If the new proposals in the latest fee schedule coming from the Centers for Medicare and Medicaid Services get finalized, then telemedicine may be expanding even more in the future with more payment for these services in store for health providers. The proposed physician fee schedule for 2019 was announced on July 12, 2018 by CMS, and this proposal would significantly expand the services that quality for telemedicine payments. This is great news for both medical practices and patients since telemedicine offers many patient benefits and offers practices with the foundation for increased growth. And while telemedicine does come with some potential billing challenges, there are ways these challenges can be overcome as practices step into the future of telemedicine.   

Telemedicine Payments May Be Expanded in Year 2019

Along with expanding the services that qualify for telemedicine payments, the new proposed physician fee schedule would also add in reimbursements for virtual check-ins via phones or other types of technology like Skype. Clinicians would also be able to get reimbursed for time they spend reviewing patient photos sent via email or text with these proposed changes. The new fee schedule would also expand the Medicare-covered telehealth services to start including prolonged preventive services. 

Of course, there are limitations on when these services can be billed separately. For example, if a short communication technology-based service originates from a related E/M service that was provided to a patient in the last 7 days by a health care professional, then this service is considered to be bundled into the previous E/M service and shouldn’t be billed separately. In the same way, photo evaluations can’t be separately billed if they stem from related E/M services offered within the last 7 days by the same healthcare professional. 

According to Administrator Verma, CMS wants to modernize the Medicare program by taking advantage of technologies that will allow beneficiaries to more easily access high-quality services in a convenient way. Since some beneficiaries face challenges that make it difficult getting to the doctor, using technology to expand access to care while creating more opportunities for patients to connect with medical physicians quickly offers many benefits. 

Benefits of Telemedicine for Growing Medical Practices

Although you already know that telemedicine offers some huge benefits to patient care, such as reducing hospital readmission and medication noncompliance, telemedicine can also help grow your practice and improve practice profitability as well. While investing in a telemedicine program for your practice does require some time and money in the beginning, it can offer some big payoffs. Some of the benefits telemedicine can offer for growing your practice and improving profitability include: 

• Keep Patients Satisfied and Engaged– To keep your practice growing and bringing in money, it’s important to keep patients satisfied and engaged with your practice. Telemedicine removes some of the hurdles your patients may have with visiting the doctor, and patients are often more engaged with their treatment with telemedicine appointments. 

• Reduce No-Shows– No-Shows and last-minute cancellations can hurt your bottom line, and it’s estimated that most medical practices have a 5-7% no-show rate. Although it’s impossible to completely eliminate last-minute cancellations and no-shows, offering telemedicine appointments to patients can reduce no-show rates. 

• Attract New Patients– Studies show that 75% of surveyed patients are interested in using telemedicine, and offering telemedicine at your practice gives you a competitive edge and can help you attract new patients to the practice. As more and more patients demand accessible care, offering telemedicine is not only a huge bonus for patients, it’s an excellent marketing 

• Ability to Offer Same-Day Urgent Care– Are you worried about losing patients to urgent care centers and retail clinics? Offering on-demand telemedicine can help you keep these patients at your practice, resulting in happier patients and a healthier bottom line. And happy patients are likely to refer family members and friends to your practice. 

• Provide Care After Hours– Telemedicine also allows you to provide care to patients after hours while still getting paid for it. You probably already have on-call hours when the office is closed to deal with urgent patient needs. However, offering after hours telemedicine visits lets you give patients increased flexibility to do appointments outside of your normal business hours and also gives your practice a way to increase revenue. 

Medical Billing Challenges of Telemedicine 

Although telemedicine offers many benefits to patients and practices, billing for telemedicine comes with some challenges. Telemedicine is a relatively new care method for the general patient population, which means the guidelines for billing telemedicine continue to form. The rules for billing telemedicine also vary between payers (Private payers, Medicaid, Medicare). As your practice deals with the challenges of billing telemedicine, here are a few things to keep in mind. 

• While most private payers cover telemedicine, that coverage is often policy dependent. Major commercial payers like Humana, Blue Cross Blue Shield, and Cigna cover telemedicine, some cheaper policies may have telemedicine listed under the policy’s list of exclusions. This means it’s always important to check the coverage of patients before offering these services. Using telemedicine insurance verification forms can help you document answers from a representative when you call payers about telemedicine coverage.

• It’s important to know telemedicine guidelines for all payers. Find out which healthcare providers are allowed to bill for telemedicine and which services can be done via telemedicine. Also ask about conditions or restrictions that may need to be met before patients qualify for telemedicine. 

• If you’re billing telemedicine to Medicare, there are only certain HCPCS and CPT codes that will be covered under telemedicine services. It’s also important to make sure you use the proper modifier when billing payers for telemedicine visits. 

In the coming year, it looks like CMS will be paying for even more telemedicine services. However, as codes and services covered change, it can be difficult to make sure your practice is billing telemedicine correctly. Telemedicine can help you grow your practice and increase your bottom line, and you may want to consider outsourcing your billing and coding to eliminate some of the challenges that can come with billing telemedicine. M-Scribe, LLC offers professional billing and coding services, and to learn how we can help you with your telemedicine billing and contacting needs, contact us today. 

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