New Challenges for Telehealth Reimbursement

Since the outbreak of the COVID-19 pandemic, clinics across the country are experiencing a surge in telehealth visits. While this shift away from in-person examinations has helped slow the spread of the virus, it’s also added a layer of complexity as providers seek reimbursement for these new services. While this pain is hopefully short-lived, providers should take a few critical steps to maximize their reimbursement for telehealth visits, because experts predict demand for these services will continue growing even as the pandemic subsides.

Before COVID-19, Telehealth Services Were Limited

Despite the widespread adoption of digital communication tools over the last twenty years, very few providers were using telehealth tools before the pandemic arrived. This slow adoption was due to many factors, including high startup costs for establishing these services and a lack of uniform coverage policies. The Centers for Medicaid and Medicare Services (CMS) only covered telehealth visits for rural areas with provider shortages. Other private insurers refused to reimburse telehealth services entirely.

One study found that “among enrollees in large employer health plans with an outpatient service, 2.4% had utilized at least one telehealth service in 2018 (up from 0.8% in 2016).” The same study found that telehealth utilization by Medicare and Medicaid beneficiaries was trending upward but remained low. This status-quo changed dramatically with the arrival of COVID-19.

CMS Changes Spur Wider Adoption

As COVID-19 began appearing in U.S. hospitals, the Federal Government made sweeping changes to CMS rules to improve healthcare access and delivery. One of the most significant changes included adding 85 new covered telehealth services, reimbursed at the same rate as in-person visits. By expanding telehealth services, patients sickened by COVID-19 could still visit their doctors without leaving home and potentially infecting others. Conversely, patients who had not yet contracted the virus could also seek needed treatment while maintaining social distancing. 

In response to these dramatic changes, U.S. telemedicine platforms reported large jumps in utilization. One recent poll found that 23% of adults have used telehealth services since the pandemic began. Now that the telehealth genie is out of the bottle, some experts predict that healthcare consumers will flock towards the technology. A recent analysis by the business consulting firm Frost and Sullivan forecasts “a sevenfold growth in telemedicine by 2025 — a five-year compound annual growth rate of 38.2%.”

Reimbursement Challenges Arise

While these quick changes were necessary to protect public health, they’ve led to reimbursement challenges for many providers. Despite CMS promising to reimburse for telehealth visits at the same rate as in-person visits, some providers see their claims returned or only partially paid. As an added challenge, Medicare promised to waive copays for telehealth visits, so many providers are already losing 20% for their services.

The root of these reimbursement challenges seems to be confusion over new policies that can change very quickly. However, the trouble is taking a heavy toll on providers across the country. When you combine fewer total patient visits, reimbursement rates at a fraction of what CMS promised, and decreased efficiency due to appealing denied claims, many clinics now face an urgent revenue crisis.

Five Steps to Maximize Telehealth Reimbursement

While the pandemic will eventually subside, telehealth is likely here to stay. In response, clinics should take a few key steps to maximize telehealth reimbursement both today and in the future.

Document Thoroughly

Under the new CMS orders, covered telehealth services must be reasonable and necessary. That means providers should thoroughly document their rationale for providing services and maintain proof that they delivered the services to covered beneficiaries. Many providers intend to carefully scrutinize bills for fraud. This means that accurate and complete patient encounter documentation is more important than ever.

Communicate with Payers

Much of the reimbursement challenges seem to stem from coding errors. To mitigate this problem, providers should check with their contracted plans on specific coding requirements, primarily related to the place of service (POS) codes and modifiers.

Check with Colleagues

Some providers may have better luck than others when seeking reimbursement. If you’re facing challenges, reach out to your colleagues to see what may or may not be working.

Explain Telehealth to Your Patients

Because many of your patients have likely never used telehealth services before, it’s wise to reach out to them before their first appointment to explain how these services work. As part of the process, be sure to share your billing policies. There’s lots of confusion in the marketplace surrounding COVID-19 billing and telehealth in general. As a result, some patients mistakenly believe that telehealth services come at no charge, which can complicate collection efforts.

Choose the Right Telehealth Partner

Implementing a telehealth solution can come with tremendous costs. To combat this, CMA eased privacy rules so providers could use more accessible technology like Skype or FaceTime. However, communicating over less secure platforms still carries a degree of risk for the provider. If possible, select a telehealth provider that provides appropriate encryption protections. And always make sure to transmit personal identifiers like social security numbers over secure channels.

Scribe-X is Ready to Help

At Scribe-X, we’ve been busy building accessible telehealth solutions for years. While we primarily provide medical scribe services, much of our work is done remotely through ScribeBridge, our proprietary telehealth platform. Our medical scribe customers get free access to ScribeBridge, making it more affordable for providers to roll out their in-house telehealth service. They also receive expert support from trained scribes who capture the entire patient encounter in the electronic medical record.

If you’d like to learn more about how we can help maximize your telehealth practice, contact us today at 503-914-5857 or by email at Together we can build a bright future that will help you reach your patients no matter where they are.