Telehealth: Billing Insurance & Getting Paid – Ask a Biller Episode 2

Written by Phillip Ziff on March 16, 2018
Telehealth: Billing Insurance & Getting Paid


In Ask A Biller Episode 2, Dylan and Maggie answer all of your questions about billing insurance for Telehealth sessions. They mention many great resources, which you can find below.

See the full transcript here:

Maggie: 00:04 Hi everyone, and welcome to this Telehealth episode of Ask a Biller. I’m Maggie. I’m an insurance specialist at SimplePractice.

Dylan: 00:12 Hi. And I’m Dylan, I’m a medical billing specialist for SmartBilling Pro.

Maggie: 00:15 Telehealth features are coming soon to SimplePractice. We’re really excited, so we put together this webinar to make sure that you’re ready and laying down a foundation on what to prepare, what to know, and most importantly, how to get paid.

Dylan: 00:28 Telehealth can be a great alternative to traditional office visits, especially for clients with limited mobility or people in rural areas where access to treatment is limited. Thanks to everyone for sending in your questions today and for joining us. Let’s get started at the beginning with HIPAA guidelines and how they relate to Telehealth.

Dylan: 00:46 Our first question comes today from Nicole.

Maggie: 00:49 Nicole asks, “What are the Telehealth regulations and is Skype HIPAA compliant?”

Dylan: 00:55 HIPAA compliance guidelines for Telehealth are basically the same as in person, but with one notable difference: you need an encrypted and secure communication platform. This means that you shouldn’t be using Skype, email, or text messages.

Maggie: 01:08 So, these platforms don’t have a Business Associates Agreement or BAA. This means Skype doesn’t take responsibility for protection of data and they don’t do routine security audits. You would be solely responsible for any breach of data that could occur, and there’s a good chance you’d fail a HIPAA audit.

Dylan: 01:27 So, basically what you’ll need is a secure messaging solution for Telehealth sessions and monitoring your client’s Protected Health Information or PHI.

Dylan: 01:36 You should be able to monitor and remotely delete PHI as needed. A good secure messaging solution will provide the same basic features as Skype, but it’ll be HIPAA compliant. Only authorized users will have access to PHI. The channel of communication will be secure and it will be actively monitored.

Dylan: 01:54 All images, videos, and documents will be encrypted to make them unreadable and unusable if a message is intercepted over public wi-fi.

Maggie: 02:02 And our next question comes from Jacob. Jacob wants to know, “Which insurance plans will reimburse Telehealth sessions?”

Dylan: 02:10 All right, Jacob. Many states now require commercial payers to offer Telehealth services. These are called parity laws. If your state has a parity law, any payer should reimburse for Telehealth if the client’s policy allows for it.

Dylan: 02:24 The major payers, Blue Cross/Blue Shield, Humana, Cigna and Optum, and United Healthcare all cover Telehealth. Aetna does as well, but they’re not embracing Telehealth in the same way as the other insurances listed above, so be aware of that going into it.

Maggie: 02:40 And Telehealth coverage still depends on your client’s policy. Make sure you’re verifying the individual client’s policy and never just assume that it’s a covered service.

Maggie: 02:50 We’re going to go over identifying client-specific coverage based on policy in just a little bit here.

Dylan: 02:56 Alright, so Carmen wants to know, “Will Telehealth require separate credentialing?”

Maggie: 03:03 The best answer here, Carmen, is it depends. If you’re already contracted with the payer and Telehealth is a covered benefit under client-specific policy, then you should be in the clear. But each state and each payer has unique requirements.

Dylan: 03:16 For example, Cigna has an online attestation form you can fill out prior to rendering services. They’re basically just asking you to attest that you only do services in state or states that you’re licensed in; they want to know that you’re using a HIPAA-compliant method of communication, and really they just want you to attest that you’re gonna meet the state requirements to practice Telehealth.

Maggie: 03:36 While we can’t go over every individual state’s guidelines here today, we’re going to do our best to provide you some of the most common rules and point in the direction of resources for your state.

Dylan: 03:47 Okay, now we’re gonna take another question, and this one comes from Rebecca. She’s wondering, “How do you check benefits for Telehealth?”

Maggie: 03:55 Great question, Rebecca. We suggest that you call provider services with the number on the back of the client’s insurance card. This is basically true for all verification of benefits.

Maggie: 04:04 The issue with mental health coverage is that sometimes it’s handled by a third party, which is not the primary insurer, and this information isn’t generally on the card or available online.

Maggie: 04:16 So, I think what’s important to know here is how to best navigate the automated phone systems to get the information that you need. The bottom line is that if you want to be 100% sure, you need to get a live representative on the phone.

Maggie: 04:31 Once you’ve connected to the benefits line, you can usually press 0 or say “representative” to get an operator. Then, you want to be sure you have the info you need so you can ask the right questions.

Dylan: 04:43 Here’s what you’re going to need: you’ll need your NPI, your Tax ID number, and sometimes they’re going to ask you to verify your office location. They will also usually ask you for your first name and a call back number, just in case the call gets dropped.

Dylan: 04:57 On the client side, they’re going to need the client’s subscriber ID, date of birth, and full name. Occasionally, they will also ask you to verify some additional information like the client’s address or a phone number. For more information on best practices for calling to verify benefits, be sure to download our Telehealth insurance questions checklist, available on our blog.

Dylan: 05:16 These questions are important for setting yourself up to bill Telehealth medicine services successfully. Don’t be afraid to call again if you don’t get all the info on the first try.

Maggie: 05:25 All right, and our next question comes from Lindsay. Lindsay asks, “Where can I find resources to determine if Telehealth is covered in my state? If it is, does it then vary by insurance plan?”

Dylan: 05:39 You see, most states have something called parity laws that we discussed earlier, and they make payers reimburse Telehealth sessions the same way or similar to in-person sessions.

Dylan: 05:48 These do vary from state to state, so we recommend learning your state’s laws. The American Telehealth Association is a really good resource for keeping up to date on parity laws in your area. You can also confirm with the commercial payers in your region to see what is allowed.

Maggie: 06:04 And here on the slide, we’ve put together a list of 29 states where informed consent is required before you can be reimbursed for Telehealth, and this is a map that includes states with parity laws for private insurance coverage of Telemedicine.

Dylan: 06:22 Okay, and now this question comes from Emily, and she’s wondering, “Where can I find out my state’s policy around Telemedicine?”

Maggie: 06:30 Emily, you can find those questions online at the Center for Connected Health Policy or is another great resource to find out what your state is doing to expand on Telemedicine coverage and just keeping up with that news in general.

Dylan: 06:50 And don’t worry about trying to jot this all down right now; again, we’ll have links on our blog.

Dylan: 06:56 And let’s get another question. This one’s coming from Megan, she asked us: “Do all insurances pay for Telehealth? Do they have different requirements, or is it all standard?”

Maggie: 07:06 There are no set standards for Telehealth. It varies from plan to plan and state to state. Since most states now have parity laws in place, commercial payers have to recognize Telehealth as a viable treatment.

Maggie: 07:17 Some payers follow the more restrictive Medicare guidelines, while others set their own. For example, in California, within state lines, payers can’t deny coverage due to a client’s location. But this is not universal. On the other hand, in Arkansas, patients are required to be in a physician’s office or hospital in order for the session to be legitimate and services can only cross the state line if the treatment was initiated in Arkansas.

Maggie: 07:44 As you can see, there are a lot of really strange intricacies and it’s super important to review your state’s rules carefully.

Dylan: 07:53 All right, we’re going to take another question. This one’s from Ulla. She was wondering, “Can sessions be done from a professional office and home office? Can client and therapist be in different states? For example, on vacation?”

Maggie: 08:08 So, that also depends. Payers will evaluate the session based on the client’s location. This can make Telehealth across state lines ineligible for reimbursement, so Medicare guidelines are pretty strict.

Maggie: 08:19 Medicare states that in order to qualify, the client must in what is known as an originating site. Originating sites authorized by states are for example, a doctor’s office, a hospital, or a clinic. Here’s a full list of what Medicare considers originating sites.

Dylan: 08:38 Many payers have much more relaxed criteria for services because they want Telehealth to be more convenient for clients. This means that more and more often these days, clients can seek treatment from home. You can check to see if your office is an eligible Medicare originating site, and we’ll have the list of links in our blog to where you can find that information out.

Dylan: 08:56 Many states are looking at adopting what’s known as licensure compacts. These are agreements that would honor your license in multiple states. These laws are always still progressing, so make sure you look up where your state stands.

Maggie: 09:12 The next thing we’re going to cover is preparing your claims for Telehealth properly. There are two main differences between coding Telehealth and in-person sessions.

Maggie: 09:19 Let’s take a few questions so we can touch on what those are. Our first question is from Ariel and the question is, “What is the difference between coding for Telehealth and in-person sessions?”

Dylan: 09:31 Alright, this is a really important question and answer, so let’s get into it. You can apply many of the same CPT or service codes you currently use for in-person sessions for Telehealth as well.

Dylan: 09:41 The best way to think of it is this: only use the codes you are already eligible to submit on your claims.

Dylan: 09:48 The big difference here is that you need to add modifiers to your CPT codes, and modifiers are an additional code that you can combine with your CPT code to indicate special circumstances occurred. Medicare and Medicaid require that you add the modifier GT and you’re gonna put this in Box 24D.

Dylan: 10:07 Starting in 2017, commercial insurances introduced the modifier 95 to reflect synchronous Telehealth services. This means the sessions were rendered in real-time using interactive audio and video.

Dylan: 10:21 Let’s take another question. This one comes from Phil. He’s wondering, “Can I bill Telehealth the same way that I bill a phone consultation?”

Maggie: 10:28 That’s a great question, Phil. No. Telehealth modifiers indicate that the care was provided face-to-face via interactive video. To bill a phone session, you’ll use the same coding guidelines that exist for phone consultations.

Dylan: 10:45 Alright, then next, Steven has a really great question that we need to clarify so that you guys can get paid with Telemedicine or Telehealth. “What location and codes do I use? Some say ‘office’ and others say ‘Telehealth’ but I’ve heard both ways being denied.”

Maggie: 10:59 Well, Steven, we recommend replacing 11, the code that equals office with 02, for Telehealth in box 24B on the claim form. Selecting the correct location and modifier will be your best bet for getting the claims accepted.

Maggie: 11:14 Having said that, there could be a lot of reasons still why claims get denied, which is why earlier, we recommended confirming the client’s benefits before you render the service.

Maggie: 11:25 And our next question is from Beth, and Beth wants to know, ” What are some common reasons for denials?”

Dylan: 11:33 Well, to put it generally, the most common reasons for your denials will be very similar to your in-person sessions. Improper coding of the CMS or HCFA 1500 form will be the biggest source of denials per usual.

Dylan: 11:45 Not choosing the proper location, omitting modifiers, or using the wrong one will cause these issues and that’s why we just went over some guidelines to help you be more successful.

Maggie: 11:56 Be careful not to accidentally code a Telehealth session as though it occurred in the office. This could be seen as fraud.

Maggie: 12:03 If this does happen, be sure to send a voided or cancellation claim and refund any reimbursement that you received as soon as you notice the error. The area on the claim to adjust is the resubmission code box, or box 22, where you can select ‘cancellation.’

Maggie: 12:19 If you’re using a CMS 1500 form not directly in SimplePractice, then the resubmission code would be the number 8. Don’t forget to enter the Claim ID, also in Box 22, where it says ‘original reference number.’

Maggie: 12:35 This is so the payer knows which exactly claim to void, and keep in mind that payers are closely watching practices administering Telehealth as they work to determine the viability and benefit they provide.

Maggie: 12:47 It’s super important to be really careful and cautious when filing these claims.

Dylan: 12:52 The other major reason for denials that you’ll see is simply not verifying benefits before the session. Don’t take a chance and just hope that everything’s going to work out and your client will be covered.

Dylan: 13:03 Do everything you can to understand the guidelines and verify the benefits before the session. And always remember:

Maggie: 13:10 Verification of benefits is not a guarantee of coverage.

Maggie: 13:14 Mitzi wants to know, “Will Telehealth sessions be available through SimplePractice?”

Dylan: 13:19 Okay, everyone. So this is the question that we’re most excited to answer, and so I just want to let you know that our product team is currently working on developing Telehealth for SimplePractice. It will be very easy for your clients to access and will be fully integrated into your SimplePractice account.

Dylan: 13:35 We’ll keep you guys posted over the next few months as we get closer to the release.

Maggie: 13:40 And that about does it for this special episode of Ask a Biller. Now that we’ve covered the basics of Telehealth, you can feel prepared to research and follow the proper guidelines for your region and understand the tricks of the trade when filling out your claims.

Dylan: 13:52 Alright guys, well, we’ll see you next time. And until then?

Maggie: 13:56 Keep it simple.

Dylan: 13:57 Keep it simple.

Webinar slides:

Download webinar slides

ask a biller telehealth slides

Telehealth payer verification guide:

Download payer guide

telehealth payer verification guide

To check your state’s requirements, use these resources:

Other resources mentioned:

Watch more:

Previous episode:
Episode 1: Enrollments

Next episode:
Episode 3: Verification of Benefits

Read more

About the Author

Phillip is the Product Marketing Manager at SimplePractice. He's an ENTP, owns over 30 board games, and can be seen around LA performing improv comedy.

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