The truth is – it’s complicated!
Although telemedicine has been around for over 20 years, there is a true knowledge base and expertise needed for accurate billing and successful reimbursement. For most, understanding the terms and components of billing is an exhausting process that few have mastered. Many will say, it has been a journey of trying to fit a square peg into a round hole.
On top of that, there are ever-changing federal, local, state and medical board laws, regulations and requirements to consider. Self-pay, managed care, private insurance, and government plans are just some of the issues that leave providers overwhelmed. And, just when healthcare facilities have begun to master the terms and conditions, there is licensing, credentialing and privileging to also consider.
How does anyone conquer this?
This is not a one-person job, but a lengthy and grueling (at best!) well-orchestrated, collaborative process!
Telemedicine billing is similar to healthcare billing. It uses the same codes and processes, but there are nuances that require new electronic billing procedures.. To be successful, you must embed the rules and process into the Electronic Health Record (EHR) and constantly monitor performance, just as you do today with standard billing. Mastery comes with learning, and by dedicating time, resources and effort to this process.
Here are a few rules to follow for successful telemedicine reimbursement:
First, create a team of subject matter experts (SMEs) within the organization. This includes:
- A telehealth lead / project manager
- Legal experts for federal, state, and local, regulatory and consent reviews
- Medical office staff for licensing, credentialing, privileging and malpractice insurance,
- EHR application specialists
- Clinical documentation (clinician/provider note requirements, telemedicine templates)
- Scheduling (visit types),
- Billing (charge master, manual versus automated)
- Patient portal (self pay, insurance verification)
- Patient registration (telehealth consent)
- Government and managed care plan representatives (rules, contracts, reporting and trending)
Once all these SMEs are all in place, you should establish a charter to outline member expectations and establish a regular meeting cadence.
Second, educate your team about telemedicine and the impact that is has on their area of expertise. Start by providing an overview of telemedicine. Create a collaboration space or central repository for documents and resource sharing. Provide a legal overview of federal and state regulations for the area of services to detail current credentialing, privileging and licensing practices.
Ensure the group understands key telemedicine billing concepts such as:
- Originating site (patient)
- Distant site (provider)
- Facility fee
- Medically underserved areas (MUAs)
- Health professional shortage areas (HPSAs)
- GT modifiers
Collaboration between SMEs is the key that speeds the learning process and the impact that each area has on the other.
Third, test and validate the EHR build. Realize that this will take time and that it does not happen quickly. Start small, and then grow in size and depth across services to validate the the build within the actual clinical/patient workflow.
In the beginning, follow each patient visit to ensure you capture all data. Monitor billing and reimbursements for reporting purposes, but also be sure to identify trends across patient populations and coverage plans. This is data that you can use to re-negotiate managed care plans, network coverage, and so on
Finally, while telemedicine billing is complicated, dedication and diligence to building a seamless process will lead to a solid, repeatable procedure going forward.
The impossible becomes truly possible as telemedicine becomes an everyday way to deliver health care. No longer is telemedicine a square peg. Its edges have been rounded, and it fits seamlessly into a round hole.