In the past year, healthcare providers have sometimes run into an issue with telehealth not being the best option for a patient’s needs, but the patient is unable to safely visit the office. That has opened up a new opportunity for the provider to look into home visits.
Typically, Medicare actually provides a higher reimbursement for home visits than office visits. They have to be medically necessary, however, which is defined as “services or supplies that are needed to diagnose or treat a medical condition and that meet accepted standards of medical practice.” Physicians will need to properly document the home visit as such to make sure its properly billed and the office is reimbursed. It will need:
  • Substantial proof that the patient is not physically capable of an office visit. It should be based on physical or mental reasons. A financial or personal issue will not be acceptable.
  • Document whether it is a one-time, ongoing, or permanent need, which will be relevant for coding.
When the patient has insurance through a company rather than Medicare, there are limited amount of codes you can use. CPT codes 99241 through 99345 are used for new patients and CPT codes 99347 through 99350 are for established patients.
  • CPT 99341. Code for home visits focused on the evaluation and management of a new patient and require 3 parts: a history summary, examination, and medical decision making. They are typically 20 minutes of face-to-face time with the patient and/or family.
  • CPT 99342. Requires the same components as CPT 99341, but they are typically 30 minutes of face-to-face time with the patient and/or family.
  • CPT 99343. Requires the same components as CPT 99341, but they are typically 45 minutes of face-to-face time with the patient and/or family.
  • CPT: 99344. Requires the same components as CPT 99341, but they are typically 60 minutes of face-to-face time with the patient and/or family.
  • CPT 99345. Requires the same components as CPT 99341, but they are typically 75 minutes of face-to-face time with the patient and/or family.
  • CPT 99347. Code for home visits focused on the evaluation and management of an established patient and require 3 parts: a history summary, examination, and medical decision making. They are typically 15 minutes of face-to-face time with the patient and/or family.
  • CPT 99348. Requires the same components as CPT 99347, but they are typically 25 minutes of face-to-face time with the patient and/or family.
  • CPT 99349: Requires the same components as CPT 99347, but they are typically 40 minutes of face-to-face time with the patient and/or family.
  • CPT 99350. Requires the same components as CPT 99347, but they are typically 60 minutes of face-to-face time with the patient and/or family.
Some programs also offer incentives for providers to participate in, so that could be something for the staff to research for increased revenue opportunities. Plus, they are an important way to accommodate elderly or disabled patients who struggle to attend in-person appointments. Whether you’ve been taking on home visits or not, medical billing can be a complicated process with costly mistakes. The experts at Outsource Receivables Inc. can help your clinic gain more revenue and streamline your processes.
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