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Telehealth is now an important way to provide counseling, psychiatric services, medication management and other behavioral health services. But virtual treatment isn’t a one-size-fits-all model. Eligibility for reimbursement could be contingent on the payer, patient location, provider licensure, method of communication, service code, documentation, and state/federal rules.
Professional Mental health billing services can assist providers in comprehending these requirements and guaranteeing that claims are prepared that precisely represent the care provided. Seasoned behavioral health billing services also keep track of policy changes which may impact coverage, coding and reimbursement. Even if the visit is clinically appropriate, a telemedicine visit may still not be acceptable, be underpaid, or not be accepted by the payor without proper supervision.
Knowing Telehealth Billing Regulations
Telehealth billing regulations dictate if and how a remote healthcare service can be covered and paid for. Requirements can be from Medicare, state Medicaid programs, commercial insurance companies, state licensing boards and individual payer contracts.
The rules vary from plan to plan. Each state has varying Medicaid reimbursement rates for telehealth services and Medicare has a specific list of services that can be reimbursed through a telehealth delivery model. Practices are required to check the rule(s) that apply to the patient, provider, service and date of treatment.
Coverage Rules – If a claim is covered or not
If the patient’s plan does not cover the service through telehealth, then coding does not insure a plan will be paid. Payers can restrict coverage based on the procedure code, providers specialty, communication technology, insurance product or patient location.
Under current Medicare policy, patients can receive behavioral/mental health telehealth services in their home without geographic limitations when the services are covered. Some qualifying services can also be provided via telephone. But providers have to confirm that the service is included in the provider coverage list and fulfills all other billing requirements.
Mental health billing services in the telehealth realm are reliable, examining your telehealth benefits prior to claim submission. This will help to minimize the chances of billing a virtual service according to the rules of another insurance plan.
Patient Location affects Billing
Telehealth includes two settings: the location where the provider provides the treatment, and the location where the patient receives the treatment. Licensing, place of service reporting, coverage and reimbursement may be impacted by the patient’s physical address.
If the patient receives telehealth in their home, Place of Service 10 is used. Place of Service 02 is for services to the patient provided at any other place outside the home where the telehealth services are provided. If the location is reported by a staff member incorrectly, there could be a payment error, or the claim might be denied.
To facilitate effective behavioral health billing, practices must verify and record the patient’s location during each virtual visit.
Provider Licensure may impact the validity of claims
Behavioral health professionals typically are licensed in the state where they provide services to the patient. A few states provide registration pathways for telehealth or have interstate registration options; however, the requirements vary by profession and jurisdiction.
Proper documentation and codes may be present, but still result in compliance issues if the provider is not permitted to see the patient at that address. Business health care billing providers work closely with credentialing and compliance departments to uncover possible credentialing issues prior to claim settlement.
Modifier codes and Place of Service Codes are important
For the majority of claims, certain modifiers and place-of-service codes are necessary for telehealth. These claim elements describe whether the service was sent via real time video or audio only or another form of approved communication.
Modifier 95 has been applied to qualifying real-time audio-video services and modifier 93 has been applied to applicable audio-only services. These modifiers may require being used with the appropriate place of service code. There may be different instructions for commercial and Medicaid plans.
Billers with mental health expertise keep aging the billing rules for each particular payer instead of using the same combination of modifiers for each claim.
There may be different payment for Audio-Only services and Video services
Audiocare may be more suitable for patients who lack a reliable internet connection, private video facility, or appropriate technology. But it’s not guaranteed that payers will cover treatment delivered over the phone the same way they cover treatment via video.
Medicare allows audio-only delivery of eligible behavioral and mental health telehealth services, which may differ by Medicaid and commercial insurance policies. Approved code, modifier, reimbursement rate and documentation requirements, therefore, may vary.
Behavioral Health Billers ensure accurate communication prior to coding. This will avoid the possibility of submitting an audio-only visit as an audio-video visit.
Documentation Supports Reimbursement
The telehealth document should assist with clinical service in the same way as an in-person document. The note should include patient’s condition, medical necessity, treatment provided, time required, and the patient’s response to the treatment.
Practices may also need to record how the patients were communicated with, where the patients were located, where the provider was, consent, and any technical issues that impacted the appointment. If there is a gap in any information, the claim may be hard to defend in the event of a claim review by the payer.
Correct documentation ensures that mental health billing services will be able to select the right codes and handle documentation requests or denials with utmost success.
Telehealth Operations May Be Impacted by Privacy Requirements
Protected Health Information (PHI) privacy and security must be supported by the Telehealth platforms. The HIPAA Security Rule prohibits an organization from using inappropriate administrative, physical and technical measures to protect electronic health information. HHS also establishes that when appropriate HIPAA requirements are met, audio-only telehealth may be utilized.
Even with a convenient communication platform, there is compliance risk when the practice has not considered access to the information, handling of data, privacy protections and business associate responsibilities.
While billing practitioners don’t choose clinical technology in their own right, behavioral health billing services ought to be aware of any gaps in compliance data that could impact audit preparedness.
Informed Consent Must be addressed
In many states, patients may have to sign a consent form before receiving a telehealth treatment. Consent may include what the virtual treatment will be like, the restrictions on privacy, the protocol for emergencies, and the patient’s right to end the session.
Practices should have a standard procedure for consent and retention of telehealth. If consent is a prerequisite to coverage or reimbursement, absence of documentation can jeopardize reimbursement.
There are times when regulations bring about a loss of revenue
Medicare rules, Medicaid policies, commercial payer bulletins and state licensing decisions all have the potential to shift telehealth rules. A claim which was previously paid could not remain paid due to a policy change.
Denial, underpayment, patient balances, and payer recoupments are possible due to out-dated billing instructions. If the same error is repeated throughout the week of therapy or by the same therapist, the financial impact is more severe.
Professional mental health billing services keep track of policy changes, update claim rules, train staff and audit telehealth payments. This enables regulatory monitoring to become a useful strategy for revenue protection.
Specialized Billing Support Enhances Outcomes
Telehealth billing is not as simple as adding a modifier to a typical claim. The billing team is responsible for verifying coverage, confirm provider eligibility, review patient location, apply payer-specific coding, review documentation, and monitor payment outcomes.
Mental health billing services are used by therapists, counselors, psychologists, and psychiatric practices to help these providers keep track of each payer change when they don’t have the resources to do so. Behavioral health billing services offer further assistance for organizations that offer services at several locations, behavioral health programs, multiple provider types and multiple states.
A controlled billing process minimizes errors, ensures payment uniformity and increases virtual services without compromising compliance.
Frequently Asked Questions
Do all insurance companies cover mental health telehealth services?
No. Coverage will be subject to the patient’s plan, the policy of the payor, the type of service, the type of provider, the method of communication and the location requirements.
If a provider accepts a telehealth patient from another state, can that provider provide services to the patient?
The provider shall meet the licensing requirements of the location where the patient is located. Registration and/or interstate practice options are available in some jurisdictions.
What’s the difference between Place of Service 02 and 10?
Place of Service 10 – Telehealth at home. Place of Service 02: The patient received it somewhere other than home.
Can mental health services be paid for via telecommunication only?
Certain providers reimburse for audio-only services when they meet the qualifications, but these may vary by Medicare, Medicaid and commercial plans.
Why are professional billing services important for telehealth?
Billing specialists ensure coverage, audit modifiers, check place of service details, check for missing documentation, and handle denied telehealth claims and other underpaid claims.
Conclusion
Changes in telehealth regulations directly impact coverage, coding, and reimbursement of mental health services. There are several factors to consider including provider licensure, patient location, communication technology, documentation, consent, privacy, and payer policy.
A mental health billing service can streamline these tasks and avoid unnecessary payment issues. Highly experienced billing services for behavioral health help with the added level of oversight required by the complex organization and evolving rules of payers.
Regulatory awareness, coupled with accurate behavioral health billing, can help providers safeguard revenue, minimize claim denials, and remain able to deliver virtual care that is accessible.
