Telemedicine — the act of delivering healthcare services remotely via video conferencing and other methods — is a growing trend in the United States. According to the American Hospital Association (AHA), telehealth was practiced in around 35% of hospitals in the nation in 2010. By 2017, that number had grown to 76%. Home telehealth visits also saw significant growth, increasing an average of 52% annually from 2005 to 2014.
It's easy to see why so many providers and patients are turning to telemedicine. A few of the benefits include cost savings for both parties, convenience for the patient, and the ability to get a fast answer to minor health issues without facing traffic or long waits in an ER. But telemedicine is not without challenges, one of them being reimbursement. Here are three common reimbursement obstacles telehealth providers might run into.
1. No Upfront Admin to Check the Paperwork
When billing insurance companies and government payers, some top reasons for claims denials include:
- The service isn't covered by the insurance
- The person is no longer covered by the policy
- The provider is out of network
- A pre-authorization was required
- A detail is wrong, such as the person's name, ID number, or date of birth
These are all fairly easy denials to prevent in a clinic or office because front office staff can perform checks on all this information even before the patient is seen. They typically ask patients to fill out or double check information about themselves, copy new insurance cards, and process insurance verifications via phone calls or computer systems.
When providers deal in telemedicine, they run the risk that some of these checks are suspended. Instead, the patient might access a web portal, enter their own information, and be seen by a clinician. Typos, misunderstandings about what information was being asked for, and outright dishonesty can all derail the reimbursement.
2. Potential Lack of Relationship With Patients
In a traditional healthcare setting, the providers develop at least some relationship with patients. There is face-to-face interaction as well as phone interaction in many cases. If the necessary information for billing doesn't get completed, someone in the office can easily pick up the phone and request it, and many patients are happy to help. After all, those patients are probably going to return to the office for services again in the future; it's an ongoing relationship that is important to both parties.
This can be the case in telemedicine, especially when the remote resources are used to support traditional healthcare. However, in cases where providers offer telemedicine to new patients as a way to grow patient lists and revenue, doctors may begin seeing remote patients that have never visited the office or clinic. They may field one-time calls and never hear from the patient again. These situations can make it less likely reimbursement staff will be successful in chasing patient information for claims—at the very least, it might be more difficult to get ahold of the patient and get the information.
3. Confusion About What Is Covered and Who Covers It
One of the biggest challenges to reimbursement in this new frontier of medicine is that payers simply haven't caught all the way up to the trend. Not all commercial insurance plans cover telemedicine visits, and coverage under Medicaid is up to each state.
Medicare does cover some telehealth procedure codes, but billing these services to the federal payer can feel akin to a hail Mary pass in football. Providers must get the procedure code right, code with a GT modifier to indicate that the service was offered via interactive video conference, and use the right place of service code. Plus, providers can't simply bill to any MAC. They must bill to the MAC that covers the provider's (not the business's) location. Since one benefit of telemedicine is that offices, clinics, and hospitals can draw from the expertise of providers around the country, this may mean some efforts to set up appropriately to bill from numerous states.
Help for Telemedicine Billing Challenges
If your office is struggling to integrate telehealth services into reimbursement processes, M-Scribe, can help. As a national leader in medical billing, we keep up with rules about coding and claims submission and can help ensure your claims are clean to reduce potential denial rates. Call us at 770-666-0470 to find out more or email me at firstname.lastname@example.org.