If you offer telehealth at your behavioral health or addiction treatment practice, reimbursement can be difficult to navigate. This has become a particular issue during the COVID-19 public health emergency, when telehealth has exploded in popularity.
So how can you make sure that you are reimbursed for your behavioral telehealth services?
Working with Medicare reimbursement
Medicare typically reimburses telehealth services only for beneficiaries in certain rural or underserved areas. There are also limits on where the beneficiary is physically located, the type of technology used for the telehealth services, and the type of practitioner.
Since the COVID-19 pandemic, however, the Centers for Medicare & Medicaid Services (CMS) has relaxed many restrictions. This includes an expansion of the behavioral services that can be provided remotely, including depression screening, group psychotherapy, and certain types of behavioral health counseling.
In many cases, CMS is reimbursing telehealth visits at the same rate as in-person appointments during the public health emergency. Generally, any provider who can bill Medicare for their professional services is currently permitted to bill for telehealth.
When coding for a visit, provider organizations should include the place of service (POS) where the visit would have normally occurred, adding the modifier “95” to show that it was a telehealth visit. Some private payers follow this same process.
Working with private payers
Most private health insurers have their own rules and requirements for behavioral telehealth reimbursement. For example, Humana will reimburse claims for telehealth services for as long as the COVID-19 public health emergency is in effect.
Contact each client’s insurance plan and ask about their approval and reimbursement for behavioral telehealth. When verifying your client’s coverage, be sure you have:
- Client demographic and insurance information
- Your National Provider Identifier (NPI) number and Tax ID
- A copy of your client’s insurance card with contact information for providers
When verifying telehealth coverage, ask about:
- Eligibility and benefits for outpatient behavioral health
- Whether you are in the plan’s network
- Whether the payer has approval for telehealth sessions; if so, ask what information is required to submit for reimbursement; if not, ask how to get approval for telehealth
Make sure you also confirm all claims submission information, including claims address and payer ID. Request a reference number for your call, and document it along with the date, time, and representative’s name.
Be aware of differences between states.
Every state plan includes some telehealth services, but these can vary widely by state. Many states have also made their own reimbursement changes during the COVID-19 crisis. Be sure to check your own state’s reimbursement laws regarding behavioral telehealth and reimbursement.
You can find additional resources, including information specific to your state, at the American Telemedicine Association’s State Policy Resource Center.
COVID-19 telehealth reimbursement may become permanent.
Many recent changes to telehealth reimbursement are set to expire at the end of the COVID-19 public health emergency. Providers across the nation are calling for policymakers to keep many of these changes, such as payment parity. Be sure to check updates on policies that affect your practice.
Behavioral telehealth reimbursement can be complicated, but the rest of your practice doesn’t have to be. BestNotes EHR solutions were developed specifically for behavioral health and SUD treatment providers to help you stay compliant and profitable. Contact BestNotes today to learn more.