During the pandemic, healthcare providers scrambled to offer care to their patients without exposing them to covid-19. This led to a boon in telehealth facilitated by the widespread adoption of video conferencing technology and relaxed regulations. But even as the pandemic wanes, the interest in telehealth is still going strong. Patients are enjoying the convenience and privacy, while providers get to reduce no-shows and reach people who don’t have the resources to attend in-person therapy.
Despite the widespread adoption of telehealth, each state and insurance company has different rules, and exceptions that were put in place during lockdowns are being removed, making it difficult to navigate the current landscape of telehealth reimbursement. To make sure you can serve your patients and get paid for it, here are 7 questions you should ask insurance companies before conducting telehealth sessions:
Does My Client’s Policy Cover Telehealth?
While teletherapy has generally been covered during the pandemic, it’s not uncommon for insurance companies to require copays for virtual visits. Some states don’t have parity laws, so you might get less money from telehealth than from in-person sessions. There are also insurance companies that have separate networks or PPOs for in-person therapy and teletherapy. That means that even if you’re in a patient’s preferred mental health provider network, your teletherapy services might not be included in their telehealth network, potentially making telehealth visits ineligible for reimbursement. Some states only allow teletherapy from public insurance coverage like Medicaid but will not require private insurance to cover teletherapy. Be sure to keep checking the insurance coverage, as some changes that took place during the pandemic could be cut.
Are Your Services Eligible for Reimbursement?
Even if teletherapy is covered by a patient’s insurance, some services might not be. Diagnostic assessments, standardized tests, and assertive community treatment (ACT) are frequently denied, for example. Sometimes, insurers only reimburse for a set amount of time or sessions. Some companies claim teletherapy is not as effective as in-person visits, so they don’t want to pay equal amounts. Some diagnostics might require an in-person examination. Reimbursement might also depend on the type of provider who offers the service. For example, a patient’s insurance could cover telehealth visits by psychologists or counselors, but not by a social worker.
How Is Telehealth Defined by Insurers?
Find out from the insurance company what kinds of communications qualify as telehealth, such as video visits or telephone, as well as if there are requirements for special software and equipment. Check their HIPAA-compliance requirements; not all insurers have the same. An insurer might refuse to cover a session on phones or tablets, but cover a session conducted on a laptop. You might have to follow guidelines for internet speed as well.
What Is the Billing Modifier and Service Location Code?
Make sure you’re using the correct codes you need to bill for telehealth services. Payers may also have a specific list of CPT codes they approved for teletherapy, which may differ from other companies and in-person services. Even though teletherapy can be conducted from anywhere, an insurance company might require the patient to be at home and the provider in an office, so you might need specific codes for a patient’s house and another for your office.
Are There Location Restrictions by Patient or Provider?
Find out if you can see clients in different geographic areas such as across state lines. States are constantly updating their regulations for accepted telehealth coverage, so be sure to check frequently. Telehealth services consider the patient’s location to be the physical location for billing purposes.
The big question nowadays is about reaching clients in different states. Whether a client is on vacation and still needs their sessions, a patient moved and doesn’t want to get a new therapist, or someone lives close to another state’s border and is closer to a therapist that practices out of their state, practitioners want to reach out to all patients who need them no matter where they live. While requirements were waived during the pandemic, states and insurance companies have let a lot of them lapse. Does that mean you have to get licensed in multiple states? This is especially important because of the rise of mental health professionals who conduct most of their work online since it’s much easier and cheaper than having an in-person location. That’s where the Counseling Compact comes in.
What is the Counseling Compact?
It is an agreement between states that would allow counselors to practice in-person or offer telehealth care in a member state without having to secure multiple licenses. Once a state joins the compact, it means that a practitioner can offer telehealth services in that state, and all the states in the compact.
To check which states are in the compact, visit https://counselingcompact.org/.
How Does the Counseling Compact Work?
According to their website, “professional counselors who meet uniform licensure requirements are able to quickly obtain a privilege to practice, which is equivalent to a license to practice counseling in another state”. The Compact has a system that allows to check and create license status quickly.
While you won’t have to get licensed in another state within the Compact, it does not mean there are no requirements. First, a state’s license requirements must meet the Compact’s. That means if your license does not meet all their requirements, you might need to get another license or fulfill some requirements. You need a current license, background check, potential fees, and more. The uniform licensure requirements for the Counseling Compact are listed here: https://counselingcompact.org/wp-content/uploads/2021/01/Final_Counseling_Compact_.pdf
If you want to reach patients outside of your state, it’s worth making sure you’re part of the Counseling Compact. If not, you might have to get licensed in another state or wait until the legislature brings your state into the Compact.
What Is the Reimbursement Rate for Telehealth?
Find out if the telehealth reimbursement rate is the same as a regular appointment. Not every state has a parity law, and they widely differ from each other. In addition, some insurance companies exploit loopholes to deny telehealth services or reduce reimbursement, such as claiming overuse or lack of effectiveness. A payer may decide that a service is not medically necessary for the patient. Some payers might set different requirements for in-person sessions and telehealth. Some providers can bill for telehealth while others might not be eligible.
What Special Documentation Is Required for Reimbursement?
Find out if you will need to complete additional paperwork (such as a virtual visit attestation) before starting your telehealth sessions. You might need consent forms, documentation about the method used for teletherapy, training certifications and more in addition to the usual documents provided for in-person visits. You might need to prove the technology you use meets all requirements set by the payer.
Always Verify and Get Frequent Updates
Telehealth has the potential to help you reach more patients than ever, in a more convenient manner. But while technology moves fast, requirements from states and insurance companies can widely vary and change constantly. Take advantage of things like the Counseling Compacts and tools showing you telehealth CPT code updates. Keep up with payer’s coverage requirements and changes that might come up. Make sure you don’t turn convenient sessions into surprise bills. Telehealth is still relatively new, with all the exciting innovations and confusing regulations always brought by emerging technologies.
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