How to Bill for Telehealth and Virtual Healthcare Through Medicare

Article Highlights

  • Physicians need to be ready for increased demand for telehealth and virtual services.
  • Medicare telehealth services have unique medical billing requirements.
  • PMB will provide you with outsourced medical billing services to ensure that you are reimbursed through Medicare.

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In this era of the COVID-19 pandemic, virtual healthcare visits have grown in popularity among patients, especially older patients that do not want to place themselves at risk of exposure to the coronavirus.

In fact, three out of every four U.S. adults (about 76% of adults) have a favorable view of receiving telehealth services, according to recent findings published by Mckinsey. This is expected to grow over time and become more of the expectation than the exception as virtual healthcare becomes entrenched in how healthcare is delivered.

The challenge is that when patients use traditional Medicare for telehealth visits, they need to be billed in very specific ways so that your practice can be reimbursed for services provided. This can become very complicated very quickly as your rate of providing telehealth services increases.

Let’s examine how to bill for telehealth services so that you can receive every dollar that your practice is owed for providing telehealth services for patients.

How Do You Bill For Telehealth Visits With Certain Patients?

CMS recently expanded the Medicare coverage for telehealth services so that patients have greater access to Medicare telehealth services. This way, Medicare beneficiaries can continue to receive as many services as possible through virtual means without having to travel to your facility.

For physicians, you need to be aware of the three main types of virtual services that you can provide to Medicare beneficiaries:

  • Medicare telehealth visits. These technology-driven visits are considered the same as an in-person visit. Therefore, they are paid at the same rate as a regular, in-person visit.
  • Virtual check-ins. This is considered a “brief communication check-in” with your patient. This service requires an established relationship with the patient. 
  • E-visits. This form of a virtual healthcare visit occurs when a patient communicates with you using an online patient portal without visiting your office. Again, you must have an established relationship with the patient to bill for this service.

The virtual check-in and e-visit services have unique billing codes depending on the nature of the communication, the length of the communication, and the type of digital evaluation provided. Let’s examine further each of these three categories.

1. Medicare Telehealth Visits

Medicare patients can use telecommunication technology for office, hospital visits, and other services that generally occur in person. As the provider, you must use “an interactive audio and video telecommunications system that permits real-time communication” between your location and the patient at their home location.

The advantage for physicians is that you do not have to provide the service. The following medical professionals can furnish this service and enable your practice to receive payment for covered telehealth services:

  • Physicians
  • Nurse practitioners
  • Physician assistants
  • Nurse midwives
  • Certified nurse anesthetists
  • Clinical psychologists
  • Clinical social workers
  • Registered dietitians
  • Nutrition professionals

2. Virtual Check-ins

CMS allows for established Medicare patients to have “brief communication” with their established medical care provider via communication methods that include a telephone call or a virtual meeting. CMS encourages Medicare beneficiaries to initiate this type of virtual service. However, physicians are allowed to educate patients on the availability of this service prior to patient initiation. 

Medicare will reimburse physicians for this type of virtual check-in visit, as long as the visit is with an established patient. Additionally, the visit must meet the following timeline requirements:

  • The communication cannot be related to a medical visit from within the previous 7 days.
  • The communication cannot lead to a medical visit within the next 24 hours (or the soonest appointment available).

3. E-Visits

E-Visits are focused on the interaction between a Medicare beneficiary and a physician through an online patient portal where communication does not happen in real-time. In other words, you or a member of your practice are not communicating directly with the patient over the phone, face-to-face, or through a virtual meeting.

This service can only be reported if your practice has an established relationship with the patient, and if the patient generates the initial inquiry. This type of communication can occur over a 7-day period. Your practice would then bill based on the cumulative length of time required to respond to the patient’s inquiry during the 7 days.

Contact PMB for Medicare Telehealth Billing Support

When working with traditional Medicare patients, it can be challenging to keep up with the billing requirements for telehealth visits and manage the billings for various patient interactions. This is where Precision Medical Billing (PMB) can help.

At PMB, we provide reliable medical billing services for your practice. By working with our team, we’ll help you address hassles associated with patient billing, especially for Medicare telehealth services, so that you can optimize revenue collections.

Our expert team of medical billers will ensure that you collect every dollar that you are entitled to. In fact, we increase revenue for 100% of our clients! Working with PMB, you and your office can focus on growing your telehealth service offering so that you can continue to provide high-quality virtual care to patients.

Contact us today to schedule a medical billing consultation with our team. We’ll show you how we can help you bill for telehealth services.