In the Behavioral Health and Substance Use Disorder (SUD) industry, telehealth has become a crucial tool for ensuring patients receive essential care. However, navigating the billing process for telehealth services in Addiction Treatment Centers requires careful attention to detail. This guide provides comprehensive and updated billing guidelines to facilitate accurate claims processing.
When considering adopting telehealth services, revising the patient intake process is essential. This involves adding specific questions related to telehealth and the patient’s plan into the VOB process. The following questions are essential to gather pertinent information related to telehealth and the patient’s insurance plan:
A standardized script for obtaining authorization from insurance companies is crucial to transition to telehealth successfully. This script includes key steps such as verifying demographics and insurance information and obtaining approval for telehealth sessions. It also emphasizes recording essential details like reference numbers and claim submission information.
For professional claims, it’s advisable to use appropriate CPT codes and apply a modifier with the correct place of service code (02) in most cases. The modifier 95 signifies synchronous telemedicine service through real-time interactive audio and video. However, it’s emphasized that modifier requirements may vary among payers, making it essential to verify for each patient.
Several billing codes are relevant to telehealth in addiction SUD treatment services, including:
Important POS codes for telehealth include:
In institutional claims, where the Place of Service is not on a UB-04, adding a modifier of GT is typical for telehealth. This modifier indicates services rendered via telecommunications.
Here are vital tips to ensure compliance with billing guidelines for Telehealth in Substance Use Disorder (SUD) Treatment :
Implement standardized documentation procedures for patient intake and Verification of Benefits (VOB). Consistent and accurate record-keeping is essential for successful claims processing.
Implement the recommended script for obtaining telehealth authorization consistently. Not only this, but you should also ensure that all necessary information, including demographics and insurance details, is collected during calls to insurance companies.
Stay informed about changes in federal and state regulations related to telehealth billing. You should regularly update the internal processes to align with changing guidelines to avoid compliance gaps.
Double-check and verify the correct application of modifiers (e.g., 95 or GT) based on payer requirements for professional and institutional claims. Thereby, the consistent application helps prevent claim denials.
You should focus on establishing a robust review process for submitted claims. Such a review process will ensure that all required information, such as reference numbers and claim submission details, is accurate before submission to minimize errors.
If utilizing billing software, ensure the system is configured correctly for SUD telehealth services. Leverage available technology to streamline the billing process and enhance accuracy.
Conduct regular internal audits of billing practices to identify and rectify deviations from established guidelines. Proactive monitoring helps prevent issues before they escalate.
Failure to adhere to the above billing guidelines for telehealth in substance use disorder (SUD) treatment can have significant consequences for Addiction Treatment Centers. Non-compliance may result in delayed or denied claims, leading to financial losses for virtual centers. Without proper implementation of changes to patient intake and Verification of Benefits (VOB) processes, there is a high possibility of inaccuracies in billing, potentially resulting in claim rejection. Moreover, applying the correct modifiers on professional and institutional claims may lead to claim denials by insurance providers. This impacts the center’s revenue and also disrupts the continuity of care for patients in need of addiction treatment services.
Outsourcing SUD billing processes to experts like 24/7 Medical Billing Services is the optimal solution in such situations. By outsourcing the billing tasks, Addiction Treatment Centers can focus more on delivering high-quality virtual care services with confidence that their billing processes are in capable hands. This collaborative approach optimizes operational efficiency and reinforces the commitment to providing uninterrupted, quality care to those in need of SUD treatment services.
About 24/7 Medical Billing Services:
24/7 Medical Billing Services is the nation’s leading medical billing service provider catering services to more than 43 specialties across the entire 50 states. You can rely on us for end-to-end revenue cycle management. We guarantee up to 10-20% increase in the revenue with cost reduction of your practice for up to 50%.
Call us today at 888-502-0537 to know more on how we can help boost profitability for your practice.
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