Telehealth Billing Made Simple in 3 Steps
At this point it is likely that you are intimately familiar with telehealth billing. The COVID-19 pandemic required that all healthcare professionals become familiar with virtual sessions overnight. However, we still get a high volume of questions that serve to clarify the telehealth billing process. We want to do our best to make this complicated process simpler by providing some best practice tips and tricks for your practice. In this blog we will cover software requirements, billing terminology, and claim submission and follow up tips to help your telehealth claims process as fast as they can.
Telehealth Software Requirements
First and foremost, you will need to research and select a software tool that enables you to conduct sessions virtually. There are a variety of options that you can utilize in your practice, but they are not all the same. Since they are not all the same you will need to do detailed research into each one to find out which one is going to be the best fit for your practice and your team.
This would be a bad time to do quick research and make a fast decision only to change to a different software later on in the life of your practice. As much as you can do to limit the amount of pivots in critical software infrastructure the better.
The other pitfall that would be good to avoid at this juncture in your practice is picking the cheapest and or the newest software system. There is some value in picking a moderately expensive and older software system. The reason why we would recommend prioritizing those software systems is to limit risk in your practice. Sometimes newer and cheaper systems don’t have the compliance capabilities as a larger system or a more expensive system. You will want to be cautious to make sure that you are picking the best system for your practice long-term and that includes security.
Here is a list of telehealth platforms to start your search:
These are some of the more established telehealth platforms that exist in the market. They will likely appear in most of your Google search results and they are trusted sources for compliance software requirements to do telehealth care.
In addition to a software system that will allow you to conduct the actual session, you will need a software system to be able to file and track claim submissions. The system that you use to file and track claim submissions will ultimately be one of the biggest decisions that you make in private practice because your electronic healthcare system will be used throughout your organization and every employee that you hire will touch it. You will want to make sure that you give thought to this decision and make sure you are comfortable with the system that you choose.
Billing Terminology for Telehealth
The next step in simplifying the telehealth billing process is to understand the various billing terminology that you will encounter throughout the insurance industry. The first term that you will want to familiarize yourself with is modifiers. Modifiers are codes that clarify specific situations to the insurance company. Keep in mind that the purpose of a claim in the insurance industry is to lead to payment. This is one of the broadest criticisms of our healthcare system that has been levied against the claims system. Nonetheless you will need to use modifiers in order to communicate a telehealth claim properly to the insurance company. There are a couple different modifiers that insurance companies will use to signify a telehealth session. The first modifier is code 95. The second modifier is GT. You will want your biller to confirm with each insurance that you take which modifier you need to use for your telehealth claims. Some insurance companies require both.
The next term that you will need to familiarize yourself with is the place of service code. It is a code that communicates to the insurance company where the service was held. There are a host of place of service codes. There are codes that communicate inpatient hospital stays, outpatient hospital visits, and home health care visits. The code that you are looking for to bill telehealth is 02. It is important to know which codes the insurance companies require.
The insurance billing industry changes from time to time and with those changes come adaptations in Billing terminology. It is important to stay up-to-date on any relevant changes for the mental health industry. We update our content every week so that you have the most up-to-date terms and changes in the industry.
Claim Submission and Follow-Up
Once you have your software tools in place and are familiar with the Billing terminology, the next step is to submit claims and follow up with the insurance companies. At this point in the process you will have seen a client and entered all the relevant documentation into your software tools and are ready to submit your claim. Once you submit a claim there are a couple things you want to look out for. The first is a rejection report. Most software tools provide what is called an EDI report. This report shows you where the insurance company is at in processing your claim. This report also populates when a claim has been rejected. If your claim has been rejected it is important to address that as quickly as possible. The error on the claim could be something as minor as a name inconsistency or an address listed incorrectly. Whatever the issue is it will be important to address any issues as they come up.
If your claim arrives at the insurance company cleanly, then the claim will process and it will either deny or process. Either way, you will receive either a paper EOB (explanation of benefits) or ERA (electronic remittance advice) demonstrating how the insurance company decided to process the claim.
It is at this point in the process that it will be important to have a professional biller look at the ERA or EOB to determine what to charge the client or appeal the claim based on the decision of the insurance company. A professional will also be able to maintain accurate records in relation to patient payment and the insurance payment.
Telehealth billing is the new normal in regard to the delivery of healthcare services in the world. It is not a trend that can easily be ignored. If you are in private practice and you are starting the process of implementing a telehealth billing process, then we are here to help you! We want to make sure that all the work that goes into billing insurance is done with precision and speed. Feel free to reach out to us if you need help with your billing and we would be happy to walk through the process with you!