A Year of Change

The year 2020 has been a year of fast, sweeping changes. At the time of this writing, many places in the United States are seeing spikes in COVID-19 cases and considering reverting to stringent lockdown protocols. Since the last column, the company I work for, Sceptre Management Solutions, along with many other billing companies, has transitioned from a traditional brick and mortar workplace to employees working from home. This change has allowed Sceptre Management and other billing companies continue to maximize revenue for our clients while complying with state health department guidelines.

Physician offices and dialysis facilities alike have been scrambling to provide their patients with the best possible care, minimize the risk of exposure to COVID-19 for both patients and caregivers, and comply with ever-changing state and federal safety guidelines during this public health emergency. Insurance companies have also made changes to facilitate contact-free access to healthcare for their members. Medicare released a list of 239 Current Procedural Terminology (CPT) codes that are payable under the Medicare Physician Fee Schedule when they are furnished via telehealth. Most insurance companies have followed Medicare’s lead and expanded their list of covered telehealth services to allow patients more flexibility in accessing healthcare. Now, more than any time in our history, people are receiving healthcare via telehealth.

Along with all the changes in covered services, there have been changes in the billing requirements for telehealth services. Now, it is critical to stay up to date on billing regulations and requirements. Not only has the number of patient visits dwindled in many practices, but staff being unfamiliar with current telehealth billing requirements can result in a loss of revenue. There are three steps that can be followed by billing staff to ensure maximum reimbursement is obtained for telehealth services during this time of change.

Step 1. Stay Current on Billing Requirements

The first step to obtaining maximum reimbursement for telehealth services is to stay up to date on the billing requirements for all the insurance companies you submit claims to. Many payers send updates via email while others maintain bulletin boards on their website. Whatever the distribution method, read all the updates released by the payers you submit claims to as the updates become available.

Step 2. Communicate Billing and Coverage Information with All Billing Staff

When it comes to billing and reimbursement, knowledge is power. Ensuring a more cohesive approach to capturing reimbursements requires educating all team members who deal with telehealth billing regarding the services covered via telehealth and coverage requirements for each insurance company.  For example, some insurance companies are waiving copays for telehealth visits. Educating your patient collection team about which insurance companies are waiving copays and which ones are not will help them collect copays when needed and avoid unnecessary overpayments from patients.

Step 3. Reviewing Remittances for Correct Reimbursement

While most insurance companies have made sweeping policy changes to allow for more flexibility for patients and providers in regard to telehealth services as well as some increases in reimbursement for certain telehealth services, it remains imperative that billing staff review remittances to ensure receipt of appropriate reimbursement. One coverage change from some insurance companies that has been welcomed by patients and providers alike is the waiver of copays and patient liabilities for some telehealth services. The challenge billing staff encounter with this reimbursement change is that when the payer processes the claims, although the payer’s policy states copays have been waived, the remittance may show that the patient was assessed a copay. To correct the error, the biller must call the payer and request the claim be processed according to the payer’s updated policy. Copays are so commonplace that it would be easy for a biller to overlook a claims processing error such as this. Knowledge of and familiarity with each payer’s policies and a process to review remittances for accuracy are imperative to ensure billing staff are capturing all available reimbursement for your practice.

Sarah Tolson is the director of operations for Sceptre Management Solutions, Inc., a company specializing in billing for outpatient ESRD dialysis programs, nephrology practices, and interventional nephrology. Your questions are welcome and she can be reached at [email protected], 801.775.8010, or via Sceptre’s website, www.sceptremanagement.com.