How doctors can leverage telehealth to help their patients and their practices

While most insurance plans now accommodate telehealth, you should still know how to bill it properly to avoid unpaid claims.

In light of the COVID-19 pandemic, providers must be even more creative and resourceful when helping their patients. Telehealth represents a prime opportunity for physicians to do just this. Through telehealth, doctors can treat patients through synchronous audio-video telecommunications systems carried out from separate locations.

Telehealth usage has risen sharply during the pandemic and is unlikely to go away after it ends. Our 2021 Patient Perspective Survey found that roughly half of all patients participated in telehealth during 2020, increasing satisfaction levels as more people experience a virtual visit. Therefore, your practice should consider incorporating telehealth into your patient care plans if you haven’t already. Here is how to best implement telehealth to satisfy patient needs and further grow your practice.

Determine how to incorporate telehealth into your practice

The U.S. Centers for Medicare & Medicaid Services (CMS), which governs Medicare policies and influences commercial plan protocols, has overhauled many pre-pandemic restrictions to make telehealth more attractive to patients and providers. Under revised CMS guidelines, practitioners can now bill for telehealth and be reimbursed as they would for an in-person visit. Eligible visit types include initial patient visits, ongoing healthcare management, and therapeutic procedures, including therapeutic exercise, neuromuscular reeducation, gait training, and ADL instruction.

Just because the CMS proposes new codes does not mean that Medicare is necessarily bound to all of them when reviewing and paying out claims in day-to-day practice.Supplemental or secondary insurance typically kicks in to cover what Medicare does not.However, CMS guidance often serves as an influential springboard for commercial healthcare insurance carriers to build off the CMS’s suggestions and cover more robust treatment options in their policies. Your practice's strategies for leveraging telehealth will depend on your specialty, patients, and your patient's insurance carrier policies. Collecting patient feedback — in person and via patient surveys — can help guide your practice toward the best ways to implement telehealth technology at your practice.

How to bill for telehealth

Physicians have to be careful when billing for telehealth services, as not all codes addressing electronically administered care can be sufficiently specific to the format of visits that take place via technology. . Codes 99441-99443, for example, cover telephone calls only.

Conducting telehealth visits with your patients is similar to holding live patient-provider meetings, albeit through encrypted, synchronous video-audio connections. Therefore, doctors can bill out telehealth as E&M or therapy treatment.

While you should always consult the updated CMS guides and commercial carrier telehealth policies for detailed information, you can consider the following options when billing for telehealth services:

  • If you are billing out an E&M visit, use codes 99202-99205 for new patients and 99212-99215 for established patients, along with POS 2 and modifier 95.
    The E&M code you use will depend on the duration of the treatment, the severity of the injury, and the complexity of the medical decision-making involved. Regardless, you will need to use place of service (POS) code 2 to indicate you are using telehealth, along with modifier 95 to show you conducted the treatment in real-time using a synchronous audio-video system. While using modifier 95 is optional when billing E&M visits, you should include it nonetheless due to varying carrier billing requirements.
  • If you are billing for telehealth-based therapy treatment, use the telehealth billing code appropriate for that therapy along with POS 11 and modifier 95.
    When billing for therapy treatment, your place of service code will need to reflect where the patient’s therapy would usually take place if held in person. Therefore, you will likely use POS 11 as it encompasses in-office treatments. Although modifier 95 is optional with E&M, carriers require this modifier with therapy entries.
  • If a carrier you bill does not acknowledge modifier 95, use modifier GT instead. While uncommon, some commercial insurers may reject claims using modifier 95. If this is the case, use modifier GT instead to indicate you used interactive audio and video telecommunications to administer care.

Not all video- or audio-based treatments qualify for telehealth reimbursement. For example, insurers will not reimburse pre-taped videos and training programs since they do not involve interactive, synchronous two-way video and audio communication. Additionally, telehealth visits are subject to identical information and time recordkeeping requirements, utilization management policies, payment audit programs, and medical necessity requirements for face-to-face treatment.

How to optimize your practice for telehealth

While the HHS Office of Civil Rights’ (OCR) temporary telehealth guidelines are relatively open regarding the types of video-audio communication tools doctors can use, this will likely not be the case for post-pandemic requirements. To ensure utmost HIPAA compliance and security, physicians should work with HIPAA-compliant telehealth providers that can enter into HIPAA business associate agreements (BAAs). They should also carefully consider the technical capabilities of the video-audio platforms they choose. At a minimum, your telehealth platform should support the following:

  • HD two-way video communication for optimal picture quality and clear diagnosis of symptoms
  • Patient digital registration capabilities that allow for seamless and secure intake processes
  • Integrations with your existing practice management software for secure payments, document uploads, patient scheduling, and appointment reminders

From there, your practice must market and integrate your telehealth technology into your day-to-day services. Dedicated informational website pages, FAQ sections, blog posts, and email blasts can all help promote and define your telehealth services to patients and potential referral sources. Finally, as you determine the best ways to integrate the technology into your care plans, be sure to consult with other doctors and staff at your practice.

Travis Schneider, Co-Founder and Co-CEO of PatientPop, the industry’s most complete all-in-one practice growth platform is known for his revenue growth strategies and visionary leadership.