22 Apr How To Get Reimbursed for Telehealth
Medical reimbursements can be difficult to navigate, even without the fast introduction to telehealth. With different insurance rules, it can be a very tedious and baffling undertaking just to keep up, particularly for autonomous private practices.
Despite this, implementing telehealth as an option for patient care is critical not only for the health and safety of your patients but for you and your team. With the rapid move to telehealth due to social distancing and regulation changes, private practices must keep up in order to stay current. Telehealth is the wave of the future and it is here to stay.
In order to optimally provide telehealth services, medical practices must be in the know for changes and regulations the Centers for Medicare and Medicaid Services (CMS) and commercial insurance payers. Here is some helpful information for obtaining medical reimbursements for telehealth:
What Is Telehealth?
As with in-person visits, repayments and necessities for telehealth can change contingent upon the insurance provider, services needed, and state regulations.
In light of the COVID-19 pandemic, the CMS and insurance companies have relaxed numerous telehealth requirements to give patients extended access during this crisis.
To guarantee you have the most current telehealth information for your state and administrations, you should:
- Check with your state board to see any laws or requirements
- Contact the insurance companies you work with to learn about the requiring billing codes you need.
How To Get Reimbursed For Telehealth
Common Billing Codes For Telehealth
Medicare and major insurance providers have deferred common limitations that characterize when a virtual visit is justified — during this current crisis, all patients are qualified for telehealth visits, not only those with specific circumstances. Along these lines, codes for ordinary E&M visits are currently generally accessible for telehealth charging use. For billing, Medicare requires the “place of servicer” modifier for telehealth — POS – 02 Telehealth — and some private payers are sticking to this same pattern during the COVID-19 emergency.
Two kinds of patient visits are generally used for virtual consultations:
Medicare telehealth visit: Audio and video visit. Applies to most providers. Cost-sharing (deductibles and co-protection) can be postponed. For the span of the COVID-19 pandemic, reimbursements are equivalent to the rate for an in-person visit.
Common CPT Codes
New patients: 99201, 99202, 99203, 99204, 99205
Existing patients: 99211, 99212, 99213, 99214, 99215
Online digital visits/check-ins: Brief virtual visits, generally started by the patient, for an impromptu discussion, or to share a video or picture. This should be possible by means of video or live call, and specialists may react to concerns through content informing and patient entry informing. CMS has deferred the necessity that virtual visits be directed with existing patients.
Common CPT codes
99421, 99422, 99423
98970, 98971, 98972 (non-physician healthcare professional)
For more information about Medicare billing for telehealth, click here for a fact sheet from CMS.
Private Insurance Providers
Here is a brief insight into major insurance provider’s reimbursement for telehealth. Be sure to contact each of your insurance providers to gain a full insight into telehealth repayments.
Aetna: All patient expenses for telehealth visits are postponed through June 4, 2020, when patients see an in-organize supplier conveying virtual consideration, including the utilization of video conferencing innovation. Click here for more information.
Blue Cross/Blue Shield: Coverage for telehealth has been extended to all individuals for 90 days, as of March 19, 2020. This incorporates forgoing cost-sharing for completely safeguarded individuals seeing system telehealth suppliers. Earlier approvals have additionally been deferred. Click here for more information.
Humana: Patient cost-sharing has been deferred for all telehealth visits, including routine primary and specialty care, for 90 days as of March 10, 2020. Applies to in-network providers utilizing video conferencing as well as traditional audio calls.. Prescription Meds can also be refilled early for an additional 30 -90 day supply. Click here for more information.
UnitedHealthcare: Patient cost-sharing has been deferred for all telehealth visits through June 18, 2020. This applies to individuals from Medicare Advantage, Medicaid, and commercial plans. Click here for more information.
As of Fall 2019, each of the 50 states has Medicaid repayment for video telehealth visits. Fourteen states give Medicaid repayment to healthcare practices utilizing telehealth for store-and-forward activity: Alaska, Arizona, California, Connecticut, Georgia, Maryland, Minnesota, Nevada, New Mexico, New York, Tennessee, Texas, Virginia, Washington.
State plans are currently urged to consider telehealth as a method of care conveyance in light of COVID-19. States are not required to revise their arrangement (with a State Plan Amendment, or SPA) on the off chance that they decide to repay telehealth visits similarly as they would for in-person visits or interviews.
Likewise, with any repayment program that has state-by-state prerequisites or rules, it’s constantly prescribed to contact your state Medicaid program for telehealth subtleties, both now and after the COVID-19 emergency. Click here for more information.
The Center for Connected Healthcare Policy has an interactive map for repayment plans for each U.S. State. Click here for more information.
To assist healthcare providers with staying up to date with recent regulations, the CCHP has two frequently updates sources:
We hope this information is helpful for you and your team to navigate how to get reimbursed for Telehealth.
For more information about telehealth and how to market this part of your practice, contact us today!