Insurance filing FAQ’s
How do I know if insurance will cover my charges for TeleHealth?
You will need to check with the patient’s insurance to see if they approve to cover your charges for telemedicine/telehealth services. The law in most states is that if they cover these services, they must pay the same reimbursement as they would a face-to-face appointment. You will need to check with your state medical board for further information and validation.
Since the coronavirus devastation, telemedicine services are now reimbursed more often, especially after Medicare expanded their benefits for this type of medical visit to comply with the social distancing caused by this viral pandemic.
Are private insurance plans required to cover telehealth services?
Most states have parity laws in place that require private insurers to cover telehealth services the same as they cover in-person services. The last count was 37 states with parity laws, but this number is increasing due to the COVID-19 pandemic necessitating more telehealth services. Benefits need to be checked to know if any particular insurance company provides payment for these services.
What are the different types of telehealth services?
Here are the typical codes and descriptions for telemedicine services.
Physicians may also reduce or waive cost-sharing for telehealth visits.
What is the difference between synchronous and asynchronous telehealth services?
Synchronous telehealth services are services where there is a live virtual face-to-face video-conferencing office visit with the doctor or high-level provider. It requires the presence of both parties at the same time and a communication link between them, which allows a real-time interaction to take place.
Asynchronous telehealth refers to “store-and-forward video-conferencing”. This involves acquiring medical data and then transmitting this data to a doctor or medical specialist at a convenient time for assessment. It does not require real-time face-to-face live discussions. Typically, transmission does not take place simultaneously. The information can be stored and transferred at a later date.
Further information can be found in a Lancet article. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3157842/
How do I bill for telehealth services?
Professionals submit their telehealth service claims using the appropriate CPT or HCPCS code. If you perform the service synchronously, the actual office visit code is used with the modifier GT. Modifier 95 is also used for specific codes listed in Appendix P of the CPT manual. There is much overlap between these two modifiers. Ask your insurance carrier what they prefer.
If through asynchronous telecommunications system, add the telehealth GQ modifier with the professional service CPT or HCPCS code. For example, a new patient office/outpatient visit lasting 30 minutes would be billed 99203 GQ if asynchronous, or 99203 GT if synchronous.
There are other requirements for the insurance billing of telehealth claims. Further information may be found on the CMS site (https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/TelehealthSrvcsfctsht.pdf)
What are the time requirements for Physicians billing telehealth and E-visit codes?
Here are the CPT Codes and Time requirements for billing these codes:
Which place of service (POS) code should I use?
The normal POS Code is: 02 Telehealth
You can find further information on this code from the Medicare Coding site:
What about informed consent and is it required for reimbursement?
Just like in a regular face-to-face office visit, the patient must consent to having the charges billed for services and the moneys sent to you. You must have adequate documentation of the visit appointment to qualify for reimbursement, just like you do for regular office visits.
However, the requirement to document informed consent has been temporarily waived as a result of the COVID-19 pandemic. It is still recommended that practitioners should always make adequate documentation wherever possible. (see https://www.aafp.org/news/health-of-the-public/20200323covidtelehealth.html)
Privacy practices and Terms of Agreement must also be accepted by patients prior to the visit, just like they do in regular office visits. These are easily done on the TrueMD TeleHealth system. The document links are on the site. The patient clicks on the links if they want to read the documents, then clicks on the box to state they agree with these documents.
What are the documentation requirements for telehealth encounters?
Essentially, documentation requirements for telehealth services are the same as those for documenting in-person care. You should check with your state board of medicine rules to know what these requirements are.
Normally, these requirements are covered in the SOAP note. Other than the “Objective” signs that you would see on a physical exam, you would document the Subjective concerns (the concerns of the patient and HPI), the Assessment (your diagnosis), and the Plan (what you prescribed or did for the patient and the next plan of action, including the next visit appointment)
TeleHealth services are time-based, and the amount of time spent with the patient is recorded on the system for documentation. Real-time (synchronous) videos, such as during a video visit, or video phone calls (temporarily permissible for billing purposes) are not required to be stored. Asynchronous (shown not during the visit at another time) videos, images and communications must be stored, for billing purposes, and retained for a duration pursuant to state regulation. Note that many insurance companies do not reimburse for asynchronous visits.
Are there ways to evaluate physical findings via telehealth?
There are many new devices available that can sync with telehealth platforms to provide objective data regarding patients’ condition. These include glucose monitoring and blood pressure control. More devices will be available as technology advances allowing you to perform even better assessments of patients via telehealth.
Photos and videos of skin lesions, wounds, etc. may be seen on the telehealth platform for evaluation. Although not as good as face-to-face evaluations, they allow the practice provider to perform an exam while maintaining social distancing to decrease potential viral or bacterial exposures.
Lab tests can be ordered via telehealth systems without the patient needing to go to the physicians’ office. Most lab companies, such as Quest, LabCorp, CPL, etc., have multiple draw stations where patients can give blood or urine for lab evaluations. New COVID-19 tests are being developed and new corona virus centers are popping up that allow the patient to get a COVID-19 test performed without potential exposure to others.
Do commercial insurers bill the same as Medicare plans?
Medicare Advantage plans follow rules set by the Centers for Medicare & Medicaid Services Center (CMS). Some Medicare advantage plans also have additional policy options beyond these. Commercial insurance may or may not provide telehealth visits. During the COVID-19 pandemic, many commercial payors such as UHC and BCBS have offered to remove “originating site” restrictions from their policies. You will need to check with each to find out if they cover or exclude these services, and what benefits they provide.
Do patients need to be considered “established” patients in order to bill for telehealth services?
Since the COVID-19 pandemic, CMS does not require that patients have an established relationship with the physician providing telehealth. A physical exam is no longer required, especially in this time of social distancing, unless the physician feels it is necessary for the exam.
Has reimbursement of telehealth services changed?
Not only will Medicare pay physicians for telehealth services, but effective March 1st and throughout the COVID-19 national public health emergency, they will pay physicians for these services at the same rate as in-person visits for all diagnoses, not just services related to COVID-19. Commercial insurance reimbursements will vary, so you need to confirm benefits if you bill insurance.
Are HIPAA requirements still in place?
Although you should always follow HIPPA requirements for patient privacy, CMS has waived some requirements related to informed consent and potential HIPAA penalties for good faith use of telehealth during this emergency may be waived.
Do I need to be licensed in the state of the patient I am providing care for?
Each state medical board has their own requirements regarding physicians licensed in one state and providing services in another state, particularly for Medicare beneficiaries. Generally, you can only provide services in state you have a medical licensure.
Further information can be found on the AMA website:
What about geographic and rural site requirements?
All geographic and rural site requirements have been temporarily waived. “Patients can receive telehealth services in all areas of the country and in all settings, including at their home.”
Are Behavioral Health, Physical Therapy, Occupational Therapy, Speech Therapy covered under new guidelines?
Many commercial insurance companies have updated their guidelines to allow for reimbursement of these telemedicine services, especially to comply with the policy of social distancing due to the COVID-19 pandemic. UHC has included a sample list of CPT codes for these services. Just like normal, you will need to check with your patient’s insurance carrier before treatment in order to verify benefits and coverage.