Publication Year: 2020
Last Updated: 2020-02-19 13:15:25
Keywords: telehealth, billing, coding, policy, medicare, medicaid, federally qualified health centers, HRSA
The Center for Connected Health Policy has released a new guide for successfully setting up and maintaining billing for telehealth services. The guide covers fee-for-service Medicare and Medicaid billing for live-video, store-and-forward, econsult, remote monitoring and mobile forms of telehealth.
Among the most frequent questions raised regarding telehealth is how an encounter is billed. According to the American Hospital Association, “76 percent of U.S. hospitals connect with patients and consulting practitioners at a distance through the use of video and other technology.”1 It is not surprising then that the question of billing is the foremost question heard by telehealth resource centers, followed by, “will I get paid?” Further complicating the situation is that reimbursement policies vary from payer to payer. For example policies that apply to a Medicare beneficiary are different than those that apply to a Medicaid enrollee. Other common questions include: What are contracted rates with payers for in-clinic services and what are the state regulations? What are the plan terms? What, if any, financial obligations does the patient have? Plan terms may vary from plan-to-plan located in the same regions. How much you are paid depends on whom you bill for telehealth services and what services you provide.
Payment is not guaranteed for any type of visit, whether due to frequency limitations, diagnosis code or what the plan covers: is it an ambulatory clinic encounter, a surgery or an inpatient stay? Whatever the situation, this guide provides a starting point on how to bill a telehealth encounter for eligible practitioners in your practice or your facility. The focus of this guide will be primarily on fee-for-service Medicare and an example of one Medicaid program, California, highlighted in the blue MediCal boxes. (For more detailed information on California billing, please visit the California Telehealth Resource Center’s website at caltrc.org.) Most of the descriptions and definitions are from the Centers for Medicare and Medicaid Services (CMS). Managed care plans, private payers and employer-based plans generally follow these rules though not every time, so always check with the plan. This resource is only provided as a guide and should not be considered legal advice.