COVID-19 is forcing many providers and patients to turn to telemedicine. Before the coronavirus pandemic, patients explored telemedicine as a cost saving measure that facilitated getting minor illnesses treated faster, without the need of commuting and facing traffic snarls or long waits in an ER.
The current situation is getting out of hand, and with added risk factors associated with the infectious spread of coronavirus, both parties, the physicians and patients are fearful of in-person visits, while telemedicine appears to be the most viable option.
1. Filing Accurate Claims In the Absence of an Upfront Admin
Some of the top reasons cited by insurance companies and government payers for claim denials include :
The insurance company does not cover the service
The patient has ceased to be covered under the policy
The provider is out of the network
No pre-authorization available
Incorrect patient details
The reasons for denial are not very difficult to prevent as far as in-person visits are concerned, because a routine practice that is followed by the front office staff includes verifying the information well in advance before the visit of the patient.
This is typically done over the phone, the patients are asked to fill out and review their demographic information and copy new insurance cards. The insurance verification too is done over the phone or on payer websites.
But when you are dealing with telemedicine, the scenario changes, most importantly the pre-verification process which is done during the in-person visits of the patient, has to be sacrificed.
While telemedicine encounters will entail a patient to access the web portal of a provider, and fill out their own information, before consulting a clinician. This may result in typo errors, misinterpretation of information sought or dishonestly misrepresenting information. All of which could lead to denials.
2. Remote Connect with Patients
An in-person visit establishes a semblance of a relationship with patients, with a face-to-face connect or frequent phone interaction in some cases. Any incomplete billing information can be followed up with the patient over the phone by the front office staff. These patients that are likely to be regulars, will be more than willing to cooperate, in order to maintain a relationship in anticipation of accessing the service in the future.
While in the case of telemedicine, with remote resources being used to facilitate traditional healthcare, the providers would be remotely seeing first-time patients, who may never call or access the service again. The reimbursement staff will find it extremely difficult reaching out to these patients, in case of missing information for filing claims
3. Uncertainty of Payer Coverages
Being a new frontier of healthcare, telemedicine reimbursements will prove to be the biggest challenge for healthcare systems. Since very few commercial insurance plans cover telemedicine visits, and Medicaid coverage at the discretion of each state.
Although some telehealth procedure codes are covered by Medicare, billing these services to the Federal payer is extremely complex. Procedure codes have to be accurate, with a GT modifier that indicates the service was virtually provided through interactive video, using the right place of service code. In addition, health systems cannot randomly bill any MAC, it has to be billed to the MAC that covers the providers location, not the business’s location. One of the positives of telemedicine is that health systems can engage provider expertise from around the country, although this would require an effort setting up an appropriate process to facilitate billing from numerous states.
Need help meeting telemedicine billing challenges?
If your health system is finding it difficult to include telehealth services into the reimbursement processes, the expertise of BillingParadise is worth a try. As a proven medical billing company, our knowledge of rules regulating codes and claim submission is always up-to-date and current to ensure that your claims are successfully reimbursed with minimal chances of denial. Give us a call at 1-888-571-9069 to discuss your telemedicine billing needs.
