Getting Paid while Offering Telemedicine for Patient Care

August 16th, 2019 /
Vikram Maindan
/ 5 Min Read

According to the American Well Survey, from 2015 to 2018 the number of physicians offering telemedicine increased by 340 percent. During that same time frame, those willing to adopt this technology rose by approximately 12 percent.

Insurance companies, along with the Centers for Medicare and Medicaid Services (CMS), are taking steps to improve reimbursements for physicians as telehealth continues to grow. Recent improvements in billing include payment increases, parity laws as well as simplified billing practices.

How Telemedicine Physicians Receive Payment for Their Services

There have been some changes in the billing practices for telehealth services. The good news is that these changes make billing simpler. In addition, new parity laws ensure telemedicine physicians receive the same payment as physicians who see a patient in person for a comparable service.

CMS Requirements to Receive Payment for Telemedicine Services

To receive reimbursements from CMS quickly, physicians just need to abide by the new, simplified telehealth billing requirements.

Patients Must Use ‘Originating Sites’

Medicare beneficiaries are only eligible to receive telemedicine services from acceptable originating sites. The term ‘originating site’ simply refers to the eligible Medicare patient’s location at the time the telehealth service occurred via telecommunication. Physicians can use the HPSA tool to determine which sites are eligible.

An originating site is:

  • in a county that is outside a Metropolitan Statistical Area (MSA); or
  • in a region considered a Health Professional Shortage Area (HPSA). This HPSA region must be located in a rural census tract.

Approved originating sites include:

  • Rural Health Clinics
  • Hospitals
  • Physicians’ offices
  • Critical Access Hospitals
  • Hospital-Based or Critical Access Hospital-Based Renal Dialysis Centers (this does not include Independent Renal Dialysis Facilities)
  • Federally Qualified Health Centers
  • Community Mental Health Centers
  • Skilled Nursing Facilities

‘Distant Site’ Practitioners Must Be Eligible for Reimbursement

Simply put, the ‘distant site’ is the location where the medical professional is while providing the patient with telecommunication service. Some of the medical professionals eligible to perform telehealth services and receive reimbursements from CMS (and other health insurance companies) include doctors, physician assistants, and nurse practitioners.

The physician’s telecommunications system must allow for interactive, real-time communication between the medical professional, who is at the distant site, and the patient, who is at the originating site.

CMS Telemedicine Billing Practices

The CMS Modifiers GT and GQ

Prior to January 1, 2018, all CMS telemedicine reimbursement documentation required either the GT or the GQ modifier. GT refers to interactive telehealth or synchronous visit. This visit includes at least two parties interacting on a live call, simultaneously. GQ refers to a telehealth visit that is asynchronous.

Asynchronous means that the visit was not ‘live.’ Instead, the patient receives information via the Internet. This information usually arrives in the form of digital images or pre-recorded videos. While Critical Access Hospitals will still use the GT/GQ modifiers, other reimbursement documentation will not. CMS’ new rule replaces these modifiers with a single code. This ‘Place of Service 02 (POS 02),’ code is for all other telehealth reimbursement documentation.

Why Critical Access Hospitals Still Use the GT/GQ Modifiers

The POS 02 code does not work for a Critical Access Hospital because the hospital remains at the same location, indefinitely. It is important to note that any provider participating in one of the Hawaii or Alaska federal telemedicine demonstration programs must continue using the GQ modifier.

Bill for the Separate ‘Originating SiteFee

Medicare will pay a separate fee for the site where the patient received the telecommunication. Facility fee details are available on the HCPCS site. The originating site facility fee code is HCPCS Q3014.

Medicaid and Telemedicine

With the continuously changing state telehealth landscape, to find out the Medicaid reimbursements in a particular area, visit theNational Telehealth Policy Resource Center.

Commercial Insurance Billing for Telemedicine Services

Although most of the major insurance companies do cover telehealth services, coverage is policy-dependent: It is essential that telemedicine physicians confirm a patient’s policy includes coverage for telehealth services before his or her consult.

While verifying coverage, speed up future reimbursements by asking the insurance questions about:

  • which CPT and HCPCS codes to use for telemedicine billing
  • restrictions on locations
  • whether a modifier is necessary (e.g., 95 or GT)
  • any specific information/notes needed to accompany the billing
  • which providers are eligible to perform telehealth services (e.g., nurse practitioner, physician’s assistant, etc.)

Government Policy Promotes Telehealth Services for Medicare Patients in Rural Areas

On August 2, 2019, CMS finalizes policies designed to promote Medicare patients’ use of telemedicine in rural areas. The goal is to provide Medicare patients access to the same treatment and technologies available to those on the private market. Also, to encourage medical professionals to practice in more rural areas, CMS is increasing the wage index across certain geographic regions. Besides simplifying billing and increasing wages in rural areas, CMS has increased the New Technology Add-On Payment (NTAP) by15 percent. Now, the reimbursements CMS offers for eligible new technologies, including telemedicine, is 65 percent.

Physicians can benefit from adopting Telemedicine Services for providing quality care to their patients. To further explore how our Telemedicine Software can be beneficial for your practice, Contact Us today.

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