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.

Marketing A Medical Billing Business



Marketing a Medical Billing Business is a huge part of starting a medical billing business.  From our experience it is the most difficult part of getting a new business established.  Many very competent billers may start a business but struggle with finding clients.  If they don’t find the clients, their business never takes off.


This is our 24th year of running a medical billing business so we have found new clients many different ways.  We did have a difficult time getting started back in 1994.  We did not realize how hard it would be to obtain clients and we were shy and didn’t like talking to doctors.  We were hesitant to tell providers what a good job we could do.  Fortunately we were patient and stuck through the hard times.  When we look back today over all the different ways that we have found new providers to work with we are surprised at all the different ways providers have found us.


We started out doing mailings.  They don’t require you to talk to anyone so it works well for the shy person.  The downside is that the results of mailings are pitifully small.  If you get one or two responses from 100 letters, it is good.  Those are just responses, not accounts.  Now you still have to sign them up.  We quickly found out that we would have to find other ways to find providers or we would starve.


Many of the people we talk to think that if they build a website they will find providers.  We have signed up a few clients as a result of our website but if we had to wait for those people to find us we wouldn’t have survived.  We found the accounts we have worked with over the years in a large variety of ways.  My point is that if you are marketing your medical billing business you need to try many different ways of marketing.  You never know which effort will deliver you a new account.


One of our first larger accounts we found by answering an ad in the newspaper for a medical biller.  Michele answered an ad that said to stop in the optometrist’s office with a resume.  They were not aware that there were services available but it was a great solution for their office.  23 years later we are still working with them.


When NPI numbers were first required we had to obtain them for all of our providers so we wrote a few articles about NPI numbers and posted them online.  We offered to obtain an NPI number for providers  that we didn’t work with for $29.95.  We still get calls today for NPI numbers and still charge $29.95 for obtaining them.  At first we were surprised that after obtaining the NPI for the provider we were asked if we knew where they could find a biller.  We have signed up many accounts over the years after getting them an NPI number.


We found a very small account early on who was a social worker.  We worked for her for several years when she referred a family doctor who was a patient of hers to us.  The family doctor is still working with us 20 years later.  Over the years many of our accounts came from referrals.  Referrals are a great way to grow your business but you have to make sure you are doing a good job with the accounts you have to earn a referral.


Make sure you reach out in many directions with your marketing.  You never know where the next lead will come from.  You must be determined if you are to succeed.  It is important to recognize how difficult marketing can be so that you don’t get discouraged.





New Marketing Offer

     Medical billing services are often looking for new accounts and new ways to market their services.  We offer three ebooks on marketing to help these business owners find new opportunities.  So we are always looking for new opportunities to teach to our readers.  This week we got a call from a company who asked if we were interested in getting government contracts for medical billing.  We weren’t sure if it was something we would be interested in or not but thought we should learn about it to offer the information to our readers.  We got the basic info and made an appointment for a fifteen minute phone call to hear the details.  Here is what we found.

This was a private company that offered the service of completing the hundreds of pages of application necessary for the government to offer you jobs.  Contracts were granted for 5 years with the opportunity to renew 3 times for 5 year periods.   The company would keep your applications up to date and renewed for 20 years.  They guaranteed you would get work or our money was refunded.  We were asked if we could promise to take on 2 new accounts in a six month period.  We were told that we didn’t need to bid on these jobs.  As a preferred provider the government and some city or county owned organizations were required to utilize preferred vendors.  When medical billing services were required they would get a list with your name at the top and you would get the job.  You could charge between 8% to 13%.  Their charge was $5500.00 for their service.

They also told us that there was only one GSA preferred provider in New York State and they were in the NYC area.  There was a great need for medical billing providers and this one company couldn’t fulfill all the needs.  We asked if we were limited to the NYS area and were told no, they could put us on the national list.

Red flags went up at some of the things we were told.  Some things just didn’t make sense.  The man we were speaking with happened to mention the name of the one preferred provider in NY so we told him we would think about it and he could call back on Friday.  We “googled” the name he mentioned of the other service and sent an email inquiring about the GSA contract.  A few minutes later we got back an email saying don’t do it.  It’s a scam.  She spent $8000 and got nothing in jobs and no inquiries.  She also said that she had to bid for the work and that there was only one instance in 18 months that she could bid on and she didn’t get the bid.  So beware of this tactic.  It may have worked out for some and we would love to hear about anyone else’s experiences.   If you have had any experience with this type of work please share your information.  We can all help each other.

Marketing Advice for Medical Billing Services

Marketing can be the hardest part of starting/running a medical billing business.  Recently on our forum someone asked a question about marketing their medical billing business.  Their question was regarding cold calling and they were asking for any tips/suggestions.  Another forum member responded in what some might consider a negative way but in reality, they gave medical billing owners a great insight into what the cold call looks like from the provider’s office.  She stated the following:

“This is probably not what you are going to want to hear, but here goes…

I am the office manager for a solo practitioner, and I have always done her billing. The very last thing I want is unsolicited phone calls during office hours when we are busy with patients. And I get quite a few in one week. We don’t need a billing service, we don’t need a debt collection agency, we don’t need a new copy machine, etc. In fact, if I were in the market for any of those services, and numerous others I didn’t mention, I would find one on my own, by asking for referrals from other practices, by going online and looking at websites for various companies, contacting the local Chamber of Commerce, etc.

There is truly nothing more annoying than having to put a patient on hold on the phone, or have to leave a patient in a room during a history taking to answer the phone, and find out it is a cold caller. So my suggestion is if you are going to cold call, do so after hours, when you can leave a message on the practice voice mail. That way, you are not interrupting the doctor/staff during valuable patient hours, when what we want to focus on is the patients. It really is the equivalent of how people hate getting telemarketing calls when they are at home.

As far as obtaining a list goes, I have no idea where you could get something like that. What you can do is research the practices you are thinking of calling by looking at their websites, and see if they appear to be truly solo, or are part of a hospital, etc. Probably it is even better if they DON’T have a website, and are solo/smaller, because that means they are more “old school” about things, and have not signed on with a larger entity. Using the phone book, you can probably figure out who is solo/smaller, and who is not.
Finally, and this is just from MY experience, I work for three billing companies(two small ones, one large one) doing remote billing in addition to my full time job. Not one of those billing companies has ever gotten a client from cold calling. It has all been from knowing someone who needs a biller, then onto referrals from satisfied clients, and also from actually stopping in offices and dropping off information about their services. They all gave up cold calling early on, it just didn’t get results.”

My response was:

“Actually, Kristin gave some good advice.  It was interesting to hear her viewpoint too.  But don’t take it as ‘what you don’t want to hear.’  She actually gave you great insight into what you are up against.  And after 20 years at this I would say that is what we have found to be true as well.  The only time we cold called on the phone is to smaller mental health practices who don’t usually have a receptionist/secretary and who are known for having an answer phone.  We would create a short, to the point message letting them know about us and asking them to call us if they were interested in hearing more.  That got good results.  If we were targeting larger medical offices (not the big ones, but ones that had staff – solo MD w/an NP, etc.) we would physically go in to the office usually bringing a handout with information about a current issue.  Also candy is a huge hit.  Even some of the hardest office manager’s will soften at the sight of chocolate.     When we brought info it would be something like:

“Did you know that Excellus BCBS is now requiring taxonomy codes on all claims?  They started it on Monday (they really did in our area!).  Here is some information regarding that.”  Then hand them a flyer telling them about the problem and of course your information is on the form as well explaining what you do and that you can help them if they are having a problem with this new requirement or any other billing issue.”

(Note:  We have a free medical billing forum where you can post any questions or just read others questions and responses.)

New Marketing Opportunity

In the last two months we have signed up more new accounts than we generally sign up in a year.  When we talk to others we find that this is very common right now.  This is a great time for medical billing services to be out marketing.  Providers are looking for solutions to the problems that are arising with all the changes happening in the field of medical billing.  The change to ICD10s seems to be freaking out a  lot of providers.  Some just do not wish to update their software to become compliant with the changes.  Some just want some of this work taken from their offices.

We have also heard and seen ourselves that some billing services have recently gone out of business.   We were recently contacted by a marketing service we previously used.  Our representative told us that they have had really good results lately particularly with medical offices that have been billing in house.  They feel with all the changes in the field this year that it is too much to handle the billing in house any longer.  The rep also told us that several medical billing services have gone out of business leaving their accounts to find new billing services.

With the costs involved in updating practice management systems for the new CMS 1500 forms and ICD10 codes, many struggling businesses decided to call it quits.  We personally are seeing the results of a local billing service that wasn’t doing a very good job fall apart.  This is a great opportunity for the billing service that wants to offer great customer service to their clients to advance.  It’s a great time to be marketing!