Seeing patients virtually has become such a common practices that many healthcare providers and patients prefer it over in-person visits. The best way to keep your reimbursement flowing for these encounters is to ensure that your telehealth billing practices are compliant.
Check out four common telehealth billing mistakes that could derail your pay for these services, along with tips on how to avoid these issues in the future.
1. Multiple Telehealth Visits in a Short Time Period
If you’re reporting telehealth visits several days in a row for the same patient, that could raise a red flag with payers and auditors.
This includes such examples as:
- Providers calling patients as an unplanned follow up within the same week as a telemedicine visit and billing an E/M code for the phone call
- Physicians performing telemedicine visits, then an in-person visit for the same diagnosis immediately thereafter
- Providers calling patients they had not recently seen and who had not requested an appointment to “check up” on them — then billing an E/M code
2. Impossible Hours
When billing E/M services over telehealth using time as the basis or when reporting timed-based procedure codes via telehealth, providers are flagged if they bill for services totaling more than 24 hours in a day. Keep an eye out for any providers at your practice who are reporting excessive services over telehealth that add up to more than the provider could feasibly handle.
There are situations in which telehealth services can be legitimately billed by a single provider in excess of 24 hours per day, such as services being rendered via incident to, but if this isn’t your situation, then take action.
3. Telephone-Only Services With Modifier 25
Not all services can be performed via the telephone, and payers know that. So if you report a phone visit and append modifier 25 to it, along with a procedure code that can only be billed for an in-person visit, you’ve just raised a red flag with payers.
For example, suppose you bill for an excision and a telephone-only E/M code (such as 99441), appending modifier 25 to 99441. The payer would wonder how you performed an excision over the telephone, and would not only deny the services, but would likely audit additional claims.
4. Telehealth Billing for Excess Time
OIG auditors recently examined claims for telehealth care that involved E/M visits with add-on psychotherapy services. The audits discovered clinics billing for more time than was spent with clients for the psychotherapy services, as evidenced by the time recorded in the medical records and by the time stamps in their telemedicine platforms.
To avoid this issue, providers are encouraged to implement processes to ensure that claims for services billed as time-based CPT codes are based on the actual length of services provided.
You can boost your telehealth billing accuracy by documenting and coding correctly every time, thanks to advice from Maya Turner, CPC, CPMA, AAPC-Approved Instructor. During her online training event, Prevent Top Telehealth Billing/Coding Errors to Boost 2024 Pay Up, Maya will share the strategies you must know to optimize your telehealth reimbursement and curb errors. Register today!
Check out our Coding and Billing Playlist on YouTube for the latest expert advice, and subscribe to our YouTube channel for step-by-step guidance!
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