The landscape of healthcare delivery has undergone a profound transformation in recent years, with telehealth emerging as a pivotal player in enhancing patient access and convenience. The COVID-19 pandemic expedited the widespread adoption of telehealth, pushing medical practices to explore the possibilities of this digital frontier. In this comprehensive guide, we will delve into the intricacies of billing for telehealth services, encompassing Telehealth Common Procedural Terminology (CPT) codes, the rules governing their use, practical steps for implementation, crucial considerations such as state medical board requirements, site resource assessment, and the benefits of telehealth.
Understanding Telehealth CPT Codes:
At the core of billing for telehealth services are the CPT codes designated by the American Medical Association (AMA). These codes are essential for accurately reflecting the nature and complexity of virtual encounters. Familiarize yourself with the following key telehealth CPT codes:
- 99201-99215 (Office or Other Outpatient Visits): These codes cater to the evaluation and management services conducted through telehealth, allowing for differentiation based on the complexity of the visit.
- 99421-99423 (Online Digital Evaluation and Management Services): Designed for brief online interactions, these codes are apt for virtual check-ins and concise consultations.
- 99441-99443 (Telephone Evaluation and Management Services): These codes apply to telephone-based consultations, with variations based on the duration of the call.
Understanding Billing Rules:
To ensure a smooth incorporation of telehealth into your practice, it is imperative to be well-versed in the billing rules governing these services:
- Patient Location: Many payers stipulate that the patient must be in a designated eligible location, such as a rural area or a Health Professional Shortage Area (HPSA). Familiarize yourself with individual payer requirements.
- Eligible Providers: Confirm that your healthcare professionals are eligible to provide telehealth services and bill for them. Given that state laws and regulations may vary, staying informed is crucial.
- Telehealth Consent: Obtain informed consent from patients regarding telehealth services, ensuring that the documentation is recorded in the patient’s medical record to comply with regulatory standards.
State Medical Board Requirements:
State medical boards play a pivotal role in shaping the regulatory landscape for telehealth. Most boards require physicians providing telehealth to hold a license in the state where the patient is located. The Interstate Medical Licensure Compact offers a streamlined application process for physicians to obtain licenses in multiple participating states, facilitating the expansion of telehealth. Additionally, hospital-based patient sites may require physicians providing telehealth to hold specific privileges, which could include telehealth-specific privileges.
Site Resource Assessment:
The effectiveness of a telehealth program hinges on the readiness of participating sites, necessitating a thorough resource assessment. Technology serves as the bridge connecting healthcare providers with patients, and a failure to ensure adequate technology may lead to suboptimal patient care. Conducting a site assessment involves evaluating equipment readiness, addressing security concerns, and ensuring a strong internet connection.
Trained information technology and network staff should be involved in conducting assessments, and mock visits can be conducted to evaluate equipment readiness. Adequate broadband access is crucial for the transmission of high-quality audio, text, and imaging. Patients, as well as healthcare providers, must have access to reliable connectivity for effective telehealth delivery. Challenges related to poor broadband access or difficulty in using telehealth tools must be addressed to ensure equitable access to quality healthcare services.
Benefits of Telehealth:
According to the Centers for Medicare & Medicaid Services (CMS), the benefits of telehealth are plentiful for both patients and healthcare providers. These advantages include:
- Increased continuity of care
- Extended access to care beyond normal hours
- Reduced patient and provider travel burden
- Solutions for clinician shortages, especially among rural and other underserved populations
- Support for patients managing chronic health conditions
- Screenings for patients with symptoms of COVID-19 and referral to next steps as appropriate
- Remote patient monitoring for those who are vulnerable to COVID-19
- Helping to stop the spread of infectious diseases and improving public health
Telehealth and Your Practice’s Bottom Line:
Telehealth can also significantly impact a practice’s bottom line, according to the Healthcare Financial Management Association (HFMA). A primary care physician can typically see about 12 patients within a four-hour shift. However, with telehealth, physicians may be able to “see” 16 or more patients in that same timeframe – and still receive Medicare payments at the same rate as in-person visits. In addition, telehealth can expand your geographic practice area significantly.
Refining Your Telehealth Program:
As you embark on your telehealth journey, refining your program is crucial for optimal outcomes. Consider the following tips:
Tip 1. Understand the telehealth preferences of both your patients and physicians:Patient and physician preferences may change for a variety of reasons. Periodically reassess everyone’s preferences. For example, determine which type of telehealth service schedule works best for you and your practice. You may decide to dedicate certain days or blocks to telehealth, or only provide certain types of services through it.
Asking whether your patients want telehealth services is important to ensure you are offering services they will use. You can conduct a brief survey to gather patient feedback, or you could ask patients at their next visit.
If the majority of your patients prefer to receive their care in person, telehealth services may not be necessary.
Tip 2. Make sure you’re using the right technology for your patients:Consider having staff ask patients which platform they prefer to use when the patient is scheduling their appointment. If the patient is unfamiliar with the platform or has not used technology, your front office staff call patients beforehand to walk through logging in and troubleshoot any issues so that you can stay focused on the patient during the visit.
Tip 3. Market your telehealth services:Let patients know what is available to them. Patients may be unsure if you are still providing telehealth services or when it’s appropriate to use telehealth instead of coming in person.
It can be helpful to remind patients that telehealth is available when they can’t make it to the clinic or if they need to stay home for health reasons.
Consider promoting it as an offering on your practice’s social media accounts, as well as other avenues. Educating patients about when and how to access telehealth services at your practice is key to making your program a success.
Tip 4. Review your telehealth workflow:Often a workaround or temporary workflow becomes the established way of doing things, regardless of whether it’s the most effective or efficient process. These examples can help you make proactive improvements:
Discuss with your team what’s working and what could be modified or improved.
Identify ways to utilize your whole team more fully. For example, you could assign a medical assistant to a physician who is conducting a virtual-only clinic session. They can help get the patient checked in as well as manage your inbox or knock out some other administrative tasks during their shift.
Conclusion:
As telehealth continues to redefine healthcare delivery, medical practices must navigate this digital landscape with finesse. Understanding telehealth CPT codes, adhering to billing rules, implementing a streamlined billing process, considering the benefits and requirements of telehealth, and refining your program based on patient and physician preferences are foundational steps for embracing this digital future. Effective communication of billing information to patients fosters transparency, ensuring a patient-centric approach to high-quality care in the evolving landscape of healthcare. Embrace the possibilities of telehealth to provide accessible, efficient, and patient-friendly healthcare services.
