Navigating Billing, Coding, and Compliance Challenges

Telehealth is under rapid growth. During the COVID-19 pandemic, telehealth usage skyrocketed by over 300%. Today, it has evolved to be a pivotal aspect of healthcare, helping people attain medical attention without having to go in person to the healthcare firm.

As telehealth grew popular, it transformed the healthcare system. Telehealth has made it easier to receive care. But comes with its challenges, especially in areas including coding, billing, and compliance.

Revenue Cycle Management is essential for rectifying such telehealth concerns. RCM helps healthcare practitioners handle their payments better and ensure they are following all required regulations.

Understanding the Telehealth RCM Landscape

RCM is the process of managing and tracking revenue flow in healthcare, particularly in revenue associated with patient services. In telehealth, RCM is key as it aids providers manage claims and payments quickly and ensures all telehealth services are billed properly.

Telehealth providers go through some major challenges. They often handle more claims, follow various rules from insurance providers, and leverage specific telehealth billing codes. These differences make it difficult to handle telehealth claims compared to regular healthcare processes.

Key Billing and Coding Challenges in Telehealth

1. Billing Complexity: Telehealth billing can be complex. Each insurance firm may have distinct rules for telehealth claims payments, and rates differ. This makes it hard for providers to understand when and how much they’ll get paid for each virtual visit.
2. Coding Issues:

• Telehealth-Specific Codes: Telehealth has specific codes, like special CPT codes. These codes must be accurate, or the insurance provider might deny or reject the claim, which means the providers won’t be paid.
• Modifiers and POS Codes: Codes referred to as modifiers, including -GT or -95 and Place of Service codes, indicate the service performed on a virtual platform. Using the wrong codes can result in denied claims, which impacts provider revenue flow.

Research indicates that telehealth billing issues can lead to high denial rates, which means most claims do not get paid. These denials add costs and minimize revenue for healthcare providers, which is why accurate coding is essential.

Common Compliance Pitfalls:

Privacy Concerns: HIPAA rules are essential in telehealth as they safeguard patient information. Providers must make the best use of secure platforms that maintain data privacy and safety from unauthorized access.

Interstate Licensure: Telehealth can link patients and doctors across various states, but this brings licensing issues. Each state has its own set of rules and regulations, so providers must understand how cross-state care impacts billing.

Staying compliant is important not only for legal concerns but also for attaining patient trust. Following these regulations minimizes the risk of fines and financial issues for healthcare practitioners.

Strategies to Overcome Telehealth RCM Challenges

Investing in Specialized Software: Leveraging RCM software which is devised for telehealth can make coding and billing seamless. This software can automatically update codes and display real-time patient details, minimizing mistakes and saving time.

Staff Education and Training: It is pivotal to train billing and coding teams on telehealth-specific regulations and rules. This education aids staff in having a clear view of the latest codes, and billing standards, ensuring fewer claim errors.

Regular Audits and Compliance Checks: Performing regular checks and audits for compliance helps healthcare practitioners identify and rectify errors in billing workflows. Compliance checks ensure that billing meets all the regulatory standards, minimizing concerns.

Future Trends in Telehealth and RCM

Expansion of Remote Patient Monitoring: RPM allows providers to track patient’s vitals and health status from a distance, using devices to attain data like blood pressure and heart rate. As RPM transforms and expands, it brings new paths for telehealth billing services and needs special billing codes.

Evolutions of Telehealth Policies: Telehealth policies are changing constantly, and future laws may affect compliance and billing. RCM solutions must be flexible to stay informed on the latest policies and ensure providers get paid properly.

Technology, including Artificial Intelligence in RCM, is likely to make telehealth way more effective. It will help reduce errors. AI can help manage huge chunks of data and make quicker and more accurate billing processes.

Final Words

Telehealth brings unique challenges and concerns in coding, billing, and compliance to the picture. So, it is essential to adjust RCM services to manage these demands to ensure providers get paid properly and abide by the rules.

Partner with Practolytics to handle telehealth RCM inefficiencies. Practolytics delivers expert aid, advanced RCM innovation, and optimized processes to improve revenue and maintain compliance seamlessly.

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