3 Key Differences in Telehealth Billing vs. In-Office Billing


A telehealth therapy session vs. an in-office session


As the summer wraps up with those last few days of summer vacations coming to an end and school going back in session, many people are starting to think about getting back into the swing of therapy. The holidays are approaching, which can be a difficult time for people, and they are thinking about their normal healthcare routines. However, this year is different! This year is the first year back after the COVID-19 pandemic lockdowns and it seems like each state and educational district has different rules and regulations around in-person and remote schooling.


The disparity between teaching modalities is going to ensure that some clients prefer in-person sessions as opposed to telehealth visits. As clients express their desires for different kinds of treatment modalities, it is going to be important for your practice to keep the rules and regulations of telehealth billing and in-person billing at the front of your mind.


For this blog, we want to make sure to cover 3 big differences between telehealth billing and in-person billing so you can avoid claim denials and capture an opportunity to serve your clients as best as you can.


Place of Service Codes


The first key difference between telehealth billing and in-person billing is the place of service code that you use to submit your claims. During the pandemic, there were different rules and regulations from the insurance companies about how they wanted those claims submitted. Some insurance companies prefer that you insert place of service code 02 indicating telehealth as the location. The normal code that you would use is 11 for in-person sessions.


However, some insurance companies required (and still do) that you use place of service code 11 with a 95 modifier to document telehealth sessions. It is important to understand how each insurance company wants you to document telehealth sessions to ensure compliant claim submission and so claims don’t deny or reject for a preventable reason. The way you would confirm with the insurance company is by calling them, or asking your biller to confirm how they want the claims sent.


Oftentimes, insurance companies publish how they want telehealth claims submitted and how those should be coded. It would be wise to check the online resources first before calling the insurance companies because insurance companies are unusually busy right now, especially as people resume “normal” life.


Documentation


The second key difference between telehealth billing and in-person billing is the documentation needed from the provider on the session. According to multiple insurance company websites and CMS audits and documentation, in-person visits presuppose where the client is and how long the client was at the office. However, telehealth documentation varies a little bit from the normal course of documentation. According to the CMS website, telehealth visit documentation must include some of the following:

  • Date of the visit

  • Whether the visit was real-time audio and video or audio-only

  • The indication that patient consent was obtained (verbal or written)

  • Patient location for the visit (e.g., home)

  • Provider location for the visit (e.g., clinic, provider home)

This is not a comprehensive list, but this list highlights some of the key differences in what needs to be documented.


The reason why this is important for billing purposes is that if the insurance company requests additional information and this documentation is not included in the medical record, the claims could remain denied indefinitely. Our hope would be that your EHR provider is able to provide seamless documentation on these fronts, and we would encourage you to reach out to your EHR provider and inquire about documenting these particulars.


There are times where the insurance company is going to request that you send in additional information for a telehealth visit and it is important that you have all the relevant information to provide in order to get paid as quickly as possible.


Collecting Patient Information


The last difference between telehealth billing and in-person billing is in the process of obtaining client information. . When a client comes into the office, you or your staff have the opportunity to troubleshoot any issues with their information immediately. However, with digital communication, obtaining information and troubleshooting demographic information or insurance information may remain difficult to obtain. The reason why this is a difference for billing is that most billing issues can be prevented by obtaining and entering all patient data accurately into your EHR system.


As a general rule, insurance companies are very picky and unforgiving when it comes to attention to detail around patient information. If even one digit is wrong in the patient record or claims the insurance company will likely reject or deny the claim. Therefore, extending the time that you and your practice are reimbursed for the services that you provided.


Ensuring that you have a system in place to collect all the patient information and run a verification of benefits is crucial before submitting a claim, and the remote-based treatment that people have grown accustomed to can provide an opportunity for missed or inaccurate information. We would recommend that you review your processes and procedures for obtaining patient information to ensure that you are collecting all the information that you need and that your process is translating to a low error rate in claims processing.


We hope that you had a wonderful summer and that you are enjoying getting back into the fall season. We know that transitions can be hard and it is our goal to make sure that you are empowered to focus on patient care while we worry about the billing process. If you have any questions about the difference between telehealth and in-person billing or would like to get rid of billing so that you can focus on clients, please give us a call and we will be happy to talk with you more about your practice’s needs.


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