Tele Health Question-Asking for Clarity

[socaldk]

We have a client who insists that they can bill "tele-health" (95) when the provider only does a phone call.

We can not find any exception to allow this. It is our contention the CMS does pay for phone calls (but at a MUCH lower rate).

The client wants to bill for face to face when knowingly using only voice. Their contention is that they won't be audited.

We know the doctor can state that the "did" visit using face to face technology even if they didn't. That becomes an "issue" for the doctor. We're wondering if we accept that note and the doctor didn't actually do the face to face phone call, if we're "liable" in any fashion.

Thoughts?

[Michele]

Under normal circumstances that would not be allowed, however during COVID19 they are allowing phone only.  Are they wanting to do this all the time?  Or just during the pandemic?

[kristin]

You mentioned CMS...was this a Medicare patient? If so, Medicare has published rules about what codes should be billed if a patient is "seen" over the phone only, or with video also. There are different codes depending on what the doctor actually did, and the doctor cannot bill for a video call if all they did was a phone call with no video element. You will be liable if you submit a claim that is not accurate.