Update on place of service and modifiers for telehealth…

As the COVID-19 Pandemic continues, providers and billers look for updates on coding for telehealth services.  Prior to COVID-19 the average biller didn’t have to know anything about telehealth billing but post COVID-19 almost all billers have had to learn.  So where are we almost eighteen months later?  Basically in the same position. Each insurance carrier has their own guidelines for billing telehealth services.  Most of the restrictions have been lifted allowing almost all providers to provide telehealth services.  The insurance carriers were scrambling to set up guidelines for billing and they didn’t all set up the same.  Here are some of the ones we know:

Medicare requires that telehealth services be billed with a place of service code of 11 and a 95 modifier.

TRICARE requires that telehealth services be billed with a place of service code of 02 and a 95 modifier.

CIGNA  requires that telehealth services be billed with a place of service code of 11 and a 95 modifier.

MVP  requires that telehealth services be billed with a place of service code of 11 and a 95 modifier.

Aetna requires that telehealth services be billed with a place of service code of 02 and a 95 modifier.

Health First requires that telehealth services be billed with a place of service code of 02 and a 95 modifier.

Emplem requires that telehealth services be billed with a place of service code of 11 and a 95 or a GT modifier.

Most BCBS plans requires that telehealth services be billed with a place of service code of 02 and a 95 modifier.

There is no way to list them all.  Bottom line it is important to figure out how the carrier that is being billed requires it to be submitted and follow those rules.  If a claim is denied, check with the carrier to see what their requirements for telehealth services are and refile the claim.

7 Steps To Improve Billing And Collections

We get a lot of questions on how to improve billing and collections.  It is crucial in today’s world to make sure that all that is due is being collected.  Providers have added expenses to ensure patient safety in this pandemic state we are still in, and many offices cannot see the number of patients in the same amount of time, that they were seeing pre-pandemic.  It is important that nothing is slipping through the cracks. 

There are several things that can be done to improve billing and collections that start before the patient is seen, and continue on through until the claim is paid. 

  1.  Insurance Verification  –  we cannot stress enough how important it is to make sure the patient is covered under the plan/policy that they are presenting with.  There is so much confusion out there today with all of the Medicare Advantage Plans, and Medicaid Advantage Plans, not to mention patients changing jobs or employers changing insurance plans.  It is crucial to make sure the correct insurance is being billed from the beginning, and to make sure the provider accepts the patient’s plan and does any pre-authorization that may be required.  Since most insurances allow online access, this is an easy task.
  2. Accuracy inputting patient data  –  make sure the front office staff (or whoever is responsible for inputting the data) is careful when inputting the patient information.  Simple typos can be very costly and time consuming to correct.
  3. Verify information  –  when repeat patients come in, verify their information.  Make sure they have the same insurance plan, and the same demographic information.  Correct data makes for clean claims.  Incorrect data can cause delays or even denials of claims.
  4. Collect copays  –   copays should always be collected at the time of service.  It is more likely that a provider will be paid if the money is collected in the office.  Also, it costs money to send out patient statements.  If the copay is collected at the time of service it eliminates the chance that the provider will not get paid, and cuts costs of sending out statements unnecessarily. 
  5. Submit claims timely  –  we still hear of billers that hold claims before submitting.  There are different reasons behind why.  Some just don’t have time, while others believe that sending a bunch together is more efficient.   However, the quicker you submit the claim, the quicker you will learn of a problem if there is one, and the quicker payment will be received. 
  6. Check clearinghouse reports regularly  –  most clearinghouses provide daily reports of denials and rejections.  These should be checked regularly.  The quicker a denial or rejection is handled, the more likely it is to be corrected. 
  7. Work Aging Reports  –  most medical offices lose money on unpaid claims because they are not working aging reports regularly.  It is important that an aging report is run, and any claims outstanding over 30 days are checked on.  Most clearinghouses (at least the good ones) allow for claims to be checked through the clearinghouse.  At the very least they will indicate if the claim was accepted by the insurance carrier.  Most will provide payment information or the reason the claim wasn’t paid if it was denied.  Denials should be caught before the aging report, but if they slip through they will get caught now.  The aging report is the last step for catching money before it is lost.  Unfortunately many offices put this job on the bottom of the to do list and it often gets left untouched.  Offices that are not working the aging report regularly can be losing up to 30% of their revenue. 

Billing and collections is one of the most important jobs in the office.  It is right up there next to treating the patients.  If the providers are paid for their services, they won’t be able to continue treating patients.  Following the 7 steps above will help make that process as smooth and efficient as possible.