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4 Avoidable Billing Pitfalls of Telehealth


4 Avoidable Billing Pitfalls of Telehealth

The Covid-19 (aka Big 'Rona) shanningans has caused quite the upheaval in the medical billing world and has turned the world of private practice upside down. At this point, the biggest change that has occurred because of the virus is the widespread adoption of telehealth services.


Because of the widespread adoption of telehealth services from the public and private health insurance industries, policies have been put into place very quickly. Any swift change like this is bound to have bumps in the road and potential pitfalls.


The Practice Solutions team wants to look at the trends that we are seeing and provide you with the most up to date information that we are seeing.


In today's episode, Jeremy Zug talks about 4 pitfalls that the Practice Solutions team is seeing and how to avoid those. We want you to continue to get paid for the sessions that you are conducting and these are the biggest barriers to getting paid.






The first pitfall is a failure to put the place of service code 02 on claims that were conducted via an audio-visual platform. The reason why the place of service code 02 is important is that it delineates that the session was a telehealth session.


We are seeing quite a few providers continuing to bill with the place of service code 11, which means that you saw the patient in your office instead of a telehealth session.


The best way to avoid this is to contact your EHR vendor to add this place of service code to your practice or to contact your biller to make sure claims are going out with the correct place of service code.



The second pitfall is a failure to put the correct modifiers on your claims (i.e. 95 or GT). Modifiers in the mental health billing world are a designation of education level or how a session was conducted. Historically, the 95 modifier was used to demonstrate that a session was conducted via phone and the GT modifier was used to show that a session was done via a telehealth platform like doxy.me.


Each insurance company is handling the modifier requirements differently so be sure to know how each insurance company is handling the modifier conversation.



The third pitfall is a lack of communication about the start date of coverage of telehealth visits. Each insurance company is has a customized policy on the start of telehealth coverage and the end of telehealth coverage through this time. It is important to know how each insurance company is handling these critical policy decisions.


One recommendation that we have is to research each and every insurance company that you are in and out of network with to find out their timelines and policies. If you are using a billing company they should be tracking this information pretty thoroughly.



The last pitfall is the ambiguity around patient payments. Right now most insurance companies are saying that they are waiving the cost-share for patients (i.e. copays and deductibles). However, Practice Solutions' billers have not seen the "proof in the pudding", as in we have not seen massive amounts of claims processing this way across the country.


We want to trust what the insurance companies are saying but we want to proceed with cautious optimism. We believe that it is easier to refund patients as opposed to asking for more money. You can collect what your patients owe and then apply any credit to sessions after this situation is over or you can refund your patients if the insurance companies process the claims how we think they will process them.


We are encouraged by the sheer amount of support from insurance companies and states around mental healthcare. We are also very encouraged by the amount of new patient visits that we are seeing now that shelter-in-place has become a more regular reality.


You, the therapist, are truly front-lines heroes and we are so proud to be able to support the deployment of widespread mental health care in this critical time.


Feel free to reach out to our team if you need assistance or consultation with anything billing or credentialing related!


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