Telehealth Reimbursement Requires Provider Education, Documentation

Now that Medicare and other major payers have added telehealth reimbursement flexibilities, healthcare organizations must put clear documentation and coding processes in place so providers are paid accordingly, said experts at Xtelligent Healthcare Media’s Reimbursement Virtual Summit.

Since the onset of COVID-19, Medicare and other payers have begun to support better telehealth reimbursement. However, for physicians to get paid for their care delivery, they must be aware of the codes and documentation necessary when billing telehealth visits.

Panelist Ginna Evans, a coding educator at Emory Healthcare in Atlanta, said that the key to successful telehealth reimbursement is provider coding education.

To prevent denials, Evans and the coding educator team at Emory provided physicians with clear documentation requirements for coding by developing a grid that categorized telehealth visits by methods of communication such as Zoom, telephone, or telehealth and patient portal visits.

This resource allowed providers to easily categorize visits using the correct interprofessional console codes, as many had not used them prior to COVID-19.

“When you do a telehealth visit, there are suggested attestations that you add in to provide your documentation to show that it is a telehealth visit,” said Evans. “That is very important, and we did a lot of education upfront with our providers on that.”

While making sure providers knew how to code telehealth visits in alignment with Current Procedural Terminology (CPT), AMA, and E/M guidelines, this resource also gave coders a framework for what to look for when auditing provider notes.

“I personally think that the new guidelines really help some of these providers, as long as they have the documentation,” said Evans. “And even from my standpoint, auditing, I find auditing their notes much quicker and easier with these new guidelines.”

The modifier for telehealth varies by payer and can change frequently, Evans said, so coders have to stay on top of these adjustments in order to ensure telehealth reimbursement.

“On top of the E/M changes, I don't ever remember a year where we've had two off-cycle changes on ICD coding like we've had,” said Evans.

While Emory coders look at some provider entries in the billing system on an inpatient basis, they do not have the bandwidth to look at every bill. Therefore, provider coding education is key to avoiding telehealth payment denials.

Keynote speaker, Bob Flannery, CPA, senior vice president and chief financial officer at UW Health echoed Evans’ remarks on the importance of a clear framework for appropriate coding practices.

“It's important for all revenue cycle operations to really review and verify that they've got a good system of accurate documentation that leads to appropriate coding,” said Flannery.

“We need to make sure that we're verifying that our documentation is catching the complexity of the patients that our organization is serving, so then we as the revenue cycle team can submit accurate bills and be paid appropriately for services that the organization has provided.”

Many providers are calling for policy makers to ensure that some of the programs put in place for telehealth reimbursement are kept post-pandemic.

“Even after the crisis as a healthcare consumer myself, there's a lot of interactions that I would greatly prefer to do through my phone or through my computer the way I experienced so much of the rest of the economy,” keynote speaker Joseph Walker, CFA, senior vice president and corporate treasurer at Providence noted.

“Making sure that [telehealth] is incorporated into the reimbursement schemes is critically important, and I think it's a great area of collaboration between health systems and payers. It's sort of a win, win, win for everybody involved if we can get to the right payment models,” Walker continued.

Flannery noted that telehealth is allowing organizations to scale up in ways they were never able to do before. However, to effectively utilize telehealth as a care delivery model, organizations must make sure to price virtual care in a way that is attractive to patients and payers.

“There is a new world that's really taking shape in terms of the delivery of care as the implementation of virtual platforms and digital health, and I think it's just going to continue to expand,” Flannery explained.

“We have to make sure that we have processes and ability to build and get reimbursed at rates that are fair. We have to make sure that we negotiate with payers and we get acceptance from patients,” he continued.