Overview

Do you know OEI has reported that during the COVID-19 pandemic, over 28 million Medicare beneficiaries and a staggering 88 times more individuals have turned to telehealth services? As the demand for remote healthcare services continues to rise, it’s evident that telehealth has become a vital lifeline for millions across the nation. But the mysterious question here is that when, during the first year of the COVID-19 pandemic. A huge number of beneficiaries used the benefits of telehealth services, then why did providers face a massive number of denied claims?Why are telehealth providers still facing lower payment postings and denials than onsite providers?

The reason is “incorrect medical billing,” which is full of coding errors and does not follow CMS-updated CPT codes. Providers don’t employ professional medical billers and coders. Who stay updated about all the regulations by CMS and payers on telehealth. This results in rejections, denied claims, and low payment postings.

Let’s encounter the challenges that healthcare providers face with telehealth medical billing and propose their solutions;

Millions Are Embracing Telehealth, But Are You Losing Revenue? Learn Why!

Telehealth billing involves a unique set of codes, modifiers, and regulations compared to traditional in-person visits. Mistakes in this area can lead to a silent thief, which is claim denials and delayed payments. These errors can cost your practice significant revenue and leave you wondering where things went wrong. Here are some common telehealth billing pitfalls that can trip you up:

• Incorrect Diagnosis Codes: It’s critical to use the correct diagnosis codes for telehealth billing, as those codes are frequently updated. Failing to keep up with the latest ICD-10 revisions can eventually lead to problems in communicating with insurance corporations, probably leading to claim denials. Selecting the incorrect code for a telehealth appointment can create troubles inside the procedure, inflicting lost claims, wasted time on appeals, and delays in getting reimbursed.

• Procedure Code Errors: According to professional telehealth medical billers, one of the biggest pitfalls is code mismatches between the service provided and what’s billed. Unlike traditional in-person visits, telehealth encounters can involve modified service delivery. Billing with the wrong code can trigger rejections, leaving both you and the patient frustrated.
  
  Telehealth CPT codes often have stricter requirements compared to in-person equivalents. For example, an in-person “new patient level 4 E/M visit” code might not be suitable for a telehealth consultation focused on a specific follow-up issue. 
  
  Telehealth codes may emphasize the type of communication (e.g., audio-only, video), the duration of the encounter, and the complexity of medical decision-making involved.
  
  Further, telehealth codes are constantly being updated as the service model matures. New codes may emerge to reflect advancements in technology or address specific telehealth scenarios. Staying on top of these changes is vital. Outdated codes or misinterpretations of new ones can lead to rejections and lost revenue.

• Missing Information/Incomplete Claim Forms: Incomplete claim forms with missing patient demographics or provider details might be denied due to processing errors. Just like with any medical encounter, complete and accurate patient information is crucial with telehealth medical billing. It requires a keen eye to double-check everything, from name and date of birth to insurance details, as a single typo can trigger processing errors and delays.
  
  It is also important to ensure all provider details, including the NPI number and specialty, are present and accurate on the claim form. This verifies who delivered the telehealth service and ensures proper reimbursement.

• Incorrect Place of Service Code: Telehealth medical billing relies on specific Place of Service codes to indicate where the service was delivered. One of the most common mistakes we see is confusion around these codes:
  
  1. POS 10 Trap: Using an in-person POS code (e.g., POS 10) for a telehealth encounter is a guaranteed rejection. Telehealth services require specific codes like POS 11 (outpatient telehealth) or POS 12 (professional service telehealth) to signal the service wasn’t delivered in a traditional healthcare facility.
  
  2. POS 11 vs. 12 Mismatch: Even within telehealth codes, there can be confusion. POS 11 is for outpatient telehealth services, while POS 12 is for professional services provided in a non-facility setting (like a physician’s home office). Choosing the wrong code, even within the telehealth category, can lead to denials.
  Using the wrong code for telehealth visits compared to in-person encounters can cause issues.

• Modifier 95 Misplacement: One of the most prone areas to errors is a misplacement of Modifier 95. While this modifier is essential for identifying telehealth services on a claim, using it incorrectly with specific Place of Service Codes can lead to frustrating denials.

• POS Code Harmony: Modifier 95 is typically used with POS codes designated for in-patient settings (e.g., POS 2) during the COVID-19 Public Health Emergency (PHE). However, for most standard telehealth encounters that occur outside a facility (like a patient’s home or a doctor’s home office), Modifier 95 might not be necessary. These encounters should rely solely on the appropriate telehealth POS code (e.g., POS 11 for outpatient telehealth).

• Double Duty Denial: Using Modifier 95 along with a POS code like POS 2 and 10 is redundant and can trigger denials. Payers see this as a billing error, potentially leading to claim rejections and delays in reimbursement.

• Unawareness of SOAP Note Requirements: Unlike traditional in-person visits, where a physical exam might be documented, telehealth encounters rely heavily on a detailed SOAP note for accurate coding and claim processing. SOAP notes are the roadmap for selecting the most appropriate CPT code.
  
  Without thorough documentation of the telehealth encounter, including the level of service provided (e.g., history review, assessment, MDM complexity), it’s difficult for billers to choose the most accurate code. This can lead to under-coding (missing reimbursable services) or over-coding (claim denials due to unsupported services).
  
  These errors can result in a frustrating cycle of denials, appeals, and lost revenue. But there’s a solution: partnering with professional medical billers and coders can help you reap all the benefits of telehealth services.

Don’t Let Denials Dim Your Telehealth Success: Reap the Benefits of Telehealth Medical Billing!

Imagine a team trained in telehealth billing dedicated to ensuring your telehealth claims are accurate, complete, and processed easily. That’s the strength of professional certified billers and coders. They act as your telehealth billing saviors, safeguarding your revenue and maximizing your financial gains.

Here’s how these experts can make a world of difference and help you acquire all the benefits of telehealth services:

• Accurate Coding for Telehealth Encounters: Professional billers meticulously analyze your SOAP notes to understand the service provided and select the most precise diagnosis and procedure codes specific to telehealth encounters. This practice ensures the correct reimbursement for the services rendered.

• Staying Current on Regulations: One of the most essential benefits of telehealth clinical billings is that these specialists stay up to date at the guidelines. They stay updated on coding pointers and policies, ensuring your claims adhere to all necessities.

• Minimizing Claim Denials: Modifier assignment and coding errors are very common reasons for denials in telehealth medical billing. Here, the benefits of telehealth billing professionals become double. Their expertise helps prevent errors in coding, missing information, and improper place of service or modifier usage, significantly reducing claim denials.

• Complete and Accurate Information: Specialized telehealth billers ensure all essential details are present on your claim form, including patient demographics, provider information, and any required supporting documentation from the SOAP note. The benefits of telehealth medical billing lie in the fact that, despite the services provided being remote, they make sure all the SOAP notes are applied properly.

• Understanding Telehealth Specifics: They recognize the unique aspects of telehealth billing, ensuring the correct place of service code (e.g., POS 11 for outpatient telehealth) and appropriate use of modifier 95 are applied to your claims. When it comes to telehealth services, healthcare providers often face low payments or denials due to errors in the placement of modifier 95. However, professionals can help you achieve the full benefits of telehealth services with their expertise in modifier placements.

• SOAP Note Scrutiny: Billers examine your SOAP notes to verify they comprehensively document the telehealth encounter. If information is missing, they promptly communicate with you to ensure a complete picture for accurate billing. This practice can save denials and the struggle to submit denied claims.

Get Reimbursed Faster & Easier with Transcure’s Telehealth Billing Services!

Professional billers and coders like those at Transcure go beyond just preventing errors. They become your trusted partners in resolving the complexities of telehealth billing. Here’s how they can elevate your practice with the benefits of telehealth billing services:

• Accurate Coding: Transcure has medical billers and coders who are experts at telehealth medical billing. They stay on top of the latest telehealth CPT codes and their specific requirements, ensuring your services are billed with pinpoint accuracy. No more under-coding valuable consultations or over-coding that triggers red flags because our experts help you get all the benefits of telehealth services.

• SOAP Notes Efficiency: Incomplete or missing SOAP notes can derail a claim. Our team acts as your information vigilantes, ensuring all telehealth encounters are thoroughly documented. They understand the level of detail needed (history review, assessment complexity, virtual exam details, if applicable) for accurate coding and enhanced reimbursement for each service delivered.

• Accurate POS and Modifier 95 Placement: Telehealth billing depends on using the correct Place of Service codes and modifiers. Transcure’s experts prevent common errors like using in-person POS codes or redundant modifiers with telehealth-specific codes like Modifier 95. This meticulous approach reduces claim denials and keeps your revenue flowing smoothly. We have a track record of not receiving a single audit request during COVID-19 from any insurance company, especially for telehealth.

• Open Communication: We establish open communication channels with you to answer questions, address concerns, and work together to achieve accurate telehealth coding and documentation for successful claims submission.

• Educational Emails & Newsletters: Our billers share informative resources, such as emails or newsletters, to keep you updated on telehealth coding guidelines, modifier usage, and the importance of detailed SOAP notes. This active approach helps you ensure denial-free reimbursements.

What to Expect When You Choose Transcure for Your Telehealth Medical Billing?

The benefits of  partnering with Transcure’s telehealth billing specialists extend beyond error-free claims, as you get:

• Boosted Revenue by 20%: We ensure reduced claim denials and faster reimbursements, which translate to a significant increase in your bottom line.

• Smooth Cash Flow: We make sure to make timely bills so you can gain a constant cash flow to aid your practice’s growth.

• Focus on Patient Care: By delegating the complexities of billing to our experts, you can free up your valuable time to focus on what matters most – providing excellent patient care via telehealth.

• Peace of Mind: Rest assured that our experienced professionals, who have a deep understanding of SOAP notes, coding, and telehealth-specific modifiers, will handle your billing. This will allow you to practice with confidence.

• Technology Solutions: Our medical billing company often utilizes advanced technology solutions like Electronic Health Records (EHR) and claim scrubbing software. These tools simplify the billing process, minimize manual errors, and further reduce the risk of denials.

• Focus on Your Expertise: By outsourcing your billing to our experts, you can focus on your core competency – providing high-quality healthcare services to your patients.

• A Team You Can Trust:
  i. Over 1100 Certified Billers and Coders: Our massive team ensures you have dedicated professionals with the experience to handle your telehealth billing needs.
  ii. EHR Proficiency Across 32+ Systems: No matter your EHR platform, Transcure’s team is proficient and ready to hit the ground running.
  iii. Specialization in 32+ Medical Specialties: We understand the nuances of coding across various specialties; that’s why we ensure accurate representation of your telehealth services.

• Proven Results:
  i. $500 Million+ in Processed Claims
  ii. 98% First-Pass Clean Claims Rate with Telehealth Medical Billing
  iii. 24-Day Average Accounts Receivable
  iv. 48-Hour Payment Turnaround

• Long-Term Success:
  i. High 99% Customer Retention Rate
  ii. 5-10% Revenue Improvement

Transcure empowers you to reap the full benefits of telehealth services for providers. It allows you to focus on delivering exceptional patient care while increasing your revenue and achieving long-term success.

Conclusion

Telehealth offers a goldmine of advantages, but complex billing can bury your practice’s profits. Avoid common pitfalls and maximize the advantages of telehealth by partnering with professional billing experts. Our expertise ensures accurate coding and smooth claim processing, freeing you to focus on delivering exceptional telehealth care. Transcure assist you to reap the full benefits of telehealth, which include increased revenue, expert billing, and the ability to prioritize patient well-being.

Frequently Asked Questions (FAQ)