Telehealth Billing Guide for Eye Care Professionals During COVID-19
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Telehealth (remote non-clinical services) and telemedicine (remote clinical services) has gone into hyper-drive for optometrists and ophthalmologists during the pandemic coronavirus (COVID-19) healthcare crisis. Because telehealth billing is not the norm for many eye care providers, trapping all the details so insurance claims get submitted and paid correctly, and on time, is a challenge.
Billing for ophthalmology and optometry telehealth and telemedicine services varies from payer to payer. However, four things you should pay close attention to when billing for telehealth and telemedicine patient care, so your practice maintains a healthy cash flow, include:
Always verify the patient’s eligibility and benefits
Use the correct CPT® or HCPCS code
Use the correct modifier
Use the correct Place of Service (POS) code
Let’s take a closer look at how you can create a proactive telehealth billing and revenue cycle management (RCM) solution to increase your cash flow and maintain healthy accounts receivables (AR).
Use Correct Telehealth and Telemedicine Codes, Modifiers and Place of Service Codes
A denied claim is lost or delayed revenue for your eye care practice—something you don’t want to experience during these unprecedented and challenging times. Continual cash flow is critical for your business to remain solvent.
An important first step for billing for telehealth services is to always verify a patient’s insurance eligibility and benefits before you provide services to the patient. While some insurance payers are waiving standard prior authorizations and referrals during COVID-19, many are still requiring prior authorization for specific services.
Before billing for a remote image/video evaluation, virtual check-in, or e-visit, make sure you will not be seeing the patient in office in the next 24 hours. If you are seeing the patient in your office, you cannot bill for the telehealth service since this becomes part of the office visit.
As of March 30, 2020, the Centers for Medicare and Medicaid Services (CMS) now requires the Place of Service (POS) to define the location/facility (where service is typically provided) as 11 instead of 02 for Medicare telehealth/telemedicine services during COVID-19.
Always verify the POS with your billers or billing services provider to avoid denied claims as some payers may require the POS as 02, even though most payers generally follow Medicare’s lead.
All health care providers must also retain or have access to appropriate Medical Decision Making (MDM) documentation if requested for Medicare claims submitted to CMS.
To ensure you are coding your eye care claims correctly, you must be diligent with Local Coverage Determinations (LCD), National Coverage Determinations (NCD), and Medicare Administrative Contractors (MAC) in your area. Also, sign up to receive payer listserv updates.
To help make the transition to billing and coding for telehealth services easier for optometry and ophthalmology practices, we’ve put together a free Telehealth Billing Guide for Eye Care Professionals During COVID-19.
What is the COVID-19 Telemedicine 1135 Waiver?
On March 17, 2020, CMS issued a Medicare Telemedicine Health Care Provider Fact Sheet that relaxes telehealth reimbursement rules as part of Waiver 1135. As of March 6, 2020, Medicare will reimburse providers for more non–face-to-face telehealth services. This waiver will ensure that those patients who are at a higher risk for COVID-19 are still able to meet with a doctor from their home.
If informed consent is required for a telehealth service during the COVID-19 crisis, verbal consent is acceptable; however, you must document the consent in the patient’s medical record or EHR.
While waiver 1135 allows eye care providers flexibility during COVID-19, it’s critical that you remain HIPAA complian (privacy and security rules) with protected health information (PHI) that was created in the processing of caring for the patient.
The Office for Civil Rights (OCR) at the Department of Health and Human Services (HHS) will waive penalties for HIPAA violations against health care providers that serve patients in good faith through everyday communications technologies, such as FaceTime, Skype, Zoom, Facebook Messenger video chat, or Google Hangouts video during the COVID-19 public health emergency. However, CMS recommends you inform your patients that these third-party applications are not HIPAA-compliant.
EyecareLive’s HIPAA-compliant cloud-based telemedicine solutions are well suited for eye care medical tele-exams, including an Amsler grid test and recording visual acuity. Doxy.me is a free secure telemedicine solution that offers a personalized room URL, but it does not offer anything eye care specific.
Telehealth and Telemedicine Industry Resources
COVID-19 Resources Webinar IV: Update on Telehealth and COVID-19 (AOA): Medicare coding and reimbursement updates and resources.
Guide to Telehealth-Based Care During COVID-19 (AOA): This guide assists optometrists who may need to use telehealth services, including state law impacts, Medicare changes, and billing and codes.
Coding for Phone Calls, Internet, and Telehealth Consultations (AAO): The American Academy of Ophthalmology (AAO) provides coding options for telehealth and communication-based technology service based on CMS guidelines.
Medicare Coverage and Payment of Virtual Services Video (CMS): This video provides answers to common questions about the Medicare telehealth services benefit.
Medicare Telehealth Services List (CMS): Download a list of services payable under the Medicare Physician Schedule.
Telehealth Services Medicare Learning Network (CMS): Information about telehealth services, billing and payment, and helpful resources.
Evaluation and Management (E/M) Services Guide (CMS): This Medicare Learning Network guide provides detailed information about common sets of codes, selecting codes, and other resources.
Coronavirus Waivers and Flexibilities (CMS): Refer to this CMS web page for the latest news about temporary 1135 waiver and other flexibilities during COVID-19.
Congress Expands Telehealth Benefits for Medicare Beneficiaries (CMS): During the COVID-19 outbreak, CMS will temporarily pay clinicians who provide telehealth services to Medicare beneficiaries across the entire country.
Medicare Telemedicine Health Care Provider Fact Sheet (CMS): March 17, 2020 fact sheet includes information on the expansion of the new telehealth 1135 waiver, and a summary of Medicare telemedicine services (includes HCPCS and CPT® codes).
COVID-19 Resource Center (American Telemedicine Association): Resources, policy updates, tools and platforms, and recorded webinars.
Proactive Optometric Billing and RCM Solutions Reduce Denied Claims
Now more than ever, the financial health of any eye care practice depends on complete ophthalmology and optometry billing and revenue cycle management (RCM) solutions. Don’t let inadequate insurance eligibility and verification and denied claims create aging bucket chaos in your practice during COVID-19. It’s critical to pay close attention to accounts receivables, use modifiers correctly, and accurately document patient records and physician notes.
The Fast Pay Health billing approach is to triple-check everything so that you see a consistent return on your investment. We know the ins and outs of working with the top insurance payers, and we take the time to verify eligibility, and research and analyze every process to maximize your payments—so you can focus on patient care. Request a free practice analysis today—we’re just a form submission away.
It is the responsibility of the health care provider to ensure that they correctly submit claims. Fast Pay Health bears no responsibility or liability, and the information within this document was current at the time of posting. Medicare, Medicaid, and third-party insurance rules can change. CPT® is a registered trademark of the American Medical Association®.