Telehealth isn't just a passing trend. It's a fundamental shift in how healthcare reaches patients, and it's here to stay. With this shift, billing practices need to adapt swiftly to handle the nuances of telehealth, including multi-state regulations and audio-only consultations. Picking the right software is critical — and not just any system will do.
What Makes Telehealth Billing Unique?
Telehealth billing comes with its own set of challenges. Multi-state operations involve navigating varying payer rules, which can be a headache without the right tools. Add in audio-only visit capabilities and it's clear that not all billing software is equipped to handle these complexities. What works for in-person visits often falls short here. For instance, many systems are slow to update for new telehealth CPT codes, costing practices time and money in rework and denials.
Key Features for Telehealth Billing Software
When evaluating billing solutions, focus on specific features tailored to telehealth:
Multi-State Support: Your software must accommodate the regulatory differences between states. This includes handling various parity laws and Medicaid reimbursement policies. Missing this can lead to denials and compliance issues.
Audio-Only Billing: Not every platform supports this well. If your practice conducts audio-only visits, ensure your billing software can appropriately code and bill these sessions. Look for software that automates updates to CPT codes specific to audio-only visits.
Real-Time Payer Updates: New codes and payer rules can appear overnight. Software that integrates real-time updates directly from payers prevents costly mistakes.
Workflow Automation: Automating redundant tasks provides breathing room for your team. From claim submissions to denial management, automated workflows enhance efficiency and reduce errors.
Top Picks for Telehealth Billing Software
Here are some standout options that cater specifically to the needs of telehealth practices:
Kareo
Kareo's platform is robust for telehealth billing. It includes features that streamline billing across multiple states and supports audio-only visits fully. Kareo updates its coding library frequently, ensuring compliance with the latest telehealth regulations. Additionally, it's known for a user-friendly interface that doesn't require extensive training.
AdvancedMD
AdvancedMD offers an integrated approach to telehealth by combining scheduling, documentation, and billing in one platform. Its robust billing engine handles multi-state guidelines efficiently. The audio-only support is reliable, making it a solid choice for practices that need flexibility. Plus, its reporting tools provide insights into revenue cycle performance, helping you identify bottlenecks.
Athenahealth
Athenahealth stands out with its cloud-based system that ensures continuous updates — essential for staying ahead of telehealth billing changes. Their software supports multi-state operations and audio-only visits. A unique feature is its predictive analytics capabilities, which help anticipate billing issues before they become costly mistakes.
DrChrono
DrChrono offers a comprehensive telehealth solution with billing capabilities integrated. It supports a wide range of telehealth CPT codes and updates regularly to include audio-only billing. Its open API allows for flexibility and customization, which can be particularly beneficial for practices with unique needs.
The Challenges of Multi-State Telehealth Billing
Operating in multiple states introduces a labyrinth of regulations. Take California and Texas, for example — both have different telehealth reimbursement rules and parity laws. Practices need a billing system that adapts to these differences seamlessly. Without this capability, a practice might face increased denial rates or compliance issues leading to potential penalties.
Handling Denials and Reworks
Denials are part of life in medical billing, but they shouldn't dominate your workflow. On average, denial rates hover around 10-15% for practices not optimized for telehealth billing. With the right software, you can cut this down significantly. Look for platforms with strong denial management features that identify the root causes of denials and automate re-submissions.
Maximizing Efficiency with Automation
Automation in billing software isn't just a nice-to-have — it's crucial for handling the increased load telehealth can bring. From verifying patient eligibility to posting payments, automation frees up your staff to focus on higher-value tasks. This can be a game-changer, especially as telehealth continues to grow.
Real-Life Example: Automation in Action
Consider a practice that sees 40% of its patients via telehealth. By using automation to handle eligibility checks and claim submissions, they reduced manual entry errors by 30%. That's less time on fixing errors and more time on patient care.
The Payer Problem: Staying Ahead
Payers are notorious for slow updates, especially when it comes to telehealth CPT codes. Some billing systems, like Athenahealth, integrate directly with payer portals to fetch the latest updates automatically. This integration not only speeds up the billing process but also ensures accuracy.
Quirks of Payer Portals
Anyone who's spent time on payer portals knows they can be a mixed bag. Some are straightforward, while others — we're looking at you, Medicare — seem designed to frustrate users. The right billing software can help bridge these gaps, pulling necessary data without the manual hassle.
Final Thought: Stay Adaptive
Telehealth isn't static, and neither should be your approach to billing it. The ability to quickly adapt and respond to changes in telehealth regulations and payer requirements will define successful practices in the coming years. With the right billing software, you can not only keep pace but also thrive in this dynamic field.
Choose wisely — the right tool can make all the difference.
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