing services.

Atlantic RCM is one of the leading multi-specialty medical billing companies in USA that serves 25+ major medical billing specialties. Our experts work across your practice in billing, collections and account receivables management, to help you succeed.

Get in touch with the leading medical billing outsourcing company to learn more. Call us at (469) 501-1500 or write to us Info@atlanticrcm.com