The COVID-19 pandemic has been a boon for telehealth, pushing much of the industry to move forward on remote care where it had been lagging for years. But the change hasn’t been without complications. Providers have seen multiple updates to telehealth billing and coding, causing many to look into new approaches to medical billing solutions and medical billing outsourcing companies.
And since changes are still emerging, that might be a smart approach. CMS has made even more recent changes to how telehealth services are treated. Here’s what we’re seeing.
Telehealth Changes for 2022
CMS is continually evaluating the telehealth services that were added to the Medicare telehealth list during the COVID-19 pandemic. Most recently, the agency has decided to finalize certain services, declaring that they will have a home on the list through December 31, 2023. This extension will give CMS more time to evaluate the services and decide whether they should be eligible for a permanent spot on the Medicare telehealth services list. The agency finalized that they will be extending the inclusion of services that would have been removed otherwise.
One of these changes includes Section 123 of the Consolidated Appropriations Act (CAA), which removed geographic restrictions, in their place adding a beneficiary’s home as an allowed originating site. This is for telehealth services that are furnished for diagnosis, evaluation or treatment of a mental health disorder. The section also requires a non-telehealth, in-person service with a practitioner or physician that must take place within six months before the first telehealth service. Afterward, an in-person, non-telehealth visit has to take place at least every 12 months. Exceptions are possible though. They can be made based on beneficiary circumstances (with the reason being documented in the patient’s medical record) and more frequent visits are allowed, depending on clinical needs on a case-by-case basis [1].
A Change in Definition
CMS has also added on to the current definition of interactive telecommunications for telehealth services. Now, it is defined as multimedia communications equipment, which at a minimum includes audio and video. It permits real-time, interactive, two-way communication that happens between a distant site practitioner or physician and a patient.
That definition has been expanded to include audio-only communication when used for telehealth services in the diagnosis, evaluation or treatment of mental health disorders. This is when furnished to established patients in their homes and under certain circumstances. They have also clarified that mental health services can be inclusive of services for the treatment of substance use disorders. The agency will be limiting the use of an audio-only telecommunications system for mental health services that are provided by practitioners who have the ability to provide two-way communications via audio and video, but in situations where the beneficiary is either unable to use or doesn’t consent to the use of two-way audio-video technology. They also concluded the adoption of coding and payment for longer virtual check-in services.
CMS has also finalized the use of modifier 93, which is used for services furnished using audio-only communication. This modifier would verify that a practitioner has the ability to provide two-way audio-video technology but is using audio-only technology because of limitations or the choice of the beneficiary. This code, Synchronous Telemedicine Service Rendered Via Telephone or Other Real-Time Interactive Audio-Only Telecommunications System, went into effect January 1, 2022.
Billing Considerations Beyond Medicare
There are many considerations you will want to keep in mind as you review the relationship between your approach to medical billing services, your relationship with medical billing companies, and the telehealth services you offer.
One of the most important is how you manage co-pays and consent. Medicare requires cost sharing for all their services. This means that consent has to be obtained. But this can be done by staff at any time, not necessarily at the time the service is rendered.
Since telehealth is provided in a manner that might not be face-to face, you might need to consider educating your patients about how your services work. This will help prevent them from being surprised when they receive a bill for a deductible or co-pay.
State Considerations in Telehealth Medical Billing Services
As you look at expanding your telehealth offerings through an evolving pandemic, you will want to stay on top of state-specific requirements. This is because policy, regulatory, and legal changes are highly state specific and can impact your approach to medical billing solutions and even how you approach outsourced medical billing.
For example, as of May 24, the Connecting Rural Telehealth to the Future Act was introduced and applies on a federal level. It would extend Medicare telehealth flexibilities implemented during the COVID-19 Public Health Emergency and permanently allow audio-only technologies in evaluating or managing patient health or providing behavioral health services.
At the state level, you’ll find a range of variation. For example, Louisiana requires health plans to cover physical therapy services that are delivered via telehealth the same way in-person services are covered. New Hampshire requires providers that deliver telehealth services be licensed, certified, or registered in the state of the patient if the patient is in the state at the time of service.
Something that will have a direct impact on your medical billing services is Payment Parity state laws. These require that providers be reimbursed the same for telehealth visits as in-person visits. These laws were implemented temporarily by many states, but today, many are making them permanent [2].
As you can see, these changes aren’t just complex, they’re also still evolving on a regular basis. This new landscape of shifting regulations and billing requirements has encouraged many providers to look into working with medical billing outsourcing companies that are able to keep up with the changes better than they are. If this is something you are considering, we invite you to contact us today.
References
[1] U.S. Department of Health and Human Services, “Social Determinants of Health,” 20 June 2022. Available: https://health.gov/healthypeople/priority-areas/social-determinants-health.
[2] U.S. Centers for Medicare & Medicaid Services, “Using Z Codes: The Social Determinants of Health (SDOH) Data Journey to Better Outcomes”. Available: https://www.cms.gov/files/document/zcodes-infographic.pdf.
[3] A. Robeznieks, “Social determinants of health and medical coding: What to know,” American Medical Association, 13 May 2022. Available: https://www.ama-assn.org/practice-management/cpt/social-determinants-health-and-medical-coding-what-know.
