Telehealth insurance
Telehealth insurance is one of the considerations after you’ve decided on your technology, chosen your HIPAA compliant video conferencing platform and delineated the process for adding telehealth services to your practice.
Summary
- Insurance coverage for telehealth varies widely by state and plan - what’s reimbursed under Medicaid or private insurance in one area may not be covered in another.
- Always verify telehealth benefits for each client, even if they’ve already been approved for in-person care, to avoid claim denials or out-of-pocket losses. Enrolling in an insurance billing course for therapists can help providers enhance their knowledge may help therapists understand this process.
- Staying informed about evolving telehealth policies and requirements is essential as legislation and insurance rules continue to change.
- Using an all-in-one EHR, billing and HIPPA-compliant teletherapy software like TheraPlatform can streamline telehealth claim submissions through automation, batching, and real-time validation - saving time and reducing errors.
→ Click here to enroll in our free on-demand Insurance Billing for Therapists video course [Enroll Now]
It’s not bad to ask the question:
“How will I get paid?”
The answer is both simple and complex. The fact is, you can have cutting-edge technology and be a rockstar therapist but if you’re not getting paid, you’re not getting anywhere but frustrated.
Of course, you may have some clients who are willing or able to pay. In most places, those clients tend to be the exception. Most of your clients will probably be covered by some type of health insurance. They will surely want (expect) to be able to use those benefits for therapy. Before you say “OK”, you need to do your homework.
If you’re new to teletherapy and/or to the world of insurance coverage or telehealth insurance, it can feel overwhelming. It’s ok! You were new to therapy once too and look at you now…checking out the latest in service provision!
In this article, we’ll talk about telehealth insurance and Medicaid and telehealth and how it comes together.
Streamline your insurance billing with One EHR
- Claim batching
- Auto claims
- Automated EOB & ERA
- Real-time claim validation
- Real-time claim tracking
- Aging and other reports
Check your plan for telehealth insurance coverage
Insurance plans, including Medicaid, and state policies are not created equally. Some plans have coverage for telehealth insurance. Some insurance plans may not have benefits for therapy. Still others may have mental health coverage but not for telehealth or may have specific criteria or designated providers for telehealth. It can be a mixed bag.
A common misconception is that there is federal policy or oversight for the types of services allowed. The fact is, states make their own policies regarding Medicaid services and what is required of commercial insurance companies doing business with people in their states. The exception is Medicare which has its own set of criteria and approved services.
The good news is, most states (48 and the District of Columbia at last count) have recognized the need for telehealth services especially in rural areas. They have added some type of telehealth services into their Medicaid programs. What is covered will vary by state.
What about commercial (private) insurance? States have taken telehealth services a step further there too. At least 32 states and the District of Columbia have adopted some policy regarding telehealth and private insurance payors. Again, this will vary by state so you want to educate yourself about your state’s policy as well as the status of telehealth with any provider panels you may be on.
Watch this video to learn common insurance billing struggles and solutions
→ Start My Free Trial
→ Start My Free Trial
Sources for understanding insurance plans and telehealth insurance
Know the policies of the plans you are associated with. Whether you’re a Medicaid provider or a provider for commercial plans, take time to find out what the telehealth insurance policy, criteria and standards are. Some plans require providers to be specially credentialed for their telehealth panel. A few tips are:
- Contact your state’s Medicaid administrator.
- Contact the insurance plans you’re a provider for. Ask lots of questions!
- Get copies of telehealth criteria or policies if that’s available.
Knowing which of your plans will allow you to provide telehealth and what is covered/excluded will save you time when a client contacts you and will allow you to recommend the best available options for that client.
Understand telehealth insurance plan restrictions
What about current clients that you might want to transition to telehealth? Do not assume that because you see a client face-to-face and receive payment via insurance that telehealth services will automatically be reimbursed. That particular plan may have restrictions or limitations on therapeutic services. Before initiating telehealth sessions, call the plan and verify their benefits. This step alone can save you countless hours of trying to get a denied claim paid or having to take a loss.
Practice Management + EHR + Telehealth
Mange more in less time in your practice with TheraPlatform
.
Verify telehealth insurance coverage each time
A lot of plans don’t require pre-authorization for routine face-to-face outpatient services. However, they may for telehealth. Again, be proactive! Make it a policy that any new client you consider telehealth for has verified benefits and prior authorization if required. Trying to get a retroactive authorization is almost impossible.
→ Download My Free Insurance Verification PDF to Know Exactly What Questions to Ask
Stay current on telehealth changes and telehealth insurance
At the end of the day, remember that telehealth is the rising star in the therapy world. With it will come a lot of policy and policy change as the insurance providers, therapists and clients all come together in this new world of service provision. Hundreds of telehealth bills have been introduced at the state and federal levels and this will no doubt continue as the field continues to be defined.
As a provider, stay informed and make sure you’re aligned with the best in technology and support.
Practice Management + EHR + Telehealth
Mange more in less time in your practice with TheraPlatform
.
How EHR and practice management software can save you time with insurance billing for therapists
EHR with integrated billing software and a clearing house, such as TheraPlatform, offers significant advantages in creating an efficient insurance billing process. The key is minimizing the amount of time dedicated to developing, sending, and tracking medical claims through features such as automation and batching.
What are automation and batching?
- Automation refers to setting up software to perform tasks with limited human interaction.
- Batching or performing administrative tasks in blocks of time at once allows you to perform a task from a single entry point with less clicking.
Which billing and medical claim tasks can be automated and batched through billing software?
- Invoices: Create multiple invoices for multiple clients with a click or two of a button or set up auto-invoice creation, and the software will automatically create invoices for you at the preferred time. You can even have the system automatically send invoices to your clients.
- Credit card processing: Charge multiple clients with a click of a button or set up auto credit card billing, and the billing software will automatically charge the card (easier than swiping!)
- Email payment reminders: Never manually send another reminder email for payment again, or skip this altogether by enabling auto credit card charges.
- Automated claim creation and submission: Batch multiple claims with one button click or turn auto claim creation and submission on.
- Live claim validation: The system reviews each claim to catch any human errors before submission, saving you time and reducing rejected claims.
- Automated payment posting: Streamline posting procedures for paid medical claims with ERA. When insurance offers ERA, all their payments will post automatically on TheraPlatform's EHR.
- Tracking: Track payment and profits, including aging invoices, overdue invoices, transactions, billed services, service providers.
Utilizing billing software integrated with an EHR and practice management software can make storing and sharing billing and insurance easy and save providers time when it comes to insurance billing for therapists.
Streamline your practice with One EHR
- Scheduling
- Flexible notes
- Template library
- Billing & payments
- Insurance claims
- Client portal
- Telehealth
- E-fax
Resources
TheraPlatform is an all-in-one EHR, practice management, and teletherapy software built for therapists to help them save time on admin tasks. It offers a 30-day risk-free trial with no credit card required and supports mental and behavioral health, SLPs, OTs, PTs in group and solo practices.
More resources
- Therapy resources and worksheets
- Therapy private practice courses
- Ultimate teletherapy ebook
- The Ultimate Insurance Billing Guide for Therapists
- The Ultimate Guide to Starting a Private Therapy Practice
- Mental health credentialing
- Insurance billing 101
- Practice management tools
- Behavioral Health tools
Free video classes
- Free on-demand insurance billing for therapist course
- Free mini video lessons to enhance your private practice
- 9 Admin tasks to automate in your private practice
Reference
Telehealth Medicaid State Policy | Center for Connected Health Policy. (2018). Retrieved from https://www.cchpca.org
