Telehealth has transformed healthcare in recent years, but a recent study by EpicResearch.org reveals a critical billing discrepancy: Telehealth visits often receive lower billing codes than in-person visits. In this brief, we’ll explore why this matters for doctors and what strategies can ensure accurate billing and reimbursement in this evolving healthcare landscape.

A practice currently involved in telehealth or considering implementing it into their practice will find the contents of the article below interesting for the following reasons:

Billing and Reimbursement: This blog will discuss the billing and coding patterns for Telehealth visits compared to in-person office visits. Doctors would be interested in understanding how Telehealth visits are reimbursed and how this compares to traditional office visits. This information can have financial implications for medical practices.

Clinical Decision-Making: Understanding that Telehealth visits tend to have lower-level service codes may prompt doctors to consider the appropriateness of Telehealth for different types of patients and conditions. It can inform clinical decision-making regarding when telehealth is suitable and when an in-person visit might be necessary for a higher level of care.

Patient Selection: Patients might self-select into in-person visits if they feel they need a higher level of care. Doctors would want to be aware of this phenomenon to ensure that patients are receiving the appropriate level of care and to make informed recommendations to their patients.

Practice Efficiency: Doctors managing medical practices might want to explore the efficiency and resource allocation related to telehealth vs. in-person visits. Understanding the billing and complexity of these visits can help in optimizing the practice’s operations.

Future Planning: Telehealth is likely to continue playing a significant role in healthcare delivery. Doctors may want to stay informed about trends and research in Telehealth to adapt their practices for the future.

Key Findings

The study’s key findings shed light on telehealth billing:

• Telehealth visits frequently receive lower billing codes compared to in-person visits.
• Contributing factors include the nature of telehealth visits, often used for chronic disease management and follow-ups, which are typically less complex.

Understanding these findings is crucial for doctors navigating the nuances of telehealth billing.

The Exception

Intriguingly, the study uncovered a notable exception:

• New patient specialty telehealth visits occasionally received higher billing codes (LOS 5) compared to their in-person counterparts.

This anomaly sparks curiosity, and potential explanations include:

• Patient preference for in-person care when seeking a higher level of assessment.
• The convenience of additional tests, services, and providers available during in-person visits, potentially elevating the complexity of care.

Further research is needed to delve into these factors and understand their role in this unique billing pattern.

Strategies for Providers

For healthcare providers seeking to navigate the intricacies of telehealth billing effectively, consider these practical strategies:

• Thorough Documentation: Emphasize detailed documentation of telehealth encounters, including patient history, assessment, and treatment plans. Comprehensive records support accurate coding and reimbursement.
• Training and Education: Ensure that your healthcare team is well-versed in telehealth billing guidelines. Regular training can help streamline the process and reduce errors.
• Coding Accuracy: Pay meticulous attention to selecting the appropriate billing codes based on the complexity of the encounter. Accurate coding is pivotal for proper reimbursement.
• Regular Audits: Conduct periodic billing audits to identify any discrepancies or errors. Timely corrections can prevent financial losses.
• Stay Informed: Keep abreast of evolving telehealth regulations and billing practices. The landscape is continually changing, and staying informed is essential.
• Patient Education: Educate patients about telehealth billing processes, including potential out-of-pocket costs. Transparency fosters trust and compliance.

Accurate coding and reimbursement are not merely administrative tasks; they ensure that healthcare providers can continue delivering quality care while maintaining the financial health of their practices.

Future Trends

The future of healthcare is undeniably intertwined with telehealth. Here’s a glimpse of what lies ahead:

• Telehealth Evolution: Expect telehealth to continue its expansion and integration into routine healthcare delivery. It will likely play an even more substantial role in improving access and convenience for patients.
• Policy Shifts: Keep an eye on evolving healthcare policies and regulations. Governments worldwide are adapting to accommodate telehealth, which may impact billing guidelines.
• Research Imperative: Recognize the imperative for further research. Understanding the nuances of billing disparities between telehealth and in-person visits will be critical as telehealth becomes increasingly prevalent.

The dynamic nature of healthcare ensures that telehealth’s role and its associated billing practices will continue to evolve. Staying informed and adaptable will be essential for healthcare providers to thrive in this changing landscape.

Conclusion

As we move forward, healthcare providers must prioritize accuracy in coding and reimbursement. Telehealth’s evolution is inevitable, with policy shifts and research guiding the way. We encourage healthcare providers to stay vigilant, adapt to changing billing trends, and remain at the forefront of this transformative healthcare landscape.