Telemedicine Billing Rules
Description:
As forms of telemedicine have become more widely covered for outpatient rehab, TheraOffice has added additional features to accommodate these new practices. Since there is some variation between payers on the allowed codes, as well as the required POS and modifiers, users can create custom Telemedicine Billing Rules to accommodate each of your payers individually without affecting other payers or in-office visits.
Applies To:
TheraOffice Onsite and Web, version .18 or above
Creating Telemedicine Billing Rules:
The addition of the Telemedicine Billing Rules feature allows you to create multiple sets of Billing Rules for each payer individually, reducing the amount of manual work for providers and billers entering charges. Each insurance can have its own Telehealth and Evisit Billing Rule set up, an one set of billing rules can be applied to multiple insurances if you prefer. To set up a Telemedicine Billing Rule:
The image above represents the Manage Menu with Telemedicine Billing Rules selected.
1. Navigate to the Backstage Menu and Select Manage. At the bottom of the Manage menu, select Telemedicine Billing Rules.
2. This will open the TeleMedicine Billing Rules. To create a new set of rules, choose Add TeleMedicine Billing Rule from the top toolbar. To edit existing rules, highlight the rule and select Edit TeleMedicine Billing Rule or double click.
The image above shows the TeleMedicine Billing Rule window.
3. This will open the TeleMedicine Billing Rule window. A new set of rules will appear blank, while selecting a set to edit will generate with the existing rules.
4. Here, you will add or edit any of the codes which your payer has indicated will be a covered service for TeleMedicine. You can also inidcate the appropriate Place of Service (some payers prefer 02, while others accept 11--be sure to confirm with your payer which they prefer) and Type of Service for UB-04. You can also indicate the required modifiers for each PT, OT, and SLP services.
5. When finished, click Save & Close.
Linking your Rules to an Insurance:
Once your billing rules have been created, they will need to be linked with the appropriate payers.
The above image shows where to locate the Insurances menu under the Manage option.
1. First, navigate to the Backstage Menu and Select Manage. Under the Manage window, choose Insurances.
2. Double click to select the insurance you would like to edit. Or, highlight the insurance and click Edit Insurance from the top toolbar.
3. This will open the Insurance window. Select the Charges / Payments / Billing tab at the top.
4. On the Charges / Payments / Billing tab, you will see the Telemedicine Billing Rules section near the bottom.
The image above shows the Insurance window with the Charges / Payments / Billing tab selected and the Telemedicine Billing Rules section highlighted in yellow.
5. Use the drop downs to link the Telehealth and/or E-Visit billing rules. Click OK to save.
Visit Types:
To indicate to the system which set of Billing Rules to use (ex: fee schedule, Telehealth, or E-Visits), the provider will mark the visit type on each document. This eliminates the need to create different cases for telehealth services and reduces the margin of error when the patient transitions back to regular in-office visits.
The above image shows the New Document window with Visit Type highlighted in yellow and the dropdown option expanded.
These visit types are indicated when the provider opens a new document, whether from the New Document button or a Document Organizer.
When a provider selects a visit as In-Office, the Suggest Charges feature will refer to that insurance or case's indicated fee schedule. If the provider selects Telehealth or E-Visit, the Telemedicine Billing Rules for that insurance will overrule the fee schedule, generating the correct POS, TOS, and modifiers.