Telemedicine — A Growing Trend In Urgent Care?

Though telemedicine has been around for several years, due to the raging Coronavirus pandemic more and more urgent care centers, hospitals, practices, and patients are discovering the importance and ease of use of telemedicine. Other benefits of telemedicine include cost savings, hassle-free medical consultation for patients, and convenience of treatment from the comfort of your home.

But even though telemedicine services have their benefits, there are several challenges that continue to pose difficulties for medical staff, especially those involved in urgent care billing. Adequate systems need to be put in place and urgent care staff trained to appropriately bill telemedicine services.

Listed below are 3 common reimbursement difficulties that are keeping several urgent care providers from turning to telemedicine.

  1. Lack Of Ongoing Relationship With Patients

Unlike a traditional urgent care setting where there is face-to-face interaction with patients as well as a series of phone interactions, telemedicine to a large extent fails to create a long-term relationship with patients. That’s because patients seeking treatment are probably not going to return to the urgent care center for more services or consultations. A one-time consultation can become a long-term hassle. This becomes a challenging scenario especially when the billing staff require necessary patient information such as their insurance details or want to find out if there has been a mismatch in the services available.

In a non-telemedicine urgent care setting the staff can sort out the missing details by either calling the patient or verifying when the patient visits again for a service or checkup. But in the case of telemedicine this is not always possible, especially while following up with new patients who may have made only a one-time call and never called back again. Reimbursements of such patients becomes a challenge for the urgent care billing staff who are unable to chase the patient for insurance claim information or for the services they availed that were not billed.

2. Lack Of Upfront Urgent Care Admin To Check Paperwork

In a telemedicine setup since there is no front office staff to perform checks on patient information, urgent care centers face a lot of reimbursement issues and claims denials. In a typical urgent care clinic or physician’s office the admin desk carries out all the checking and verification formalities even before the patient is evaluated. Patients are made to fill or double check their personal and insurance information before they are seen and this minimizes errors and denials. Because this is not possible in the case of telemedicine, a lot of unverified information causes billing issues. A lot of checks remain suspended and errors of typos, incomplete patient information, and misunderstandings remain unresolved, leading to claims denials.

Some of the main reasons that lead to claims denials and pose difficulties for urgent care billing centers include:

  • Service not covered by insurance
  • Provider out of network
  • Policy no longer covers the patient
  • Pre-authorization required
  • Missing information or incorrect detail, such as name of patient, date of birth, ID number, etc.

 

3. Absence Of Clarity Of What Is Covered And Who Covers It

Many commercial insurance plans do not cover telemedicine visits. This creates a lot of confusion about what is covered and who covers what. This is one big reason why many urgent cares are not comfortable with this new trend of telemedicine.

There are some telehealth procedure codes that Medicare covers, but it’s not easy to bill them. Urgent care billers not only need to get the procedure codes right, but also have to use a GT modifier that indicates the service was offered via telemedicine.

Also, billing centers need to bill the MAC that covers the provider’s location. To ensure services are billed appropriately in the coming times, adequate efforts will have to be made so bills from numerous states can be reimbursed.

Gables Medical Billers Can Help             

Our experts at GMB can help your healthcare facility if it is struggling with integrating your telehealth services into the urgent care billing process. As a specialist in medical billing, our staff is well trained and up to date with the changing rules about coding and submission of claims. For more details you can call a GMB urgent care medical billing specialist today: 786-725-2120; 655-469-1422 or email at [email protected]