As clients and therapists get more technologically connected, there is increased interest in doing therapy and consultations by video or phone, also known as telehealth. Since this isn’t my area of expertise, it’s time to call in Marlene Maheu, Ph.D., Executive Director of the Telemental Health Institute (TMHI).
“Many therapists think they can just jump on Skype and their sessions will be covered by insurance. Nothing could be further from the truth,” says Maheu.
Traditionally, telehealth was not covered by health insurance plans. The good news is that there has been a nationwide shift toward coverage. Telehealth has been reimbursed by Medicare and Medicaid for over a decade. Health plans are following suit, since telehealth parity is now mandated by more than half of the U.S. states. The Affordable Care Act accelerated this, with its focus on making healthcare more accessible and affordable.
The bad news is that that most plans reimburse for telehealth only in limited situations. The client may need to be in a rural area, where no provider is available within a certain mileage. Plans may require the client to be at a health facility or school in case the client needs intervention. “You also will need to be certified and contracted by the insurer, much like if you deliver services for managed care companies,” says Maheu.
What are the telehealth laws in my state?
State laws vary, including their definition of telehealth, and when/if it must be reimbursed. For a list of state reimbursement laws, visit http://tinyurl.com/telehealthreport.
What services are covered?
Covered services are defined by state law, some plans still may reject claims. Even if a plan covers telehealth, coverage may be very limited. Reimbursement policies vary between insurance plans. “Blue Cross may reimburse in one state and not in another,” says Maheu. Most frequently covered services are diagnostic intake, psychotherapy, individual and group health and behavior assessment and intervention, neurobehavioral status exams, pharmacologic management, smoking cessation, and alcohol aftercare.
What are rates like?
Usually the same as in-person sessions.
How will I know if my telehealth services will be covered?
Call your client’s plan prior to providing services. Have the CPT code ready — the same as for in-person care — but you may need the modifier -GT after the code to indicate that it is a telehealth session. Ask if your license is covered for telehealth, and any limitations, including client location. Ask whether to use the modifier -GT on the claim, and which Place of Service Code should be used. It is insurance fraud to make it seem on the claim/invoice as if the session took place in person.
What are some ways of providing telehealth?
You may also consider contracting with hospitals, schools, or nursing homes to provide video/phone consultations to staff or clients when there is no appropriate provider on staff. Correctional facilities and the Veteran’s Administration (VA) are large employers of telemental health providers.
Some additional telehealth tips from the experts:
- You must be licensed in the state where the client is when you have contact, not where the client resides. Ignoring this could cost you your license, and your malpractice may not cover you.
- Your platform must be HIPAA compliant, not just encrypted. Do not use Skype. A list of HIPAA-compliant platforms can be found at www.telehealth.org/video. Tom Farris, Ph.D, Chief Clinical Officer of SecureVideo.com, advises “get a Business Associate Agreement (BAA), which makes them legally liability for HIPAA breaches on their part.”
- Telehealth is not the same as in-person therapy. Get practice guidelines from the American Telemedicine Association (ATA) at http://tinyurl.com/telehealthguidelines. TMHI (www.telehealth.org) provides trainings covering the legal, ethical, clinical, technological, and administrative issues of telehealth.
- Select clients carefully. Plan face-to-face sessions at intervals.
- Remember, your therapy is still subject to “medical necessity” review (for more on medical necessity, click here).
Want to Learn More? Upcoming Workshops
Learn about the changing world of insurance, and what EVERY therapist should know, even if you aren’t a network provider: how to keep new clients even when you aren’t on their plan, how to join plans, how to avoid denials, and claim instructions at a California-area workshop. Click here to learn more. Can’t make it to a workshop? Get my book, invite me to speak to your organization, or schedule a phone consultation–click here.
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