Potential Pitfalls in Telehealth Claim Submissions
Have you ever been on the verge of a telehealth billing breakthrough, only to find your claims hitting snag after snag? This mismatch between booming remote care demand and bumpy reimbursement can crush staff morale and create headaches for patients in need. The sections below reveal real stumbling blocks lurking in telehealth billing, along with ways to avoid them and get paid without drama.
Key Takeaways
- Precise Place of Service Codes: Assign the correct telehealth indicators so payers don’t reject claims outright.
- Consistent Staff Training: Everyone who touches claims should know telehealth’s unique rules.
- Timely Documentation: Missing details about timing, medium, or medical necessity can stall or deny a claim.
Why Telehealth Claims Go Wrong
It’s easy to mislabel a remote video consult or skip essential documentation steps, especially when new telemedicine guidelines pop up. When staff use old codes or forget the right modifiers, approvals tank, leaving you chasing claim corrections and explaining to confused patients why payment is delayed. This tension erodes trust and blocks your revenue stream.
1) Aligning Codes with Each Service Type
Does the appointment happen via phone, video, or an online portal? Each approach might trigger unique place-of-service or modifier codes—often recognized by payers but easy to mix up. Keep a quick-reference guide in front of coders so they don’t have to guess. For instance, some insurers require a -95 or -GT modifier to signal interactive audio and video.
- Confirm Coverage First: Before the visit, verify if the patient’s plan pays for phone-only consults or requires video.
- Review Payer Policies: Some private payers adopt the same codes as Medicare, but others deviate with extra steps.
2) Real Steps to Avoid Common Errors
- Create a Workflow: Front-desk staff or coders should confirm telehealth billing codes the moment an appointment is scheduled.
- Set a Documentation Checklist: Require staff to note the mode (video or phone), call duration, and reason for remote care.
- Maintain a Claim Check: Before sending claims, check place-of-service codes, needed modifiers, and any payer-specific disclaimers.
3) Collaborating Beyond the Clinic
Think about swapping experiences with local provider groups or professional billing associations. Small tips—like a newly introduced code or a recently changed insurer policy—spread quickly among colleagues. Short case studies posted on social media or quick workshop chats can also sharpen your approach.
4) Measuring Telehealth Claim Success
Track data on your acceptance rate, time to payment, and denial patterns. If you see repeated rejections for “invalid code” or “lack of supporting documentation,” adjust your processes right away. Over time, watch your claim cycle shorten and revenue climb, indicating your telehealth procedures are smoothing out.
Frequent Trouble Spots
- Ignoring Updates: Telehealth guidelines evolve. Old codes or place-of-service designations might vanish, harming reimbursements.
- Shaky Staff Training: Without consistent refreshers, staff revert to in-person billing habits that don’t translate to telehealth.
- Overlooking Patient Consent: Many payers want explicit proof that patients approved remote care, or they may deny the claim.
Stronger Claims, Less Stress
When your team conquers telehealth claim pitfalls, it not only stabilizes cash flow but also reassures patients they’ve chosen a well-prepared provider. From verifying correct codes to triple-checking medical necessity details, each step ensures you meet payers’ requirements—and keep patients satisfied with timely approvals.
Looking for a comprehensive telehealth billing strategy? Reach out to Altrust Services. We’ll guide you in refining your remote claim submissions, reducing frustrating denials, and building a sustainable telehealth program that seamlessly fits your practice’s goals.
