3) Telemedicine Billing & Reimbursement

Telemedicine is an excellent way to increase revenue and profitability for your practice. Telemedicine billing is fairly straightforward for both private payers and government payers, such as Medicare and Medicaid. This article will address both.

Private Payers

Most private payers are now reimbursing for telemedicine similarly to in-office visits. In fact, a growing number states require that they do so.

Simply schedule a telemedicine visit by selecting “Telemedicine” as the location for visit and Kareo will automatically verify the patient’s eligibility for telemedicine. Telemedicine-specific eligibility will be found in the notes section of the appointment object.

In terms of coding, standard E/M guidelines apply to telemedicine.
  • Existing Patients: 99213 - 99214
  • New Patients: 99202 - 99203
Recommendations for telemedicine modifier codes will be populated in the notes section upon claim creation in Kareo.
For the patient responsibility portion of payment, we collect a credit card from the patient when the appointment is scheduled. If the patient is insurance eligible, we collect their portion via credit card. If the patient is not insurance eligible, we collect the self-pay fees ( typically $40-$50).

Government Payers

  • Medicare and Medicaid typically do not reimburse for telemedicine when the patient is in the home. However, telemedicine visits ARE reimbursable through Medicare & Medicaid when the patient is located at a qualified healthcare facility in a rural community.
  • More information from CMS on telemedicine reimbursement can be found here: http://go.cms.gov/20WVqC2
  • Many practices still see Medicare patients using telemedicine. Self-pay rates of $40-$50 are typically charged.
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