decisionhealth Newsletters, Coder Pink Sheets - 2020 Issue 6 (June)
Large telehealth denials should prompt practices to review evolving billing rules
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Article Overview
This article examines why telehealth claims are being denied or rejected, with a focus on changing Medicare billing guidance during the COVID-19 public health emergency and broader compliance challenges for practices. It discusses how CMS and a Medicare administrative contractor are handling telehealth claim submission details, and it also references an OIG audit of Medicaid telemedicine payments to show how documentation and oversight issues can affect reimbursement. The piece is aimed at coders, billers, practice managers, and clinicians who need to keep up with evolving telehealth billing requirements.
Why This Topic Matters
Telehealth billing requirements changed quickly during the COVID-19 emergency, and practices that miss updates can face claim denials, payment delays, and compliance risk. The article helps readers understand that telehealth reimbursement depends on staying current with payer guidance and documentation expectations.
Article Sections
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CMS and MAC telehealth billing updates
Discusses recent Medicare guidance affecting telehealth claim submission during the public health emergency and the administrative confusion created by frequent policy updates.
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Problems in the Palmetto State
Summarizes an OIG review of South Carolina Medicaid telehealth payments and the documentation and oversight issues identified in that audit.
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Resolve the problems
Offers general advice on keeping up with payer updates and reducing claim issues during a rapidly changing regulatory environment.
What You Will Learn
- How telehealth claim denials can occur when billing guidance changes
- Why Medicare and Medicaid telehealth requirements may be difficult to track
- What types of documentation and oversight problems can affect telemedicine reimbursement
- How practices can monitor payer updates during a public health emergency
Who Should Read This
- Medical coders
- Medical billers
- Practice managers
- Physicians and other clinicians
- Compliance staff
Codes Discussed
Modifiers Discussed
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