CTP Documentation and Billing 5

Question 1

A rural health clinic (RHC) patient receives a telehealth visit from a specialist at a distant site. Which facility is eligible to bill for an originating site fee?

Accepted Answer

The rural health clinic where the patient is physically present

Answer

Under Medicare, an approved originating site facility like an RHC may bill HCPCS code Q3014 for the originating site facility fee when hosting the patient.

Question 2

A telehealth provider documents 'patient connected via video, audio quality adequate, patient identity verified.' Why is this type of statement important?

Accepted Answer

It demonstrates the service met synchronous telehealth standards required for billing with Modifier 95 or GT

Answer

Documenting that a real-time audio-video connection was established and functional supports the use of synchronous telehealth modifiers and defends the claim in audit.

Question 3

Under the 2024 CMS rules, which provider type is NOT on the list of eligible distant site providers for Medicare telehealth?

Accepted Answer

Dentists providing dental care

Answer

Medicare telehealth coverage does not extend to dental services; dentists providing dental care are excluded from the Medicare distant site provider list.

Question 4

Which of the following best describes 'upcoding' in the context of telehealth billing?

Accepted Answer

Billing a higher-level E/M code than the documentation supports

Answer

Upcoding is billing for a higher service level than actually documented or provided, which is considered fraud and can result in significant penalties.

Question 5

A practice discovers that 50 telehealth claims over the past year were incorrectly billed with Modifier 95 when the visits were actually audio-only. What is the appropriate corrective action?

Accepted Answer

Conduct a voluntary repayment to the payer and correct future claims

Answer

When billing errors are identified, providers should conduct a voluntary disclosure and repayment to avoid False Claims Act exposure, and correct processes going forward.

(CTP) Certified Telehealth Practitioner Practice Test

(CTP) Certified Telehealth Practitioner Practice Test

CTP Documentation and Billing 5