6 Common Challenges in Telehealth Billing and Ways to Overcome Them

Covid-19 surged telehealth into widespread use. Virtual care claims rose by 3,060% between October 2019 and October 2020. This popularity spurred CMS to remove certain telehealth coverage restrictions.

These government adjustments are temporary, but telehealth prevalence is expected to last. Many patients and professional care providers realize the convenience virtual care offers. To meet this demand, investors are pouring money into telehealth at record rates. 

Mental health providers have committed to digital visits since the field rarely requires physical examinations. ABA practices must learn the problems associated with a sudden rise in virtual care.

Here are six common telehealth billing challenges. 

Cross-State Telehealth Regulations

Telehealth allows providers to serve a patient from another state remotely. While this ability can be circumstantially beneficial, it often causes problems. States hold unique certification and treatment requirements. Providers must earn licensing from the state to treat consumers in that area. This process can be time-consuming and cost-ineffective.  

During the pandemic, CMS declared a public health emergency (PHE) that lifted many cross-state restrictions. So, providers have taken on patients they previously would have rejected. After the PHE, physicians may need to choose between out-of-state patients and a lengthy certification process.

Telehealth Coding Limitations

Despite CMS’s expansion of telehealth coding, the field still has significant limitations. For most sectors, virtual care coding adheres to the following basic structure: 

● Medical Telehealth Visits: A virtual visit between an established or new patient and a provider. 

● Virtual Check-in: A quick check-in between an established patient and a provider using a telecommunications device to determine whether an in-person visit is necessary. 

● E-visits: For established patient/provider communications through an online portal. 

While these categories cover the basic types of care telehealth offers, specificity is still limited. Ideally, CMS will introduce new codes that empower staff to increase service classification detail. 

Telehealth Reimbursement Discrepancy

Reimbursement amounts for telehealth services are still significantly lower than in-person visits. To combat this problem, 29 states have instituted virtual care price parity laws. However, current mechanisms to enforce these laws are underdeveloped.  

Mental Health Billing Problems

Medicare reimburses mental health telehealth if the service uses audio and video. Audio-only services exclusively receive coverage during the PHE. While Medicaid specifics change with different states, the general trend is to match Medicare’s standards. The following codes are Medicare non-reimbursable: 

● 96110: Developmental screening and testing

● 96170, 96171: Health behavior intervention, family without patient

● 90875: Psychophysiological therapy

Necessary EHR Adoption

EHRs have dominated the patient information transfer landscape since 2014. The records quickly offer critical, detailed information. However, a practice subset has failed to adopt EHRs for practical reasons. 

Using EHRs requires significant security precautions that many providers can’t quickly meet. Maintaining a system that directly communicates sensitive information with other practices is challenging. Despite these difficulties, increased telehealth adoption may force holdouts to integrate EHRs, using significant resources. 

Medical Cybersecurity Threats

As more practices store critical patient documents digitally, healthcare data breaches are becoming increasingly prevalent. Providers that transmit consumer data must invest in cybersecurity. 

Plutus Health has adapted to the prevalence of telehealth billing. We’ve taken the limited virtual care codes CMS offers and have maximized revenue generation. Thanks to this efficiency, our customers have remained secure during the telehealth craze. Visit our website to learn how our virtual care experts can strengthen your RCM. 

Key Takeaways

1. Current relaxed in cross-state regulations may end which will result in providers needing to gain certifications. 

2. Telehealth codes still fail to provide the detail of their in person care alternatives. 

3. Reimbursement rates for telemedicine fall short of industry standards. 

4. CMS limits mental health virtual care coverage. 

5. EHRs may cease to be a commodity and become a necessity. 

6. Cybersecurity threats have reached an all-time high due to rise in virtual storage.