All posts by Stephen Brighton

Medical Billing for Telemedicine, Here's What You Need to Know

Medical Billing for Telemedicine, Here’s What You Need to Know

For many people, telemedicine works as a cost-effective alternative to the traditional face-to-face appointment. It helps some, such as elderly patients and those with disabilities better navigate the obstacles that may otherwise make it hard to see their doctor. For all patients, it tends to lend itself to better satisfaction and convenience.

Despite the fact that telemedicine is becoming more common, many health care providers still have trouble with reimbursement. Getting used to new rules for billing and coding procedures properly in order to get paid appropriately can take time and effort. Add to that payer differences in telemedicine coverage and policies and it can become even more complicated. Here are a few things to keep in mind about billing for telemedicine.

Ensure that telemedicine is covered by the payer

A lot of trouble is caused by the mistake of neglecting to submit claims without first checking if the payer covers telemedicine services. Before providing those services, it’s recommended to call the insurance provider for that verification. If the provider assures you that they do, be sure to document it as it may be helpful in the event of a denied claim later.

Know the specific insurance provider’s policy

As mentioned, different payers have specific policies regarding telemedicine, and you should take the time to verify this as well. This can include making sure the specific services you are covering are covered, whether it applies to the type of telemedicine you are using, any qualifying criteria, and any restrictions for telemedicine coverage.

The major payers, such as Medicare have their own restrictions and rules for reimbursement. In that case, the patient can only be reimbursed for telemedicine services if they are seen at an authorized site like a skilled nursing facility, public hospital, doctor office or certain private hospitals. The patient has to also be seen by a nurse, doctor MD, or clinical psychologist and the service itself must be within the regularly covered codes. The facility providing the telemedicine must also be located in a Health Professional Shortage Area (HPSA) and not within a Metropolitan Statistical Area (MSA). 

Meanwhile, Medicaid approves reimbursement for telemedicine on a state-by-state basis, with the policy differing within each state as well. For instance, some may cover real-time visits only, while others cover remote monitoring services as well. Private payers tend to cover telemedicine more widely, but again, the reimbursement policies can differ between each individual payer, so care must be taken to get the detail you need on their policy before submitting a claim.

Tips to help you with better billing and coding for telemedicine

As the points above have hopefully detailed, telemedicine billing and coding can be a source of some confusion and care must be taken to ensure that you’re getting the right amount of reimbursement for the services that you provide. As such, the following tips can help you ensure that you’re protecting yourself.

Be sure to document the services you provide

Documenting time spent is crucial, just as it is with all other kinds of coding. You must document the time spent for each encounter in telemedicine billing but ensure that you account for that time accurately. For instance, with some codes, the only time that counts is the face-to-face time you spend with the patient or caregiver when deciding which level of service accurately describes the appointment. 

Know about the 95 Modifier

With the video component of telemedicine encounters, you can also ensure it is accurately documented by adding the 95 modifier to the standard CPT code for the service. However, while this modifier can be used for the video component of live telemedicine services, it should not be used for any encounters that are asynchronous like emails, radiograph studies, or video services that do not involve both parties being live and actively involved at the time that the service is provided.

Don’t forget about any devices used as part of the treatment

Telemedicine assessments often include the use of peripherals and wearable devices. For instance, you may use spirometers, thermometers, glucose monitors, oxygen saturation monitors or blood pressure monitors. Make sure you document the use of any of these devices when coding as they will support the CPT code you use to bill. If you do not, you can end up having a bill rejected because your documentation doesn’t support the service you are billing for.

Billing with telemedicine doesn’t have to be so difficult

Though telemedicine billing may seem somewhat complicated, don’t let that get in the way of the benefits that it can provide. The ability to monitor your patients remotely and provide services without having to always be face-to-face can be greatly convenient for your patients, improving their outcomes as well as their satisfaction with your services.

With Medicare continuing to support and reimburse more and more telemedicine services as time goes on (and many other payers following suit if not surpassing that coverage) we can expect to see the service become more and more widely used in the 2020s. Ensure your practice is taking advantage of this new technology with help from teams like Medical Healthcare Solutions.

Read More
Coronavirus (COVID-19) Medical Billing FAQs

Coronavirus (COVID-19) Medical Billing FAQs

Amidst the outbreak of the new coronavirus (COVID-19), many medical institutions are unaware of what happens with regards to coronavirus medical billing. What gets covered in this situation? Are there any things you need to put in place? 

Below, we’ve listed some of the most frequently asked questions surrounding this topic. Information is taken from the CMS, and it is accurate as of March 5th, 2020.

Can COVID-19 tests be billed?

Yes, your healthcare institution can bill for tests for COVID-19. Typically, Medicare Part B will cover medically necessary clinical diagnostic laboratory tests when they’re ordered. As such, you can bill Medicare for these tests when they’re performed. 

However, this can only be done starting in April. CMS outlined a new Healthcare Common Procedure Coding System (HCPCS) that comes into effect in April and can be used for any tests that happened after February 4, 2020. 

Companies need to bill for these tests using the code U0001 – if the tests are developed by the CDC. For any tests that aren’t, the code U0002 must be used. 

Also, other insurers may cover COVID-19 tests, so they can be billed depending on what coverage the patient has. 

Can new drugs for COVID-19 be billed if they are created?

Any new drugs created to treat COVID-19 are covered under Medicare Part B. This includes any new antiviral drugs on the market. They will be paid by the Medicare Administrative Contractors until a new code is created. 

Some new drugs may be covered under Medicare Part D. In which case, they can be billed to the beneficiary’s Part D plan. 

Does Medicare cover the costs of a doctor or non-physician practitioner to furnish care in a beneficiary’s home?

Many people suffering from COVID-19 will require at-home care due to a reduction in available hospital beds. As such, Medicare does pay for many of the services a doctor of NPP will have to provide in the home. 

This includes evaluation and management and many other services furnished in a beneficiary’s home. It’s also possible to bill for other services that aren’t face-to-face, provided they’re used to help manage the patient’s condition. This primarily includes remote patient monitoring services and communication services used to help the patient. 

Will Medicare cover the costs of a doctor, NPP, or nurse using technology to communicate with a patient?

Many modern healthcare technologies can be expensive to use. As such, Medicare does cover various services that offer brief communications between patients and practitioners. Things that are covered include telephone calls, video calls, e-mail, online patient portals, and many more. 

Does Medicare allow billing for care provided at alternative care sites (ACSs)?

During the COVID-19 outbreak, it’s possible to reach a state of emergency where hospitals can no longer provide support for patients on the main hospital premises. As such, an ACS may be set up to continue treating sick patients. Hospital beds are reserved for the critically ill, so temporary sites can be set up in school gymnasiums, etc. 

Hospitals can add a remote location that offers inpatient services and file an amended Form CMS 855A with its Medicare Administrative Contractor. Provided the ACS fits all the requirements, then any treatments carried out at this location can be billed. 

Will hospitals that are paid by Medicare through the Inpatient Prospective Payment System (IPPS) continue to be paid this way?

IPPS hospitals will continue receiving normal payment during the COVID-19 outbreak. Some hospitals have questioned whether or not there is a special Diagnostic Related Group (DRG) for this virus, but there is not. If you are paid through the IPPS, then carry on as normal. 

Will Medicare pay for any vaccinations of Medicare beneficiaries?

As there is currently no vaccine available, this isn’t something to be concerned with, in the immediate future. However, the current law stipulates that when a COVID-19 vaccine is available, Medicare will cover it under Part D. Every single Part D plan will have to cover the vaccine when it is released. 

Does Medicare Part B cover a 90-day supply of drugs if a pandemic occurs?

COVID-19 has officially been named a pandemic by the World Health Organization. As a result, many hospitals and healthcare institutions will need to order a greater-than-30-day supply of drugs for patients. This is to cope with the increased demand and rise of patients entering the hospital. 

The current laws say that local Medicare Administrative Contractors (MACs) decide which drugs need to be ordered in or not. This is based on how necessary they are, how many patients need them, and much more. But, if orders are made for a 90-day supply of drugs, then they will be covered under Medicare Part B. 

The only exception is immunosuppressive drugs, which are generally limited to a 30-day supply. In special-case scenarios, Medicare Part B might cover a larger supply, though this is for extremely rare instances where a patient desperately needs this supply. 

How will ambulance payments be handled during the COVID-19 outbreak?

Ambulances will be more in-demand than usual during the coronavirus outbreak. As such, there are lots of questions surrounding the medical billing side of things. 

Right now, if an ambulance crew provides treatment but does not transport anyone or furnish the treatment from their ambulance, then these services cannot be billed to Medicare. These can only be billed if the patient is transported in the ambulance or equipment from the ambulance is used. 

Medicare can also be billed for all ambulance transportation costs during the COVID-19 outbreak. This will be done through the usual payment guidelines and relates to patients that are transported from home to a hospital, or from one hospital to another, or even from one hospital to a separate medical facility. 

If any additional equipment is required when transporting patients – such as a portable oxygen container – then this can also be covered and billed by Medicare. If the transport is already a Medicare-covered service, then it automatically will be supplied with the equipment through Medicare. If it isn’t, then payment under Medicare Part B can be made to cover the costs. 

For further details on coronavirus medical billing, feel free to read through the entire CMS document and any further publications released by the authority. 

Read More
6 Key Questions to Ask Before Hiring a Medical Billing Company

6 Key Questions to Ask Before Hiring a Medical Billing Company

Hiring a company to handle all of the payments and patient transactions at your medical practice is a big decision. You need to make sure that whatever medical billing service you choose offers all the features that you need. And the best way to do that is to ask questions. 

How Will The New Billing System Affect My Existing Payment Processes?

Ideally, a medical billing company should be able to adapt its services around your needs. You shouldn’t have to sweep away your old system entirely and replace it wholesale with a new and unfamiliar one. There should be some flexibility in the matter. After all, you don’t want to have to retrain admin staff from scratch. 

On the other hand, you don’t want to be inflexible to the point where you can’t benefit from streamlined payment services. Remember, the whole point of a medical billing service is to make your admin easier. 

Is The Medical Billing Service HIPAA Compliant?

Protecting patient data is a top priority for medical clinics and practices. You must, therefore, find out more about the degree to which your medical billing service is compliant. 

Remember, no medical practice or institution is 100 percent HIPAA compliant. Thanks to the wording of the regulations, there are only degrees of compliance. 

Ideally, you want a medical billing company that has stringent software and encryption practices that minimize the risk of patient data loss. You may also want to probe other aspects of the medical billing service. These might include their telephone and fax security, document destruction protocols, and procedure for wiping computer memory banks. 

Can I Meet The Person Working On My Account?

When it comes to hiring a medical billing company, you’re almost always relying on a person at the other end of the phone to keep the service running smoothly. Software is part of the story, but it can only do so much. It has its limitations. Having a human in the loop is vital.

You may, therefore, want to ask whether you can speak with the person who will handle your account. Doing this allows you to find out whether they have the requisite skills to get the job done. Remember, relationships with medical billing companies tend to be long-term, so you need to know if you get on with the person handling your case. 

How Much Will I Have To Pay? 

Medical billing companies don’t offer their services for free. There’s a fee for handling payments safely and securely. Because of this, you want to know how much a service might set you back. 

Low fees aren’t necessarily a good thing. Charging very little could mean that a company offers efficient and automated services. But it could also imply missing features and poor security compliance

It’s worth checking what functions the company performs and which they leave up to you. Ideally, you want a medical billing service to follow-up on low-ticket claims, send out statements to patients promptly, and collect all bills on accounts receivable within a reasonable time frame. Also, the medical billing service should be proactive when it comes to pursuing incomplete information distributed by the provider. 

Are You Transparent About Your Performance? 

Another reason for hiring a medical billing service is to improve your collection rates and overall financial performance. It is essential, therefore, that the billing service updates you with regular statements. These documents prove that they are working in your interest to add profitability to your practice. 

Asking for a guarantee of transparency upfront can be helpful. The medical billing service should provide regular updates on the state of your business and the effect that their operations are having on your bottom line. You should receive clear statements showing how new billing features are helping you collect payments faster and improve customer services. 

Don’t be afraid to go into detail here. Ask the medical billing service how many reports you can expect to receive in a given year. Will they issue information about your account every quarter, every month, or every week? Also, find out how you can access this information. Some medical billing outfits send statements in the post, while others provide you with an online accounts summary. 

Which Associations Are You Affiliated With? 

Quality medical billing companies should have a host of national, state, and local affiliations to prove their competence. Providers that have relationships with professional and regulatory bodies are more likely to stay up to date with regulatory changes. 

Read More

5 Fun Facts About Careers in the Medical Billing Industry

Medical coding is a huge part of the overall system of healthcare in this country. It involves assigning codes to the specific description of a patient’s status, and professional medical coders help to ensure that accurate information is conveyed between patients and doctors, in addition to doing the same with insurance companies.

According to the Bureau of Labor and Statistics, there will be a 15% increase in the need for medical coders in the decade between 2014 and 2024. This represents a much larger increase than the average for most professions. Even though this is such a rapidly growing field of endeavor, there are probably some fun things that you didn’t know about careers in medical billing.

Medical coders need to be good puzzle solvers

While a thorough background in medical billing codes is necessary, sometimes assigning codes to descriptions of medical conditions can really be more like an art form than a science. In some cases, you’ll have to track down doctors and query them about specifics, or you might have to consult with insurance companies and patients in order to retrieve accurate information. If you’re good at solving puzzles and working out problems, that will be extremely useful towards your career in medical billing.

The medical coding system is gargantuan

You might be a bit overwhelmed when you realize just how huge the medical coding system is. There are literally thousands of codes involved, to cover every kind of medical condition under the sun. Medical billing and coding professionals frequently have to work with software systems which help them assign codes, simply because of the huge body of codes that must be sifted through before finding the right one. It will help a great deal if you have a good memory as a coder, because it will generally help you to find the right codes faster. However, whenever you get hit by a brand-new medical condition, it might throw your whole process into a loop, and you’ll have to spend considerable research time finding just the right code for the situation.

Medical coders work in all kinds of settings

You might think that as a medical coder, you would always be working in a physician’s office, but that’s not necessarily the case. Since medical coders are needed in virtually every installation throughout the healthcare industry, there are literally any number of locations where you might undertake your profession. Some coders work in hospitals, some work in doctors’ offices, some work in school systems, and there are probably another 15 or 20 possible locations where you might provide service. Wherever medical healthcare is delivered, that’s a potential location for a medical coder to be employed.

There’s great deal of flexibility in the profession

There is tremendous flexibility associated with a career in medical billing. As referenced above, there are any number of different locations where you might possibly be employed, but there is more flexibility than that involved with the job. There are many different schedules and shifts that you might be called upon to work in a professional setting. Of course, many coders do work a traditional 9 AM to 5 PM shift, but a great many others work shifts that are far from traditional. Some medical coders even work directly from their homes, and only report to the workplace occasionally for meetings and for catching up with their employer. Anyone who’s interested in maintaining a balanced work-life schedule should consider a career in medical coding.

It’s easy to break into medical coding

There are many online programs available for medical coders to pursue, as a means of breaking into the profession. Many of these will help you to become a certified Professional Coder, and to complete the program, it normally only takes between two and three terms. Without even having to commute to a classroom, you could acquire all the skills and knowledge that you need to become certified in the profession, and then you can market yourself wherever a position might be available. With the knowledge you pick up from one of these online courses, you would be qualified to sit for the exam offered by the American Academy of Professional Coders (AAPC). Once you pass this exam, you’re on your way to a rewarding career in medical coding!

Read More
The Medical Billing Company Surgeons Prefer

The Medical Billing Company Surgeons Prefer

Medical billing for surgery has become even more critical to the than at any time in the past, given the fact that network health plans have become more narrow, and there is greater regulation over surgical costs. Independent surgeons are frequently encountering diminished reimbursements as a result of all that regulation, in addition to the difficulty of filing clean medical claims which are approved for reimbursement.

It can make all the difference to be associated with a medical billing company which understands all the nuances of appropriate medical claims and coding, so that fewer claims are denied or held up for correction. A savvy medical billing company will understand payor guidelines, as well as their filing requirements, and can make sure that your claims are clean when they are presented for reimbursement. In this way, surgeons can increase their pay while having far fewer hassles with all the necessary paperwork leading up to reimbursement. 

Features which surgeons seek in medical billing

In order to keep your surgical practice running smoothly and with minimum disruptions due to medical billing, a surgeon’s best approach would be to find a very capable medical billing company which offers most of the really useful services that can streamline the whole process and make it more efficient.

A secure client portal can provide detailed reports and information, as well as billing resources, right at your fingertips for you to use in any way that helps your business, or makes it more efficient. An online bill pay system is also very useful, because it allows patients to make their own payments online, in those cases where medical insurance is not involved, and the patient is managing their own payments.

Some kind of a compliance program is also a big plus, because it provides coding reviews and chart audits so that you are aware of all the coding which has been used on your medical claims, and you can verify them before they are sent out for reimbursement. This means that any medical billing company you choose should have a number of Certified Professional Coders on staff, who are aware of all the latest coding requirements and can accurately match them up to the services provided for any surgical services.

Constant access to patient data

You would also probably want to have the capability of viewing your patient data and all transaction information at literally any time of day, with no interruption of service. This can be an invaluable service to have, when you need to understand certain aspects of patient medical history, as well as any transactions which have taken place in the past.

Finally, if you’d like to focus on actual surgery in your practice and eliminate most of the details involved with running your business, you can outsource all that to a capable medical billing company which offers Comprehensive Practice Management as part of their service. This gives you the best of both worlds in that it reduces your workload at the same time that it increases your revenue stream coming in.

For surgeons who prefer to focus on areas where their real talents lie, this is an ideal solution that can keep you working at what you do best, while leaving the details of running your business to others. Of course, that means you would need to choose a medical billing company which you can trust implicitly, and for this you won’t find a more reliable and trustworthy company than Medical Healthcare Solutions.

Why choose Medical Healthcare Solutions? 

If you’re looking for a company which can provide a complete solution to your needs in the areas of medical billing, electronic health records, and practice management services, then Medical Healthcare Solutions (MHS) is the answer you’ve been searching for. With a high level of staff expertise and employing the latest in medical billing technology, you won’t find a more efficient or cost-effective solution anywhere on the market.

When clients become associated with MHS, they typically remain with the company for years and years, and that’s because MHS is able to deliver customer satisfaction better than anyone else. When you find a good partner, you should stick with them, and that’s why MHS has so many loyal clients.

Read More