Clearly patient and staff safety is the priority during the Covid-19 crisis. With this at the forefront of all of our minds, practices must determine how best to meet patient needs while keeping everyone safe.
In our previous blog, we discussed the manner in which the federal government along with many state governments will expand telehealth services for Medicare and private insurance beneficiaries and cut back on HIPAA enforcement. In this blog, we will provide an overview of performing and billing Telemedicine visits in AthenaPractice (formerly Centricity Practice Solutions).
In order to successfully implement Telemedicine in your practice, there are three primary aspects that must be addressed.
Know Your Modifiers
In most cases, billing for telemedicine looks a whole lot like billing for in-person evaluation and medication management. The biggest difference is that you will add a modifier. There are two primary modifiers that earmark a claim as telehealth: GT and 95.
GT is the modifier that is most commonly used for telehealth claims. Per the AMA, the modifier means “via interactive audio and video telecommunications systems.” You can append GT to any CPT code for services that were provided via telemedicine. It is most often used for codes like 99201-05, 99211-15, behavioral health codes and other services that are medically appropriate for telemedicine.
Modifier 95 is similar to GT in use cases, but, unlike GT, there are limits to the codes that it can be appended to. Modifier 95 was introduced in January 2017, and it is one of the newest additions to the telemedicine billing landscape. Per the AMA, modifier 95 means: “synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system.” Modifier 95 is only for codes that are listed in Appendix P of the CPT manual. There is considerable overlap between situations for using GT and 95. Codes listed in Appendix P are likely to fall under the following categories:
- Psychiatric and behavioral health treatment
- Genetic counseling and evaluation
- Some remote ophthalmologic services
- Office and outpatient services
- Some inpatient consults
- Nursing facility evaluations and prolonged monitoring services
The specific codes include:
- Consults- 99241-45
- E/M For Established Patients- 99211-15
- New Patient Evaluation and E/M- 99201-05
- Most behavioral health codes
In What Situations Do I Use GT? 95?
In short, ask your payers. Rules vary by payer, with some requiring one while others will prefer the other. It’s pretty difficult to predict, so asking is the right way to go. Reimbursement should be the same regardless of the modifier, but that might be a good question to ask as well. We have seen payments from the following payers using the 95 modifiers:
- BCBS of Massachusetts
- Tufts Health Plan Commercial
- Harvard Pilgrim Health Care
- AllWays Health Partners
- Self-pay Option: Fee set by practice
Place of Service
A frequent area of confusion for billing telemedicine CPT codes was whether the place of service changes. If the provider is at the facility but the patient is at home, is the place of service still 11? As of January 1, 2017, the recommended Place of Service for telemedicine was 02. This references a location where the service is received through telemedicine technology.
Because Telehealth visits require a different Place of Service (02) than on-site office visits, ensure you have created a telehealth facility and matching location of care. You’ll need a workflow to ensure these visits have the correct place of service to ensure your claims go out properly. Depending on your practice you may choose to have your front desk manage this or your billing staff.
A telehealth service requires the same documentation as the face-to-face service does: Chief Complaint, HPI, ROS, Consultative notes, Assessment, Plan, etc. Any information used to make a medical decision regarding the patient should be documented. Additionally, it is best practice to include a statement that the service was provided through telehealth, the reason (if pertinent), location of the patient, provider, and any other persons participating in the service.
9 Key Components of a Successful Telemedicine Visit for Patients
- Check your internet connection
- Make sure your audio and video are working
- Find a quiet, private location if possible
- Check your lighting
- Write down problems and questions ahead of time
- Dress appropriately for the visit
- Consider using headphones
- Have easy access on your computer to any pictures or medical reports you want to share with the medical provider
- Be an active participant in the exam
Due to the complexity of billing Telehealth from payor to payor it is important your billers are aware of every telehealth encounter and are prepared to adjust the claims to the necessary rules. Ensure you have a workflow in place to properly bill these from the EMR, or alert your billers so they can review and ensure these claims go out cleanly.
You will need the following hardware and software to successfully implement a robust Telemedicine platform
- Quality High Speed Internet
- Desktop Computer/Laptop
- Headset (for shared office spaces)
- HIPPA compliant Telehealth Vendor
Remember that neither Facetime nor Skype are HIPAA compliant and you will not be reimbursed if you use either of them for a telehealth visit.