The COVID-19 pandemic has led medical groups to expand telehealth services. Coding and billing regulations for these services are rapidly changing as the situation evolves. As a result, revenue cycle teams are facing additional challenges in their already difficult roles.
To help combat these challenges, we've identified four high-value rules that top performing medical groups are using to guarantee complete and accurate payment for telehealth visits. (Please note, these rules are not one size fits all; they often require customization to meet unique payer requirements.)
- Ensure the following e-visit codes are only billed once during a 7-day period: G2061-G2063 and 99421-99423.
- For place of service (POS) 02, use the POS where the patient would have been seen had the visit been face to face.
- For Medicare, remove the modifier 95, if the POS is 02.
- Remove virtual check-in codes G2010 and G2012 if they originated from an E/M service or procedure provided within the previous 7 days or lead to an E/M service or procedure within the next 24 hours.
RCxRules can help simplify the introduction of these rules into your workflow. Our focus is on helping large, complex healthcare organizations manage evolving billing and coding regulations and payer requirements. Our Revenue Cycle Rules product allows a revenue cycle team member to create custom rules based on their organization’s unique needs. The rules are presented to billers and coders in their existing workflow.
Plus, the rules engine can autocorrect routine billing and coding issues that consistently tie up your team’s valuable time. For example, rule number three above is most often set as an autocorrect rule to remove a modifier 95 when a POS 02 is noted—with no manual effort needed.
To learn more about how our rules engine can help you, schedule a 1:1 meeting.
For more detailed information on these telehealth billing/coding requirements please visit the Medicare fact sheet and CMS’s COVID-19 FAQ Sheet on Medicare FFS Billing.
