Patient Billing, Payment, Insurance Billing and Verification – Telehealth Features Series

In this Telehealth Feature Series, we’re going to cover the long list of potential telehealth features available today.  As you’re considering your own approach to telehealth, we will provide you a look at all the possible features telehealth companies are offering on the market.  Plus, we’ll offer our insight into the nuances of each feature so you can select the right telehealth company or companies you use.  Not all telehealth is created equal, so taking the time to understand all the possible features and options is worth the effort.

The next feature we’re going to cover is Patient Billing, Payment, Insurance Billing and Verification.

Ironically, this used to be one of the most important features for a telehealth platform.  They had to answer the question, how am I going to get paid for the telehealth visit?  When you look at the complexities of billing for telehealth visits, it’s no wonder that telehealth companies have had to look at sophisticated ways to handle patient and insurance billing.

One of the most important features we see in a telehealth platform is the option to collect the patient payment for a telehealth visit.  Often, the payment is collected before the visit, but sometimes it’s requested right after the visit.  Either way, it makes total sense why collecting the patient payment during the telehealth visit workflow is the best option.

While collecting patient payment used to be less of an issue, as co-pays and high deductible plans have increased, the importance of collecting the patient payment while the patient is engaged with you has become extremely important.  I heard one practice manager at the MGMA conference suggest that healthcare organizations need to get into the patient refund business.  His point being that he’d rather over collect a patient and refund them the money than to not collect and then never be able to collect the money from the patient.  That doesn’t work in all areas, but as the patient payment portion of the bill increases this move will become more important.

Outside of collecting the patient payment for a telehealth visit, it’s also important to know if insurance is going to cover the telehealth visit or not.  Doing so, is important to know how much to collect from the patient for the telehealth visit, but it’s also important to know if the telehealth visit is covered or not because neither the patient nor the healthcare organization wants to find out later that it’s not covered by insurance when they thought it was going to be covered.

During COVID-19 this became less of an issue as most payers expanded reimbursement for telehealth visits.  There are still a lot of questions and idiosyncracies that are going to happen with this, but it was relatively easier since most payers embraced telehealth reimbursement.  The problem now is that some commercial payers are pulling back on reimbursing for telehealth or are reimbursing at a lower rate (ie. no payment parity for telehealth visits).  It’s still early days on this, so we’ll see where it goes and if healthcare organizations can make the case for telehealth payment parity or not.  I think some are still waiting to see what Medicare does long term.  However, I think most would agree that telehealth reimbursement from payers is going to be complex.

When it comes to telehealth vendors, I’ve seen some who totally wash their hands when it comes to insurance billing.  They assume that healthcare organizations are going to just bill through their practice management software.  Others have built full insurance billing engines to be able to evaluate if a visit is covered by insurance or not.

Looking at this long term, I think many are hopeful that a telehealth visit will be billed just like a regular visit.  However, I think many payers are really afraid of this idea because of the fraud that could occur.  So, we’ll see where it ends up.  However, this is an area to explore if you’re evaluating various telehealth vendors.

Be sure to check out our full list of telehealth features, our deep dive into each telehealth feature, and our list of telehealth companies.

About the author

John Lynn

John Lynn

John Lynn is the Founder of HealthcareScene.com, a network of leading Healthcare IT resources. The flagship blog, Healthcare IT Today, contains over 13,000 articles with over half of the articles written by John. These EMR and Healthcare IT related articles have been viewed over 20 million times.

John manages Healthcare IT Central, the leading career Health IT job board. He also organizes the first of its kind conference and community focused on healthcare marketing, Healthcare and IT Marketing Conference, and a healthcare IT conference, EXPO.health, focused on practical healthcare IT innovation. John is an advisor to multiple healthcare IT companies. John is highly involved in social media, and in addition to his blogs can be found on Twitter: @techguy.

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