How Telehealth's Emergence Has Changed Medical Billing

by  Find-A-Code™
Sep 7th, 2023

The COVID pandemic ushered in a lot of changes in how healthcare services are provided and paid for. Among those changes was greater flexibility in billing Medicare and Medicaid for telehealth services. Some three years in, it is clear that telehealth is here to stay. Furthermore, its emergence has changed medical billing permanently.

Prior to COVID, medical billers and coders didn't need to know a lot about telehealth services. That's because CMS was very strict about its policies for paying for such services. Many of those policies went by the wayside with COVID. And even though the COVID emergency has officially been declared over, most of the flexibilities established during the pandemic have been extended through the end of next year.

The chances of those flexibilities becoming permanent are pretty high. No politician wants to be blamed for letting them expire. What does that mean to you as a medical biller or coder? It means staying abreast of any and all updates having to do with telehealth.

Everything Is Up for Grabs

With CMS basically eliminating most barriers to telehealth, healthcare providers are discovering that nearly everything is up for grabs. From standard telehealth visits to asynchronous services, they are starting to bill for everything. That is good in the sense that new revenue streams are being found. It's bad in the sense that coders and billers are struggling to keep up.

That says nothing of patients being hit with unexpected bills for consultations they expected to be free. An excellent example is found in a case featured in a recent article published by The Atlantic. The case involves a COVID patient billed $180 for a five minute phone conversation with his doctor.

The patient in question did his own research into everything from quarantining to keeping his children healthy. He didn't want the internet to be his only source of information, so he called his doctor to confirm his findings. He wasn't prepared for the bill that followed.

It Is Still a Service

In the doctor's defense, a five minute phone consultation is still a service. What confuses so many people is that doctors rarely billed for such short consultations prior to COVID. So why are they billing now? It is a matter of access.

As a billing or coding specialist, you know that clinicians expect to be reimbursed for all the services they provide. Prior to COVID, when telehealth wasn't a big thing, clinicians didn't mind providing free consultations over the phone, provided such consultations were relatively short. They also did not mind answering emails.

So what happened? Telehealth's emergence as a legitimate means of providing treatment opened the floodgates of access to patients. Clinicians are now finding that their patients have more access to them than ever before. As a result, they are being swamped with digital consultation requests.

Time Is Still Money

Time is still money even with the emergence of telehealth. If telehealth services increase the demands on a clinician's time, that time needs to be paid for. Every minute a doctor spends consulting on the phone is another minute that cannot be spent with a patient in the office. It is not time a doctor can afford to give away for free.

In terms of actual coding and billing, CMS continues to update its policies, procedures, rules, and codes. Private payers are following suit as they normally do. Expect a plethora of new billing codes over the next few years. In addition, expect CMS and private payers to update their policies relating to billing for telehealth services. Telehealth has changed medical billing forever.