Telemedicine Billing: What every Physician should know?

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Telemedicine Billing What every Physician
should know?
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Telemedicine Billing What every Physician should
know?
Physicians decreasing revenue and patient volume
is negatively impacting most practices in the
country. Physicians need innovation in practice
to fulfill their revenue demands, and one of the
ways would be technology. Though the initial cost
of investment varies from specialty to specialty
and patient diagnosis, this gives the opportunity
to the physicians to explore the avenue of
increasing revenue. Telemedicine was initially
created to reach remote patients, and it was
mostly focused on primary healthcare stage. As
the technology improved, the remote patients were
given better healthcare facilities using
telemedicine leading to the concept of a
convenient healthcare system. Telemedicine even
gave physicians a chance to provide a 24/7
facility of healthcare without overburdening.
Telemedicine gives healthcare providers an edge
in the competitive landscape while maintaining a
healthy bottom line. CMS, with a new pandemic
situation, is making telemedicine affordable to
each of American citizen. It has expanded the
benefits on a temporary and emergency basis under
the 1135 waiver authority. Using the new wavier,
Medicare will be allowed to pay for practice,
hospital, and other visits via telehealth across
the country. It will include the range of
providers such as doctors, nurses, medical
practitioners, clinical physiologists, and
licensed clinical social worker all can use the
new wavier to get paid for telemedicine. In the
earlier cases, Medicare could only pay for
telemedicine when the patient seeking the
healthcare facility resided in a rural area and
then they visits the clinic or hospital for
medical facility of the service.
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Telemedicine Billing What every Physician should
know?

• Federal authorities have largely looked at
  telemedicine as used by remote patients, over the
  years it has changed with need for access to
  virtual care. In 2019, Medicare understood the
  need for virtual health checks that didnt demand
  in-person checks and started to pay for it. Even
  for online patient portal Medicare Part B paid
  clinicians for E-visits that are
  non-face-to-face. Medicare even specified that
  patients could receive specific services through
  telemedicine, including various evaluation and
  management visits, preventative health
  screenings, and mental health counseling.
• Types of Virtual Services defined by CMS
• Virtual Check-Ins
• In all the areas, Medicare patients may have
  communication with providers using various
  communication devices. The definition of
  communication devices is kept broader with the
  use of synchronous communication devices and
  exchange of information using video or image.
  Patients must be first to initiate the virtual
  service by sending in the requirement, however,
  the provider must educate the patients about the
  availability of the service.
• Medicare will pay for virtual check-in only under
  certain condition
• Existing or established relationship with the
  practitioner.
• The communication between patient and
  practitioner should not be related to any medical
  visit for the last 7 days and should not lead to
  a medical visit in the next 24 hours.

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Telemedicine Billing What every Physician should
know?

• Patient consent is required verbally for virtual
  check-in services. Medicare coinsurance and
  deductible will be applicable for virtual
  check-ins.
• E-visits
• Patients are given an option to initiate a
  non-face-to-face communication with any doctor by
  using the patients portal. The practitioner can
  only bill in such a case when they have
  established a relation with the patient. For this
  E-visits billing, the patient must generate an
  inquiry, and communication must occur over the
  course of the next 7 days. The patient is
  required to provide verbal consent for the
  service. Medicare coinsurance and deductible
  would be applicable for all the e-visits billing.
• Medicare Part B pays for e-visits or
  patient-initiated online evaluation and
  management conducted using the patient portal.
  Practitioners will be able to independently bill
  for such e-visits using
• 99421 For established patient, Online digital
  evaluation and management service, up to 7 days
  and time period 5 to 10 minutes.
• 99422 For established patient, Online digital
  evaluation and management service, up to 7 days
  and time period 11 to 20 minutes.
• 99422 For established patient, Online digital
  evaluation and management service, up to 7 days
  and time period 21 or more minutes.

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Telemedicine Billing What every Physician should
know?

• Clinicians who are not able to bill independently
  for evaluation and management visit can even
  provide the facility of e-visits and bill based
  on the below codes
• G2061 Healthcare professionals who are
  non-qualified physicians, for established
  patients, for up to seven days with time period 5
  to 10 minutes.
• G2062 Healthcare professionals who are
  non-qualified physicians, for established
  patients, for up to seven days with time period
  11 to 20 minutes.
• G2063 Healthcare professionals who are
  non-qualified physicians, for established
  patients, for up to seven days with time period
  21 or more minutes.
• Medicare telehealth visits
• This is developed keeping in mind the current
  pandemic situation for patients to avoid
  unnecessary travel to practitioners facility or
  physician clinic where they might be exposed to
  risks. According to the Department of Health and
  Human Services (HHS) requires the patient to have
  a relationship with the practitioner, HHS
  mentions that it will avoid the conduct audits
  for such medical bills during public health
  emergency.
• Medicare telehealth visits are based on state
  laws where the practitioners can be physicians,
  nurse practitioners, nurse midwives, certified
  nurses, clinical social workers, registered
  dietitians and nutrition professionals.

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Telemedicine Billing What every Physician should
know?
Telemedicine can be regarded as a gateway for
practitioners to target patients across the
country, though regulations are curbing the
growth. Telemedicine is where the future will be
held, with technology already disrupting the
healthcare system. Physicians can provide a
telemedicine option to their patients, and even
educate them about its benefits. Telemedicine
can be co-pay, hence prior authorization will
assist you in reducing deductibles. Legion
Healthcare Solutions (LHS) has a team of billing
experts who work with payers and patients before
scheduling a telemedicine appointment. Using LHS
API-led technology, providers can share info with
patients across various channels with HIPAA
compliance. LHS believes in providing a
world-class patient care in comparison of medical
billing hence our technology experts regularly
update on various medical fronts. To get a
medical billing quote for a telemedicine claim,
please contact us.
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