Reimbursement for such services has grown during recent weeks.
Many healthcare entities are facing tough economic times. There is a possible solution that benefits patients while also providing revenue that may help healthcare organizations survive.
Send something to all patients explaining that they can use telehealth for nearly all visits during the COVID-19 emergency. People are avoiding necessary medical care out of fear of contracting the virus, so you will be helping patients and your organization by educating patients about telehealth options. Your organization has the option of waiving the co-payment and deductible for Medicare patients. (That waiver is not required, but it is allowed.) It is wise to inform patients whether they will be responsible for a co-payment when they schedule the appointment.
Telehealth is presenting a raft of challenges for everyone, including insurers. Last week I was working with a health system trying to comply with billing guidance from private insurers. A highly impressive compliance professional was able to assemble a chart listing each payer and its instructions for telehealth billing during the COVID-19 crisis.
The inconsistencies were mind-boggling. I’ll limit this discussion to place of service (POS). A few of the insurers were gracious enough to defer to Medicare policy, indicating that the POS should be location the patient would have presented. But some specifically wanted POS 2, telehealth. Others wanted the location of the patient. They recommended using 12, home, unless the patient was in a facility like an assisted living facility, in which case 13 would be used. One insurer, oddly, wanted the physician’s location to control. If the physician was at home, 12 would be used. If the physician was in the office, 11 would be appropriate. Maybe I’m just not smart enough, but I can’t understand how anyone could develop a system to comply with these disparate instructions. In particular, how does one bill a claim when there is coverage from two insurers with differing expectations?
I think it’s great that the insurers are quickly adapting to a changing environment and are willing to cover telehealth. I recognize that each needed to develop instructions, and there is no mechanism for them to easily coordinate. But it isn’t realistic for healthcare organizations to implement these widely variant instructions.
So, what do you do? My advice would be to develop a very friendly letter, saying something like:
Dear Insurer: We really appreciate the speed with which you agreed to cover telehealth services. As you may know, billing instructions from different insurers vary considerably. Because it’s not realistic for us to implement these conflicting instructions, we are going to use the approach recommended by Medicare. We will list the place of service on the claim that they would have been used, absent the COVID-19 emergency. If the patient would have presented in the office, we will use POS 11. Since this should have no impact on reimbursement, we hope you will understand this decision. If you have any concerns, please let me know.
Such a letter should eliminate any risk that an accusation of fraud arises. It also seems unlikely to stir the wrath of a payer. Just be reasonable, friendly, clear, and firm.
This approach doesn’t result in a guarantee that the payer will process your claim. But it seems like a practical, reasonable approach that balances the insurer’s needs with yours.
Programming Note: David Glaser is a permanent panelist on Monitor Mondays. Listen to his live reporting every Monday at 10-10:30 a.m. EST.
Imagine receiving notice that your healthcare organization faces a potential multimillion-dollar repayment demand based on the review of just 100 claims. This scenario, playing out
Some of you may have read my article from last week kindly published as a special bulletin. For those who did not, let me recap.
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Physician queries are essential for accurate documentation and claims data, but they are increasingly scrutinized by payors, leading to denials and revenue leakage. This webcast, led by industry expert Cheryl Ericson, RN, MS, CCDS, CDIP, provides actionable strategies to craft compliant queries, reduce denials, and enhance revenue integrity. Attendees will gain insights into clinical validation queries, how to avoid common pitfalls, and learn best practices to defend against query denials. Don’t miss this opportunity to refine your query process and protect your organization’s financial health.
Master the complexities of heart failure coding with this expert-led webcast by Emily Montemayor, CCS, CMBCS, COC, CPC, CPMA. Discover strategies to ensure compliance with ICD-10-CM guidelines, documentation integrity, and capture comorbidities like CKD and hypertension. Learn how to resolve coding challenges, improve documentation practices, and submit clean claims to minimize denials and safeguard your organization’s financial health. With practical insights and real-world examples, this session equips you to prevent revenue leakage, enhance compliance, and secure optimal reimbursement—all while supporting better patient outcomes.
Prepare your organization for the 2025 OPPS updates with expert insights from Tiffani Bouchard, CCS, CRCR, a Revenue Integrity Professional with over 30 years of experience. This webcast will address critical challenges in charge capture and coding, providing clarity on APC policies, C-APC packaging, exclusions, and payer-specific requirements. Attendees will learn actionable strategies to ensure compliance, optimize reimbursement, and mitigate risks of claim denials. Gain the knowledge needed to implement updates effectively, educate your team, and maintain seamless revenue cycle operations in the face of evolving OPPS complexities.
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The 2025 Medicare Physician Fee Schedule brings significant changes to payment rates, coverage, and coding for physician services, impacting practices nationwide. Join Stanley Nachimson, MS., as he provides a comprehensive guide to understanding these updates, offering actionable insights on new Medicare-covered services, revised coding rules, and payment policies effective January 1. Learn how to adapt your practices to maintain compliance, maximize reimbursement, and plan for revenue in 2025. Whether you’re a physician, coder, or financial staff member, this session equips you with the tools to navigate Medicare’s evolving requirements confidently and efficiently.
Dr. Ronald Hirsch provides critical details on the new Medicare Appeal Process for Status Changes for patients whose status changes during their hospital stay. He also delves into other scenarios of hospital patients receiving custodial care or medically unnecessary services where patient notifications may be needed along with the processes necessary to ensure compliance with state and federal guidance.
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