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As Telehealth Expansion Continues, How to Ensure You are Getting the Most from Your Program


Telehealth adoption has skyrocketed this year due to COVID-19 – putting the industry’s growth at a higher rate than anyone could have anticipated at this same time a year ago. In fact, recent reports highlight that April 2020 telehealth claims were up 8,300% over April 2019 claims for those with private insurance (excluding Medicare and Medicaid). Most managed care companies (including the Centers for Medicare and Medicaid Services) have relaxed guidelines to make it easier for people to get the care they need while social distancing – making telehealth reimbursement a reality for many healthcare organizations who hadn’t yet invested in the technology.

While many expected payers to tighten those regulations back up this summer, the opposite trend is underway in several states, and some experts expect others to follow suit in the coming weeks and months.

  • On June 3, 2020 Colorado passed legislation that would require payers to reimburse telehealth the same as for in-person care, extending the guidelines put into place earlier this year due to COVID-19. Furthermore, this bill goes as far as to eliminate the previous stipulation that required patients to have an established relationship with a provider to complete a telehealth visit.
  • On May 27, 2020 Rhode Island lawmakers pushed a bill through that would force payers to permanently cover telemedicine services at the same rate as in-person care. While it’s still up for a Senate vote, if passed, this legislation would expand coverage to audio-only telephone conversations and would extend coverage to virtual care delivered at any location.
  • In late May 2020, Illinois’ House passed a similar bill to extend coverage of telehealth permanently. While lawmakers adjourned before the bill went to a vote with the Senate, the hope is that reimbursement would be permanently maintained at the same rate as in-person services.

Getting the Most from Your Telehealth Program
While not every state has expanded coverage, most acknowledge that the industry will likely continue to do so in the coming months and years. Now that consumers have experienced the convenience of telehealth firsthand, there is no going back. With that said, how can healthcare organizations make the most of their telehealth programs? Here are a few surefire ways to make sure your telehealth documentation and coding are where they need to be.

  1. Time Is Money. For telehealth, keeping track of time spent on each encounter and accurately documenting all of that time is critical. That’s because reimbursement is based on time spent. Time spent before, during, and after the visit – including all parties involved – from the physician and advanced practice providers (APPs), to the clinical staff. Similarly, medical decision-making is crucial. Providers should document all possible, ruled-out, suspected, or alternative diagnosis possibilities so that the risk is clear.
  2. Documentation is (Still) King. Understanding and thoroughly documenting telehealth specific billing codes, place of service codes, and related modifiers are essential to ensure providers receive maximum reimbursement for telehealth services rendered. Not only is revenue recovery dependent on adequate documentation, it’s also critical to adhering to strict compliance rules and regulations. While the changes for coding and documentation requirements seem to be constant, you are likely to continue to see more changes on the horizon – remaining knowledgeable and current on all industry updates is key.
  3. Get Your Coding Up to Code. Because telehealth is relatively new, there is still much to learn about how to effectively and accurately code. Fortunately, telehealth isn’t limited to E/M services, so it’s important to code for remote monitoring, self-care education, and counseling. Doing so will ensure healthcare organizations are paid for all services provided. Working with an outsourced coding partner to conduct routine telehealth coding audits can help ensure you are capturing all the reimbursement available for all services rendered. Additionally, using a sophisticated E/M calculator can ensure you are accurately assigning the right level of service to all telehealth encounters.

GeBBS Healthcare Solutions offers a comprehensive range of telehealth services. With the recent challenges of COVID-19, telehealth has gone from a “somewhere in the future” patient care technology to a now technology and immediate adoption has never been more critical – GeBBS diligently works side-by-side with our large client base and industry experts alike to navigate the associated complexities of telehealth. GeBBS’ leadership and SMEs remain at the forefront of change, by continuously monitoring updates and releases and partnering with leading industry experts to transfer and share our knowledge that ensures our clients remain current and compliant in the everchanging world of healthcare. To learn more, visit www.gebbs.com.

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