decisionhealth Newsletters, Part B News - 2020 Issue 12 (December)
Telehealth update: Make sure to lock in medical necessity before billing phone E/Ms
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Article Overview
This article explains how telehealth policy during the public health emergency affected billing for telephone evaluation and management services and why practices need to confirm medical necessity before submitting claims. It is aimed at coders, billers, compliance staff, and clinicians who work with Medicare telehealth claims and need to understand documentation expectations, payer scrutiny, and audit activity. The discussion also touches on general CPT reporting requirements and the broader oversight environment for telehealth services.
Why This Topic Matters
Telehealth billing rules changed rapidly during the pandemic, and this article highlights why practices must distinguish routine communication from reportable services. It also alerts readers to compliance and audit exposure tied to documentation and medical necessity.
What You Will Learn
- How telehealth billing concerns apply to telephone-based evaluation and management services during the public health emergency.
- Why medical necessity and documentation matter for telehealth claims.
- What types of payer and audit scrutiny are associated with telehealth services.
- How general CPT reporting considerations affect telephone visit claims.
Who Should Read This
- Medical coders
- Billing staff
- Compliance professionals
- Physicians and other clinicians
- Practice managers
- Auditors
Codes Discussed
Code Ranges Discussed
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