How Does the Billing Process for Telemedicine Visits Work?

As many practices around the world are beginning to implement telemedicine visits in their daily schedules, many people are benefiting from the added safety of not having to visit a doctor’s office in person during a global pandemic.

However, as convenient as this is, many patients are wondering how exactly billing works for telemedicine. More specifically, they're wondering how it works for them at your practice. 

Today we’ll cover your options for telehealth billing in private practices, so you can make your patients aware of your policy and we can help you get back to doing what you do best: providing healthcare.

Concierge or Self-Pay

For the Concierge or Self-Pay model of telemedicine billing, your options are fairly straightforward. The main boxes you need to check are determining your telemedicine use cases, as well as pricing.

Pricing could be decided based on a number of factors, including which services you’re providing remotely, in addition to the area your practice is located.

Cash-Pay Reimbursement

In the case of the Cash-Pay Reimbursement model, patients just have to sign a waiver agreeing to pay out-of-pocket for their telehealth visit, versus having their insurance pay for it. From this point, you can develop your policy in accordance with your state’s reimbursement guidelines for payers. 

Developing your telemedicine billing policy in terms of reimbursement protocol can be complex, but there are many resources to help you navigate the process. Different payers tend to have very different methods, so it’s important to do your research prior to writing your official policy.

Medicare & Medicaid

If you’re looking into reimbursement for Medicare recipients, it’s crucial that you maintain the government guidelines of the Medicare program. 

For more information on those rules and regulations, check out the official Medicare website. This resource will provide you with more details pertaining to Medicare Guidelines and billing codes you will need to set up your program.

For Medicaid, the most important thing to do in preparation for the development of your billing policy is to check your state’s Medicaid Guidelines. It is also a good idea to contact your practice’s Medicaid Representative to ask any questions you may have, as well as receive the most current information pertaining to telemedicine guidelines.

Private Payers

Most of the major health insurance companies do already offer coverage for telemedicine visits. Additionally, make sure to check into whether or not your state has a Telehealth Parity Law, private payers are required to reimburse for telemedicine just as they would for similar in-person visits.

Overall, there are several options for telehealth billing, as well as many different situations to consider and be prepared for.

If you’re looking for more resources about aspects of running a private practice amid COVID-19, check out the 99MGMT Blog!