The Rapid Rise of Telehealth in Healthcare
Virtual care adoption dramatically accelerated during the coronavirus pandemic:
- Telehealth claim lines grew by over 4,000% nationally from 2019 to 2020.
- Telehealth visits as a percentage of medical claims jumped from 0.1% pre-pandemic to 4.1% in April 2020.
- Nearly half of all Medicare primary care visits were provided through telehealth in April 2020 compared to just 0.1% pre-COVID.
- Over 85% of consumers are interested in using telehealth going forward according to surveys.
While initially driven by necessity during lockdowns, telehealth has shown tremendous potential to improve access and convenience for patients while giving practices operational flexibility. Telehealth is projected to keep growing as a vital delivery model integrated into care workflows.
New Telehealth Services Expanding Virtual Care
Patient and provider comfort with virtual visits is setting the stage for expansion into more sophisticated telehealth services:
- Telemental Health – Virtual therapy and psychiatric services / telehealth and behavioral health are gaining traction given chronic mental healthcare shortages. Video visits enable access.
- Remote Patient Monitoring (RPM) – RPM involves using internet-connected devices to continuously track patient vitals and symptoms outside the clinic. Data integrates into EHRs to inform care.
- Wearable Integration – Similarly, data from patient wearable devices like smartwatches will increasingly integrate into virtual care.
- Digital Therapeutics – Mobile medical apps focused on managing conditions like diabetes or meditation support are emerging as telehealth-linked offerings.
- Chronic Care Management – Ongoing remote care coordination for chronic conditions via video/audio, home visits, and monitoring.
- RPM for Clinical Trials – RPM enables decentralized clinical trials, with patients using connected devices and apps to submit health data virtually to trial sponsors.
As telehealth branches into more complex services like remote monitoring, apps, and care coordination, new documentation, coding, and billing nuances arise.
Impacts on Telehealth Medical Billing and Coding
As virtual offerings diversify, telehealth billing and coding is becoming more intricate:
Evolving Place of Service (POS) Codes
Correct POS codes indicating where service occurred are vital for telehealth claims. Expanded services require additional POS codes like:
- 02 for telemental health provided to patients at home
- 10 for telehealth RPM data collected in patient homes
- 11 for digital apps furnished remotely
Service-Specific Procedure Codes
Each telehealth service has specific CPT codes practices must assign accurately:
- 90832 for outpatient psychotherapy e-visit
- 90846, 90847 for complex psychiatric telehealth services
- 99453 for remote monitoring service initial set up
- 99454 for remote monitoring device(s) supply with daily recordings/programing
Coding for Hybrid Visits
For hybrid telehealth visits involving both in-person and virtual portions, select coding to capture both components like:
- 99201 office visit + GT modifier for telehealth portion
- 82947 glucose blood test + 95 modifier for remote glucose monitor data
Payer Policies Around New Services
Expanding telehealth options necessitates checking payer coverage and restrictions based on:
- Types of virtual services covered
- Originating site limitations
- Reimbursement rates set for telehealth services
- Any prior authorization requirements
Documenting Medical Necessity for Telehealth
Medical necessity documentation is key for telehealth claims reimbursement. Factors to capture in notes include:
- Why virtual visit was medically necessary/appropriate instead of in-person
- How quality of the visit was comparable to an on-site visit
- Any supplemental medical data gathered through remote devices
- Why additional telehealth components like remote monitoring improved outcomes
Robust clinical details justify the need for telehealth services specifically.
Strategies for Optimizing Telehealth Billing
As telehealth services and codes grow more varied, steps for accurate billing include:
- Regularly update the telehealth services cheat sheet and internal coding guidelines as new options are added
- Train scheduling teams on capturing the appropriate POS codes for documentation and ordering
- Integrate EHR documentation tools and templates to prompt physicians on pertinent details to capture in notes depending on type of virtual service
- Configure software to detect hybrid visits and auto-apply the right combination of telehealth and in-person codes
- Activate claim audits and rules engines in billing systems to catch common telehealth coding errors before claim submission
- Validate payer coverage and payment parity for new telehealth service lines before delivering them
- Monitor early telehealth claims data and denials carefully to identify problem areas and optimize workflows
Constant vigilance and adaptation will be necessary to keep telehealth billing running smoothly as services expand.
Utilizing Tools to Tackle Telehealth Billing Complexity
Advanced solutions to streamline intricate telehealth billing include:
- Natural language processing to extract clinically relevant data from unstructured visit notes to assign accurate codes
- Real-time claim scrubbing to catch improper POS codes, modifiers or lack of supporting documentation before submission
- Automated workflows to determine optimal coding combinations for hybrid in-person and virtual care encounters
- Analytics evaluating telehealth utilization patterns, denials, reimbursement rates and documentation gaps to enhance workflows
- Integrated EHR and billing systems to seamlessly share coded telehealth visit data for accurate claiming
- Patient eligibility checking against payer policies for automated telehealth visit pre-authorization
- Financial counseling apps to provide estimates for out-of-pocket costs across mixed service visits
Specialized telehealth coding support and claim auditing technology will be critical as billing complexity rises.
Preparing for Evolving Telehealth Billing Compliance Needs
Telehealth growth also introduces new compliance considerations and risks:
Staying Current on Regulations
- Monitoring federal and state policy changes regarding telehealth coverage and payments to avoid outdated claim submission.
Documenting Rigorously
- Ensuring complete medical necessity and visit details are captured to justify telehealth-specific codes for payer requirements.
Assigning Correct Coding
- Preventing common mistakes like incorrect POS codes, uncertified practitioners providing telehealth, upcoding levels of service without documentation etc.
Obtaining Consents
- Having clear patient consent to provide and bill for telehealth services like remote monitoring and data transmission from devices.
Protecting Data Security
- Following cybersecurity best practices as more patient data is transmitted and accessed virtually.
Telehealth-specific compliance will necessitate adjustments as services diversify.
Summary
The meteoric rise of telehealth is ushering in an era of virtual care delivery models integrated with traditional in-person services. While telehealth billing and coding grew simpler during the pandemic, new modalities like remote monitoring and digital mental health apps bring additional complexity.
Keeping billing systems, workflows, documentation tools, and coders constantly updated on the latest telehealth codes, rules, and payer policies is imperative to minimize claim denials and delays as virtual care expands. With meticulous telehealth billing preparation, medical practices can maximize revenues while unlocking the vast potential of telehealth to improve patient access, experience, and outcomes.
