COVID-19 epidemic has led to extensive usage of remote health care services such as telehealth and telemedicine. Telemedicine and telehealth are two different terminologies with different coverage.
Telemedicine:
It uses telecommunications technology to allow health care providers to examine, diagnose, and treat patients remotely. In short it refers to the remote clinical services.
Telehealth:
Telehealth is classified as the delivery and facilitation of health and health-related services via telecommunications and digital communication technology, including medical treatment, provider and patient education, health information services, and self-care. Telehealth can refer to both remote clinical and remote non-clinical services
To guarantee that practices get reimbursement for services performed, providers, medical personnel, and billing departments must keep in touch with recent billing developments.
Modifications Related To Telemedicine Billing, Reimbursement, and Payment Practices
It has been observed that several payers such as Medicare have reduced cost-sharing restrictions for individuals suffering from COVID-19. Furthermore, some payers prefer to waive cost-sharing restrictions during this period irrespective of patient’s diagnosis. In addition to the COVID-19 public health emergency, Health and Human Services Office for Civil Rights (OCR) will exercise enforcement discretion, submitting Health Insurance Portability and Accountability Act (HIPAA) penalties for health care providers who serve patients in good conscience using standard communication technologies (e.g., Zoom, Skype, etc.).
Telehealth/Telemedicine service code standards are as follows:
99201-99205 — New patient
99211-99215 — Returning patient
99411-99443 — Audio only/phone consultation
99421-99423 — New telehealth/E-Visit codes
Modifier 95 — Use by Commercial payers
CR Medicare Modifier — Describes a disaster or an emergency.
Some commercial payers require practices to use POS 02 code to distinguish their telehealth encounters; consequently, a practice’s billing staff must know which commercial payer needs to use this POS number. Furthermore, several commercial payers who have indicated that they will cover telemedicine services should recommend medical billers to implement E&M codes (99201-99215) for these remote service visits.
POS 02 does not invoice following Medicare codes:
G2061: An existing patient’s online evaluation and management by a certified health care practitioner (non-physician) for up to seven days with 5-10 minutes.
G2062: An established patient is evaluated and managed online for up to seven days by a competent health care practitioner (non-physician) in 11-20 minutes.
G2063: An established patient’s online evaluation and management by a certified medical professional (non-physician) for up to seven days with 21 minutes or longer.
CPT codes 98970-98972 are used for non-physician, E-Visit codes for commercial payers and the Healthcare Common Procedure Coding System (HCPCS).
Modifications made by Medicare to approved remote health care service sites and medical practitioners:
- Medicare requires patients to visit a medical institution to get telehealth services. Thanks to Medicare’s 1135 Waiver which has helped patients to obtain medical care services via telemedicine through any healthcare institution while sitting in their own home. Concerns about getting COVID-19 at healthcare institutions have been removed because patient can get treatment at home.
- Medicare’s 1135 Waiver made it possible for beneficiaries to receive telemedicine services from various healthcare providers, including physicians, physician assistants, nurse practitioners, nurse midwives, nutrition professionals, and clinical psychologists.
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