Telemedicine has been around for a while, but during the COVID-19 pandemic, there was a spike in its use, and people understood its importance. Telemedicine has gained much importance from medical practitioners and patients as it provides remote health care services. It is quite an accessible and comfortable way of getting healthcare services. However, with the increased use of this service, telehealth billing is a significant concern for patients and healthcare providers.
Physicians who want to enjoy the privileges of telemedicine must get complete knowledge of telehealth billing to get the reimbursement rates on time. Its billing process is quite different from the common billing processes. Regulatory authorities have policies and standards for telemedicine billing, and medical practitioners must comply with these policies. The Affordable Care Act has recently introduced some regulations in telehealth billing, and it is mandatory to understand these regulations.
In this article, we will learn about the telehealth billing models, legal considerations for billing, and the telemedicine billing software and tools. This will give us a complete understanding and clear our queries related to the telehealth billing process.
What is Telemedicine Service?
Telemedicine provides healthcare services to remote patients utilizing telemedicine software and applications. Telemedicine service is used when distance is a major factor behind no access to healthcare facilities. Consultation for the specific disease is done through video calls, secure messaging, or email networks or by getting the patient’s data from various sources and analyzing the health-related issues. Diagnostic test reports, X-rays, or CT scans can be sent to the medical practitioners to judge the disease best. Telemedicine billing is necessary for the revenue generated for the given services and to comply with the terms and conditions set by regulatory authorities.
Telemedicine Billing Models
There are different telehealth billing models, and the healthcare provider has the choice to select the model of his interest. They have to comply with that specific model, and they can only provide healthcare services to those patients who come under that particular model. Here are four known models for the telemedicine billing:
This model doesn’t have any subscription criteria. However, the medical practitioners get the service fee each time after providing the service. This is like a fee-per-encounter billing model. The medical practitioner should know the accurate coding. He needs to document all the services to get the reimbursement. Before providing any service, they should determine the patient’s insurance status and whether his health insurance company covers the telemedicine service. Many insurance firms cover it, but it is wise to be sure. While providing the telemedicine service, the billing staff is supposed to let the patients know every detail, like the healthcare services and the billing methods.
2. Subscription-based Models
It is the package model for providing healthcare services to the people. In this model, patients pay a specific amount per annum or per month to enjoy healthcare services when needed. The extent of coverage of healthcare facilities is different in different subscription models. These services in subscription should comply with the healthcare standards. Getting the reimbursement in this telehealth billing model is done with the help of software or a third party. In case of the provision of healthcare service out of subscription, the medical practitioner must obtain the consent of the patient before providing the service.
There is a payment method in which employers pay the medical bills for the services rendered to their employees. In this case, employer-sponsored health insurance is provided to the employees. Physicians offer the telemedicine service to the employees, and the medical bill is sent to the employers. The payment, number of medical services, and other terms and conditions are decided between the healthcare provider and the employers. It is also necessary for physicians offering telemedicine services to comply with healthcare laws such as HIPAA to get reimbursement. Privacy rules should also be kept under consideration while providing employees with personal and medical information.
Medicare and Medicaid are the healthcare programs started by the government, and the state also bears all the expenses. This program also covers telehealth services and bills. Physicians must provide healthcare services to the eligible population for the Medicare and Medicaid programs. Physicians should have complete knowledge and understanding of medical billing and coding to claim for the services. Medical bills are sent to the regulatory authority of this program for reimbursement rates.
Telehealth Billing Software and Tools
Many tools are useful for the telemedicine billing process. These tools streamline all the processes involved, from making the medical bills to getting the reimbursement. All the steps are followed efficiently to increase the output. Some software and tools are described below:
This system is responsible for making the telemedicine billing process smooth from start to end. The practice management system helps in scheduling the appointments of the patients with the doctor, and it also notifies the patients about their meetings. It also helps in generating accurate medical bills and mentions all the necessary codes and patients’ information. After this, it submits the claims to the insurance companies and tracks the status of the claims. The patient’s information and the history of his online visits and interactions are also recorded.
● Telemedicine-specific Software
This type of software coordinates with other telemedicine tools like the video conferencing tool for accurate exhibition of remote consultation. It has another great feature as it sends the digital prescription directly to the pharmacies to send the medicines to the patient. It keeps a record of information about online consultations, payment methods, and personal data of patients.
● Telehealth Platforms
It is not always necessary for physicians to have all the tools and digital equipment for providing the telemedicine service. There is another third-party system in which the telehealth platforms connect the healthcare providers and the patients. These platforms maintain the schedule for appointments and handle the telehealth billing process.
Legal Considerations for Telehealth Billing
Healthcare regulatory authorities have set some rules and regulations for the legal practice of telemedicine, and every provider must abide by the rules. Legal actions will be taken in case of any violation of the healthcare policies and laws, and claims for services will also be denied. There are some important considerations described below:
● HIPAA compliance: The Health Insurance Portability and Accountability Act (HIPAA) focuses on patient data privacy and confidentiality. Healthcare providers must take steps to maintain the privacy of the patient’s data. Safe communication tools should be used. There should be no leak of data like video recordings and ailment descriptions.
● State licensure: Telemedicine service is provided across the border. That’s why the providers need to have a license to practice across the border. Some states have reciprocity agreements, and physicians just need approval for telemedicine practice without any additional licenses. For some states, getting a state license is necessary.
Telemedicine is an emerging healthcare opportunity for both healthcare providers as well as for patients. It provides healthcare services remotely and has different billing standards. There is a need to understand telehealth billing rules and regulations to get the reimbursement on time without any objections from the insurance companies. It has many payment methods like fee-for-service, subscription-based models, direct-to-employer, and Medicaid and medicare models. Providers and patients need to select the method according to their requirements. Providers must understand the medical coding system for the successful submission of claims. Telemedicine tools like practice management software and telemedicine-specific software help streamline the process. Providers can also use telehealth platforms to provide telemedicine services to patients. Compliance with government health-related policies and laws should also be practiced to avoid any kind of obstacles in the way of completion of the telehealth billing process.