After you’ve decided on your technology, chosen your platform and delineated the process for adding telehealth services to your practice, there’s one more question you need to ask:
“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 private 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 telehealth and/or to the world of insurance coverage, 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 insurance and Medicaid and telehealth and how it comes together.
All Plans Are Not Created Equally
Insurance plans, including Medicaid, and state policies are not created equally. Some insurance plans have coverage for telehealth. 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.1 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.1 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.
Knowledge is Key
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 policy, criteria and standards are. Some plans require providers to be specially credentialed for their telehealth panel. 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.
Don’t Assume Coverage
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.
Trust But Verify – Every 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.
Keep Abreast of Changes
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. TheraPlatform remains on the cutting edge of the exciting world of telehealth and will provide you with the best and most accurate information that you need to know to be successful in the telehealth market.
1. Telehealth Medicaid & State Policy | Center for Connected Health Policy. (2018). Retrieved from http://www.cchpca.org/telehealth-medicaid-state-policy