As with most billing and reporting practices in behavioral health, you have to pay close attention to a host of often complicated requirements if you want to maximize reimbursements. Those rules often vary from payor to payor, and in some cases, by state. Before venturing too far into the process of establishing these services, you will need to do a good deal of research around which providers are eligible to bill which payors for telehealth (sometimes called telemedicine or telepsychiatry). Telemedicine services can be lucrative, but you have to explore your options carefully. As always, the last thing you want is to perform services that end up being non-billable or even illegal.
Once you’re clear on the parameters surrounding providing telehealth services, you can move along to understanding how to use billing codes. In some jurisdictions (it varies by insurance company and by state), you can list both a CPT code and a T code for reimbursement. The relevant add-on codes, as of a July 2008 Centers for Medicare & Medicaid Services (CMS) change, are 0188T and 01889T (Scroll down to: 5. Category III CPT Codes). In some places, coverage is based on the amount of time you spend with the patient.
It’s also worth your time to see if you’re eligible for Distance Learning and Telemedicine Grants. Funding from the U.S. Department of Agriculture, for example, may support purchases of audio, video, and interactive video equipment; broadband facilities; computer hardware, network components, and software; and technical assistance and instruction for using eligible equipment. These grants range from $50,000 to $500,000. Several other public and private agencies offer grants for telemedicine equipment and training as well.
Aside from grants, internal practices are important as well. Here are 11 tips to make sure you correctly bill and get reimbursed for telehealth services:
- Schedule patient visits and record appointments so they are audit-ready.
- Use correct CPT codes and/or apply appropriate modifiers to indicate to insurance company that the claim is for a telemedicine visit.
- Check the policy, not just the insurance company, to make sure it covers telemedicine (make sure telemedicine is not listed in the policy’s exclusions).
- Confirm what healthcare services you can perform via telemedicine.
- Determine the type of telehealth services you will offer (e.g., live video or software for distance monitoring). The type of solution you use will affect how you bill and how you get reimbursed.
- Ask about any restrictions or conditions that need to be met before a patient qualifies for telemedicine, such as distance from provider, established provider-patient relationship, or informed patient consent in writing.
- Ask about restrictions on the number of telemedicine visits patients may make per year.
- Check state rules on recording sessions (some require it while others forbid it).
- Make sure you have the correct platform and ensure it is HIPAA-secure.
- If you bill through Medicare (and sometimes Medicaid), see if you are eligible to bill a facility fee if you host a patient for a telemedicine visit.
- Keep in mind coverage is most often determined by the client’s home plan, not the service’s local plan.
ClinicTracker’s provider-specific credentialing restrictions make sure you only perform telehealth visits that are likely to get reimbursed. We’ll also help you set up modifier rules and CPT override rules that can automatically bill correctly for these appointments. ClinicTracker allows you to customize your EHR with state and payor-specific rules. It offers a Patient Portal to access telehealth services, which is integrated with the Scheduler and works across time zones and multiple locations.
Overwhelmed? Let our Billing Service handle it for you. We’ll develop a fully accountable and effective billing process, customizing the software so that it submits claims insurance companies are likely to accept. We can assume responsibility for your revenue cycle management tasks, from patient registration to billing compliance.
ClinicTracker is a robust, future-proof mental health and substance abuse EHR. Michael Gordon, a respected clinical psychologist, and Joshua Gordon, an award-winning software engineer, founded the company in 2000. ClinicTracker EHRs powerful software empowers your agency to succeed. ClinicTracker will automate many of your clinic routines, boost staff productivity, increase billing efficiency, and provide the tools you need to manage your clinic effectively. While mental health and substance abuse agencies are our main focus, our software is compatible with foster care agencies, social services, equine assisted therapy, university clinics, academic counseling, family counseling services, and eating disorder clinics.