How to Get Telehealth Services Covered by Insurance

How to Get Telehealth Services Covered by Insurance

Over the course of this year, telehealth appointments have quickly become the safest medium of providing health and wellness care to clients and patients.  Offering telehealth services allow practitioners to overcome barriers such as distance and time to provide high-quality care to clients they would not otherwise have the ability to work with.  A McKinsey report stated that physicians see 50 to 175 times more patients via telehealth than they did prior to COVID-19.  

If your practice is insurance-based, it is important that you take care to ensure telehealth insurance coverage and reimbursement for both you and your clients when providing telehealth services.  Recently, especially with the expansion of telehealth during the pandemic, insurance providers are offering increasing coverage for telemedicine services across a variety of health and wellness services and specialties.  

How to Get Telehealth Services Covered by Insurance

✔️ Ensure you’ve met the legal requirements

Telehealth in the United States is currently affected by laws and regulations at the federal and state levels. In short, this means that telehealth laws, regulations, and reimbursements are determined by each state government — making it impossible to have a “uniform” telehealth policy.

What you ultimately need to understand about legally providing telehealth services, is that you must abide by state regulations in the state where your client resides. Even if you are a licensed registered dietitian, physician, or physical therapist in your state, you may not be able to counsel a client who resides in a different state, if their state has strict licensure for healthcare providers.

Additionally, depending on your state, receiving a telemedicine informed consent form may be required for your profession.  While getting a patient’s consent for telehealth visits may not be a requirement in your state, you may still want to consider having your clients fill out a telemedicine informed consent form regardless of the regulations. It’s also best practice to document in every session note that your client did verbally consent to conduct the session using telehealth.

Lastly, in regards to legal considerations, every nutrition professional seeing clients privately should have professional liability insurance. This will help protect you, and your business, in the case of a lawsuit. If you already have liability insurance, then you can call your insurer and ask if your current plan covers telehealth/virtual nutrition services. Some insurance plans require you to have a telehealth waiver obtained from your client to activate coverage (see Informed Consent above for a sample copy).

✔️ Use HIPAA-compliant software

HIPAA-compliance ensures that a patient’s health information is protected in a consistent and secure manner by all health professionals.  When holding appointments virtually and storing client information electronically, it is difficult to keep that information secure and safe.  HIPAA-compliance ensures that the method you use to communicate with clients, share personal information, and hold appointments will store the data safely, and protect both you and your clients from any breach in security.  

Be sure to put the Business Associates Agreement (BAA) in place with the telehealth platform that you use. This will be required for insurance reimbursement for telehealth. Without one, you’d be solely responsible for any breach of data, and if an insurance company ever completed a HIPAA-audit of your business, you likely would not pass this.

Additionally, in order to ensure complete HIPAA-compliance, it is extremely important to host telehealth appointments from a secure and private location, such as your office or clinic.  This ensures that personal health information will not be overheard by others it is not intended for.  Providers should not hold sessions in public places, such as coffee shops or co-working spaces, in order to protect your client’s privacy.

✔️ Fill out CMS-1500s with the correct codes

While filling out a CMS-1500 for telehealth services won’t differ too much from billing for in-person services, there are a few areas to ensure you fill out correctly to get the proper reimbursement.  

Billing for telehealth nutrition services may vary based on the insurance provider. When creating your insurance claim, most providers will accept your typical CPT codes submitted (ie. 97802, 97803, 97804).  It is not necessary to change your CPT codes if you are now offering services over telehealth.  You have not changed the type of service you are offering, just how you offer it.

As of 2018, instead of using a modifier, you can indicate your services were rendered through telehealth using the place of service code. You can now use 02 – Telehealth for when “health services and health-related services are provided or received, through telecommunication technology.”

Some other insurance payers may require you to also include a modifier code in your CMS 1500 claim when billing for telehealth. The most commonly used modifiers for telehealth are:

  • GQ – Asynchronous Telecommunications systems, such as a pre-recorded video
  • GT – Interactive Audio and Video Telecommunications systems, including a live video conferencing session
  • G0 – Telehealth services for diagnosis, evaluation, or treatment, of symptoms of an acute stroke
  • 95 – Synchronous Telemedicine Service Rendered Via a Real-Time Interactive Audio and Video Telecommunications system

In certain cases, insurance companies may allow you to bill for telehealth services using the place of service code 11 (office), even if it takes place using telehealth.  In this case, be sure to use a modifier code.  Modifier codes provide additional information about a procedure or service without redefining the service provided.

When filling out your CMS-1500, be sure to not change your location address UNLESS it has been approved by the insurance company.  In order for your claim to be approved, the address on the CMS-1500 must be the same as what is on file at the insurance company.  Even if you are providing services from your home, leave your business address in order to ensure reimbursement.

Leveraging Healthie for Telehealth Billing & Insurance  Coverage

With Healthie, you can host telehealth appointments as well as bill for those services, all within one platform.  Individual appointments can be hosted directly within the app, no downloads or plugins required. Quickly (and securely) connect with patients for convenient telehealth care. Expand your telehealth services to include group sessions, leveraging Healthie’s direct integration with HIPAA-compliant Zoom.

Using Healthie’s intuitive insurance billing feature, create a CMS-1500 claim and submit to your clearinghouse.  Monitor claim status and store client’s telehealth insurance information throughout the billing process for simplified insurance billing.

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