Telehealth Claim Denial

Claim Denial Telehealth: Check 2 Items Before Refiling

QUESTION: We just received our first denial for a telehealth service using audio-visual. The claim was filed with office visit code 99212, place of service 02 for telehealth and modifier 95. Can you tell us what we did wrong so that we can get paid for these visits? Question from Palatine, Illinois Subscriber ANSWER: Based […]
Medicare Telehealth Reimbursement

Master 4 Conditions to Qualify for Medicare Telehealth Reimbursement

On April 21, 2021, the Department of Health & Human Services (HHS) renewed the Medicare telehealth requirement waivers that were implemented last year during the pandemic. The new expiration date for these relaxed rules is set for the end of July. This means you have a little while longer to take advantage of these telehealth […]

Get Paid for 60 New Telehealth Codes in 2021

After a year of constant updates, the rule changes for telehealth coding have “finally” been finalized in the 2021 Physician Fee Schedule final rule. Keep reading to ensure you’re getting paid for every service—including the newly reimbursable telehealth codes. CMS Adds Services to Telehealth List. Beginning January 1, 2021, the list of services reimbursable when […]
CPT telehealth audits

Ace Telehealth Audits and Keep Your Reimbursements

Important: Your CPT codes 99201-99215 claims are under attack. CMS and private payers started their telehealth exam post-payment audits which include reviewing your records and contacting your patients. Address these telehealth audit targets right now so you can hold onto more of your office visit pay and prevent future compliance penalties. Telehealth Exams Must Include […]
2021 Medicare Physician Fee Schedule Telehealth

2021 CMS Fee Schedule Proposes 5 Telehealth Changes

Your telephone, telehealth exam, and virtual check-in pay could come to a grinding halt unless you’re up to date on the latest potentially upcoming changes to the 2021 Medicare Physician Fee Schedule. Auditors will be checking to see if you tightened your regulations for coding, compliance and more. Prep your practice now on the top […]
Telehealth HIPAA COVID

3 Ways to Avoid Telehealth HIPAA Violations During COVID-19

While HHS gave you a carrot and on the last possible day extended the public health emergency through mid-October, you better use the time to tighten up your telehealth privacy – or you could face expensive HIPAA violation penalties. Telehealth HIPAA COVID. CMS has added telehealth audits to its new work plan, so take it […]
OIG Telehealth Audit

Learn How to Avoid Telehealth Audit Traps

It’s now official: your telehealth services are on CMS’ radar. The Office of Inspector General (OIG) just announced that it will start reviewing claims for specific violations. The last thing you want to do is pay back money for incorrect telehealth reporting. But that’s exactly what could happen if you don’t tighten up your telehealth […]
CPT code 99441 telehealth

Collect $46 for Telehealth CPT Code 99441 vs 99213

QUESTION: Our patients really love the convenience and safety of telehealth, and we are planning to continue offering the services long-term. Can you provide us with some clarification on how to use CPT code 99441-99443 vs 99201-99215 when the video exam is not straightforward? Some example include:  What if there are technical issues and the […]

Liability Waivers for COVID-19: Put Stronger Safeguards in Place Now

QUESTION: Can we be sued if a patient thinks they got infected at our practice? Will a COVID-19 liability waiver protect us from patient lawsuits claiming they contracted the virus at our office? Question from Austin, Texas subscriber   ANSWER: You are right to be anxious about the reality of being sued. More than 800+ […]
CPT code 99211 specimen collection

Telehealth Plus Specimen Collection: Prevent Revenue Loss

QUESTION: Our doctor performed a telehealth exam that resulted in the patient coming into the office later that day for an in-person COVID-19 test. Can we bill CPT code 99211 for the specimen collection AND 99203 for the telehealth encounter when they occur on the same day? If so, should modifier 25 be added to […]