THIS ARTICLE IS NOW OUT OF DATE DUE TO COVID-19 CHANGES: FOR THE LATEST INFORMATION GO TO www.theinsurancemaze.com/coronavirus
Video and Phone Sessions — Will Insurance Pay?
By Barbara Griswold, LMFT (Updated September 7, 2018)
One of the most frequent questions I get in my consultations involves billing for telehealth. “Many therapists think they can just pick up the phone or jump on Skype and their session will be covered by insurance. Nothing could be further from the truth,” says Marlene Maheu, Ph.D., Executive Director of the Telebehavioral Health Institute (telehealth.org). For the answers to your questions in this area, I’m interviewing Marlene, an internationally-known expert on this topic.
BG: First, Marlene, how is telehealth defined?
MM: It varies depending on state law. Some states don’t include telephone, email, text or chat-based sessions, while others do. Always go to the state’s website and search for their definition.
BG: Do insurance plans cover telehealth?
MM: In a majority of states, state law requires “telehealth parity,” that is, that all insurance plans must cover telehealth. Rates are usually also addressed, with most states requiring insurers to pay clinicians at the same rate for a telehealth session as they would in-person sessions. In these parity states, you might still find a payor who refuses payment based on technicalities, but this can be challenged if it is clear that they are denying coverage simply because the encounter is telehealth-based.
BG: How will I know how my state defines telehealth, and what laws apply?
MM: Go to the Center for Connected Health Policy (CCHP) website at www.cchpca.org; click on “Telehealth Policies for All 50 States.”
BG: Let’s say I have a client interested in telehealth. What should I do?
MM: Contact the plan and check coverage for telehealth and any limitations. Remember, one Blue Cross client might have telehealth coverage and another Blue Cross client might not. Ask what you must do to provide telehealth to members (if anything). Some plans require preauthorization, or require you be on their telehealth provider list, or attest to knowledge of state telehealth laws. Ask for any coding tips, if they have them.
BG: How are telehealth sessions coded?
MM: Use the CPT code for the type of session you provided (ex. 90834, 90837) followed by the modifier 95 to indicate it was a telehealth session (on the CMS-1500 claim form this goes in Box 24D in the column marked “Modifier”). Also, you should list the Place of Service Code as 02 (the telehealth code) on your invoice or in Box 24B on the claim form. Remember, you can only use these codes for sessions that meet your state’s definition of telehealth.
BG: Is modifier GT being phased out?
MM: Yes, it’s gone, replaced by modifier 95.
BG: How do I choose a platform to provide video therapy?
MM: Don’t use Skype or Facetime – they are not currently HIPAA-compatible. To view our list of HIPAA-compatible video platforms click here
BG: Is it true that some plans won’t cover telehealth when the client is in their home?
MM: Yes, this is sometimes the case, and is true with Medicare at this point in time, but not necessarily Medicaid.
BG: What about when a client travels out of state?
MM: The general rule is that you shouldn’t provide services unless you are licensed in the state that the client is in at the time of the session, but don’t assume it can’t be covered. Contact the licensing board in the other state and in your state (email may be best). You may need to take a jurisprudence exam to show awareness of the other state’s documentation laws and local reporting laws, but it may be a simple, open-book test. You should also check with your malpractice carrier to see if you are covered in this situation. Some states will simply register you, and others don’t even require that. The thing is, cover yourself by having contacted them ahead of time. And waiting until the last minute is not a good idea, since some states require a few months to get back to you.
BG: What if I travel out of state and provide services to a client in my home state?
MM: Your physical location at the time of the session can also be an issue, so always contact the state board in question — and contact your own. Some states such as Florida and Alaska have very specific requirements and associated fees for professionals who are out of state and serving people on their turf at the time of the session.
BG: What are the biggest mistakes providers make when billing for video therapy?
MM: First, not billing for telehealth, assuming it won’t be covered. Second, not calling the payer in advance to find out coverage, authorization requirements, billing timelines, whether they cover out of-network providers, etc. Third, not documenting the details from this call, including who you spoke to, the number you called, the date, the representative’s department, a call confirmation number, and what they said.
BG: How would I challenge a denied telehealth claim?
MM: If you’ve confirmed that state law says it should be covered, copy the related legal statute and its source, including the link, if applicable. Forward this information to your payer. If this first step fails, go to the Telehealth Resource Center (www.telehealthresourcecenter.org) or the CCHP to seek resources to challenge the decision. You may also want to contact your state’s Department of Insurance, your governor, or your elected officials to rally support and resources. This also is when belonging to a state or national professional association can be very helpful. Recruit their advocacy departments and see if they can help. Providers need to speak up to get such circumstances changed.
BG: What if my state doesn’t mandate coverage?
MM: Again, fight it. Write to your Congressional representative or governor. This won’t change without a legislative mandate.
BG: I worry that many providers just start doing telehealth sessions without getting all-important training on the clinical, ethical, legal, technological, and practical differences of providing therapy this way.
MM: Yes, that’s true. At our Institute we provide many different levels of online training for someone interested in providing telehealth services. If you are interested visit telehealth.org/courses, you can choose between a Basic Course or two more in-depth Telehealth Professional Training Certifications, whatever fits your needs.
BG: Thanks, Marlene! And to all my readers: I strongly recommend TBHI’s trainings and urge everyone to subscribe to their e-newsletter. I also recommend that readers download the American Telemedicine Association’s Practice Guidelines: click here.
Remember, if your client’s insurance doesn’t cover video or phone sessions, of course you can still do them. Draw up a Private Pay Agreement for the client to sign, stating s/he understands the service is not covered, that insurance won’t be billed, and outline the costs (a Sample Agreement is in the back of my book).
For more helpful articles like this, click here. For more help navigating the insurance maze, contact Barbara.