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  • Writer's pictureAHAP Inc.

Telehealth Audit Checklist


With the outbreak of coronavirus (COVID-19), many providers, outpatient clinics and facilities find themselves not ready for telehealth visits. The need for Telehealth services have never been more essential than now. Healthcare teams need to be able to treat their patients from a distance and in real-time.

With expansion of telehealth Insurance companies and Medicare are updating and changing telemedicine policies almost on daily basis. Billing telemedicine sometimes can seem confusing and overwhelming. There are specific professional codes (CPT/HCPCS) that can be used to report telemedicine and telehealth services. Telehealth reimbursement can vary depending on your state, practice, services, and the third-party payer.

Use Detailed Documentation

There are many questions most often from providers and organizations about telemedicine CPT codes for billing claims.

· How should we bill telemedicine?

· What codes should we use?

· Are bills accurately coded?

· Does the documentation support the service coded and billed?

· What are the restrictions and how does telemedicine reimburse?

Patient records for all services provided via telehealth must be maintained in a manner consistent with telehealth standards of practice and there are certain documentation requirements that must be documented in patient charts for all telehealth services provided and represent Best Practices in the delivery of elemental health services.

· Ensure that the CPT code listed on the claim matches the telemedicine service documented in the medical record including modifier.

· Ensure that the CPT code billed is an allowed code per state telehealth policy.

· Ensure that the documented date of service matches the date of the claim.

Perform Regular Audits

To ensure better coding accuracy, schedule regular audits to discover if you have any coding issues. With expansion of telehealth, now more than ever regular coding audits has become an important aspect of any healthcare provider. Insurance companies and Medicare are updating and changing telemedicine policies almost on daily basis. Regularly scheduled audits can identify areas where additional training or support may be necessary.

We understand keeping up with constant medical coding changes can be overwhelming at times and may even be costly as it relates to training and education. But it is necessary to ensure that you can always provide accurate coding. If you are too busy to manage your coding efforts or do not have the financial means to be on top of the latest changes, consider adding outside audit services and outsourcing your coding practices to a coding expert.

Contact us to learn more about any of the services we provide and to discuss how we can help you achieve your objectives.

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