Telehealth has emerged as a critical service offering for FQHCs and RHCs, particularly in the wake of the COVID-19 pandemic. However, navigating the complexities of telehealth reimbursement can be challenging, especially as federal and state regulations continue to evolve.
The Importance of Telehealth for FQHCs and RHCs
Telehealth services allow providers to expand access to care, especially for patients in rural or underserved areas. For many organizations, telehealth has become a lifeline for maintaining continuity of care and generating revenue during times of uncertainty.
Challenges in Telehealth Reimbursement
- Regulatory Variability: Medicare, Medicaid, and commercial payers have different reimbursement policies, creating a complex billing environment.
- Service Limitations: Some payers restrict reimbursement to specific services or conditions.
- Coding Complexities: Accurately coding telehealth visits requires knowledge of modifiers, place-of-service codes, and payer-specific rules.
- Pending Federal Rules: Uncertainty around the final CMS rules on telehealth billing adds complexity to long-term planning.
Metrics to Monitor
- Telehealth Utilization Rates: Track the percentage of visits conducted via telehealth to assess patient engagement.
- Revenue Per Telehealth Visit: Compare telehealth reimbursement rates to in-person services to evaluate financial impact.
- Denial Rates for Telehealth Claims: Monitor and address common reasons for denials, such as missing modifiers or incorrect place-of-service codes.
Actionable Steps to Maximize Reimbursement
- Understand Payer Policies: Review payer-specific telehealth guidelines to ensure compliance with coverage and billing requirements.
- Train Staff on Telehealth Coding: Provide training on the proper use of modifiers (e.g., -95 and -GT) and place-of-service codes for telehealth claims.
- Audit Telehealth Claims: Conduct regular audits to identify and correct coding or billing errors.
- Enhance Documentation Practices: Ensure providers document all telehealth visits thoroughly, including patient consent and details of the virtual encounter.
- Optimize Technology: Use telehealth platforms that integrate seamlessly with your EHR system to streamline clinician workflows, data capture, and billing.
Addressing Uncertainty in Federal Rules
The final CMS rules on telehealth billing will shape the future of telehealth reimbursement. In the meantime, FQHCs and RHCs can prepare by:
- Keeping abreast of regulatory updates from CMS and state Medicaid programs.
- Engaging in advocacy efforts to support favorable telehealth policies.
- Building flexibility into their operational and financial plans.
The Role of Leadership
Executives and finance teams must take a proactive approach to telehealth reimbursement. This includes:
- Allocating resources for training and technology upgrades.
- Setting benchmarks for telehealth utilization and revenue performance.
- Monitoring regulatory developments and adjusting strategies accordingly.
Why Telehealth Is a Strategic Priority
As telehealth continues to evolve, it presents a significant opportunity for FQHCs and RHCs to expand access to care and diversify revenue streams. By addressing the challenges and uncertainties associated with telehealth reimbursement, organizations can position themselves for long-term success.
Struggling to navigate telehealth billing? BCA offers expert support to help you maximize reimbursement and streamline your telehealth services. Contact us today.
At BCA, we offer auditing and consulting services to support your practice in maintaining compliance and enhancing the quality of care, with documentation review starting at $499 per clinician. Please contact us at info@bcarev.com to learn more about our tailored solutions and how we can help you optimize your quality initiatives.