How Telehealth Is Changing the Future of Medical Billing and Coding

The rapid expansion of telehealth services over the past few years has fundamentally changed how healthcare is delivered and, consequently, how it’s billed and coded. The shift to virtual healthcare was accelerated by the COVID-19 pandemic, but even as the world adapts to a post-pandemic reality, telehealth continues to thrive. With this shift comes new challenges, especially in the realm of medical billing and coding, which is often seen as one of the most complex and technical aspects of healthcare administration.

In this blog, we’ll explore how telehealth is transforming the landscape of medical billing and coding, and why Provider Credentialing Services are more important than ever in this evolving ecosystem.

The Rise of Telehealth and Its Impact on Medical Billing and Coding

Telehealth allows healthcare providers to diagnose, treat, and monitor patients remotely through technology like video calls, phone consultations, and even digital health devices. While this increases access to care for many patients, it introduces new complexities for medical coders and billers.

Historically, billing and coding for in-person visits followed a well-established, standardized system. Healthcare providers used Current Procedural Terminology (CPT) codes, Healthcare Common Procedure Coding System (HCPCS) codes, and ICD-10 codes to categorize services and procedures accurately. However, when telehealth services are provided, these codes may change, depending on the modality of the visit.

For example, a provider may use a different CPT code for an in-person consultation than for a telehealth visit. Certain services or procedures may be reimbursed at a lower rate when conducted virtually compared to in-person. Telehealth has introduced both confusion and opportunity for coders to navigate new coding rules and reimbursement rates—each of which can vary by insurer, location, and the technology used.

New Billing Challenges in Telehealth

1. Adapting to Telehealth-Specific Codes
   A major change in medical billing and coding is the introduction of specific codes for telehealth services. The Centers for Medicare and Medicaid Services (CMS) have developed new billing codes for virtual visits. However, different payers (including private insurance companies) may have their own rules, reimbursement schedules, and coding variations. Coders need to stay up-to-date with constantly evolving coding policies and ensure that they are using the correct codes to avoid claim denials.

2. State and Payer Variability
   Laws surrounding telehealth vary from state to state, and payer policies can differ significantly. For example, a state might allow telehealth reimbursement for a broader range of services than another, and one insurance provider might only cover telehealth consultations when performed on specific platforms. Navigating these differences makes billing and coding more complicated.

3. Reimbursement Rates for Virtual Visits
   Reimbursement for telehealth services may not match the rates paid for in-person visits. While some payers have made temporary adjustments to reflect the value of remote care, others may continue to reimburse telehealth visits at a reduced rate. Billing departments must be proactive in understanding and applying the most current reimbursement policies, which are subject to frequent changes.

4. Increased Administrative Burden
   As telehealth has become more common, many healthcare organizations are finding themselves dealing with an influx of virtual care visits to process. This creates additional workload and strain on the billing team to track the proper codes, ensure compliance with various payer policies, and avoid under- or over-billing. Healthcare organizations may need to invest in training or software solutions that are specifically designed to streamline telehealth billing.

Why Provider Credentialing Services Are Crucial for Telehealth Success

With the integration of telehealth services, Provider Credentialing Services have become even more essential for healthcare organizations. Credentialing involves verifying the qualifications of healthcare professionals, ensuring that they meet the standards set by regulatory bodies and payer networks.

In the telehealth environment, credentialing becomes even more important due to the complexity of state-specific regulations and payer requirements. Each state may have different laws regarding the qualifications and licensing of healthcare providers offering telehealth services. Some states have reciprocity agreements that allow providers licensed in one state to practice in others, while others have stricter licensing requirements.

Provider credentialing services ensure that healthcare providers meet these regulatory standards, which is essential not only for ensuring compliance but also for getting reimbursed for services. If a provider is not properly credentialed or does not have the right qualifications in a given state or payer network, their claims may be rejected.

How Telehealth Is Shaping the Future of Medical Billing and Coding

As telehealth continues to evolve, it’s likely that we’ll see more advanced technologies and innovative solutions in billing and coding. Artificial intelligence (AI) and machine learning (ML) tools are already being implemented to automate the coding process, reducing the risk of human error and speeding up the reimbursement cycle.

In the near future, it’s possible that:

• Automated Coding: AI tools may automatically generate the appropriate codes for telehealth visits based on the documentation entered by the provider. This will streamline the billing process and reduce administrative burden.

• Telehealth Billing Platforms: Specialized platforms designed to handle telehealth billing will emerge, allowing for seamless integration with electronic health records (EHR) systems and simplifying the tracking of patient claims, payer requirements, and reimbursement schedules.

• National Standards for Telehealth: There is hope for the establishment of national telehealth billing standards, which could reduce some of the complexity around payer variability. If these standards are adopted, coders will have a much easier time navigating the billing landscape.

Conclusion

Telehealth has undoubtedly changed the healthcare industry in profound ways, and its influence on medical billing and coding is no exception. While the new landscape presents challenges, it also provides an opportunity for innovation and efficiency improvements in the healthcare system. As the sector continues to grow, the need for skilled professionals who understand the complexities of telehealth billing, along with the importance of Provider Credentialing Services, will only increase.

For healthcare organizations navigating this new reality, staying up-to-date with coding rules, reimbursement policies, and credentialing requirements will be essential for success. As we look toward the future, embracing technology and staying flexible will be key to adapting to the changes brought about by telehealth.