CMS Telehealth Coding Presents New Challenges

cms telehealth coding

As our recent article on Telehealth indicated, the Centers for Medicare and Medicaid Services (CMS) officially expanded its payment protocol to cover Medicare telehealth services in March of 2020. This meant that providers had greater flexibility in providing treatment and visits, with Medicare covering treatments that they previously would not have.

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Telemedicine Services Are Here to Stay Thanks to COVID-19, Shows Telehealth Billing Statistics

telehealth billing

The number of telehealth visits via real-time audio-video communication, as well as audio-only phone calls, skyrocketed in 2020, telehealth billing statistics show, due to the outbreak of SARS-CoV-2 and stay-at-home orders nationwide. Nearly half (43.5%) of Medicare primary visits were done via telehealth in April, compared to just 0.1% in February prior to the public health emergency (ASPE-HHS, 2020).

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Eleven New Telehealth Services Added to Medicare Reimbursement List

list of medicare telehealth services

CMS has added 11 new services to the Medicare telehealth services list. These new services focus on specific neurostimulator analysis and programming, and cardiac and pulmonary rehabilitation (CMS, 2020). There have been over 135 services added to the list of payable Medicare telehealth services since CMS started expanding Medicare coverage, including ED visits and inpatient encounters. Review our Telehealth Resource Center for the full list of revised coding and billing guidelines for COVID-19. If your facility is struggling with deciphering the revised telehealth guidelines, contact YES HIM Consulting for coding support from our HIM-credentialed experts.

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How to Overcome These Common Challenges in Telehealth Coding & Billing

Knowing how to accurately code and bill telemedicine services has been one of the biggest telehealth problems that practices are running into due to the amount of policy changes released over a short time period and the lack of experience in documenting these services. Here are the other most common challenges in telehealth and most popular questions about telemedicine.

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CMS Guidelines for Telehealth Coding & Billing During PHE

CMS guidelines for telehealth

The Centers for Medicare & Medicaid Services (CMS) has decided to update the CMS billing and coding guidelines for telehealth or in-home provider services due to the urgency of the current 2019-Novel Coronavirus (COVID-19) pandemic (CMS, 2020). CMS has broadened the scope for reimbursement for virtual check-ins and other digital communications with patients to safely and effectively respond to this Public Health Emergency (PHE). In the interim, telehealth services will not be limited by program restrictions put in place by Medicare (Federal Register, 2020). Evaluation and management (E/M) service codes cover these remote and communication technology-based services performed by a physician or non-physician practitioner (NPP).

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