Become an Annual Subscriber and Get $350 Off + Amazon Gift Card SHOP NOW

5 Measures for Assessing Risk Among Your Telehealth Claims

Share: Share on Facebook Share on Twitter Share on LinkedIn

5 Measures for Assessing Risk Among Your Telehealth Claims

Share: Share on Facebook Share on Twitter Share on LinkedIn
telehealth

Even though you’ve been deeply immersed in the telehealth codes since the pandemic began three years ago, that doesn’t mean you’re coding and billing correctly. In fact, a recent audit showed that every single telehealth claim the government reviewed had errors on it. To avoid the most common issues that the government sees, it’s a good idea to have a checklist you can consult at your practice to assess your telehealth risk—and this is especially true as the pandemic winds down and some payers halt their relaxed telehealth rules.

Train your staff on these five telehealth risk areas so you can report these services compliantly and avoid scrutiny.

1. Frequently Billing Telehealth With Facility Fees

If you report a telehealth service in the facility, that’s not necessarily an issue. But if you bill for a telehealth service along with facility fees for the majority of your patients, that could raise a red flag. It doesn’t necessarily mean you’re doing anything improper, but it’s sure to catch auditors’ eyes. If you bill telehealth and facility fees together frequently, take a look at the documentation to ensure that both are warranted so you could easily answer questions about it if audited.

2. Always Billing the Highest Level of Care

Some practices see very sick patients, and therefore bill at high levels for every patient, even those that you see over telehealth. If your documentation can back that up and you can demonstrate that every patient needed a lot of time or had a high level of medical decision making, then you may have nothing to worry about. But it’s important to know if you fall into this category so you can be ready to explain why all your telehealth visits are billed at high levels of care.

3. Billing Telehealth for Most Beneficiaries

If your practice is in a rural area or sees a lot of patients who are immobile, it’s understandable that the vast majority of your visits take place over telehealth. But in other cases, payers may wonder why you aren’t seeing many patients in person. As with any risk factor, this doesn’t mean you’re necessarily doing anything wrong, but you do want to make sure you’re billing and coding compliantly if you do report a lot of visits as telehealth.

4. Billing Telehealth and Ordering Medical Equipment for Many Patients

The government has been conducting quite a few sting operations and charging numerous practices for situations when the provider doesn’t even see the patient, but orders expensive medical equipment for them, which they may not even need. One red flag that such a type of operation may be taking place is when the provider bills a high number of telehealth visits that are followed by orders for expensive medical equipment.

5. Reporting More Hours of Telehealth Daily Than the Doctor Practices

Suppose your physician reports time-based E/M codes via telehealth. There’s certainly nothing wrong with that—unless the time spent totals more time than they could actually be in the office. If an auditor sees that the provider is reporting claims totaling more time that the doctor works (or in some cases, more hours than are even in one day), that could be a red flag. Of course, there may be legitimate reasons for this (for instance, a mid-level provider is billing incident-to under the doctor’s NPI). But be ready to justify and explain the situation if your practice falls into this category.

Now that you’ve got the tools to understand risk, don’t stop there! Get to know how to halt all of the telehealth billing and coding errors that plague practices. Expert Kim Huey, MJ, CHC, CPC will show you during her one-hour training event, Stop 2023 Telehealth Billing & Coding Errors to Keep Cash Flowing. Register today!


Subscribe to Healthcare Practice Advisor
Get actionable advice to help improve your practice’s reimbursement, compliance, and success in this weekly eNewsletter.
  • Hidden
  • Hidden
  • Hidden
  • Hidden
  • Hidden