Telehealth and Insurance – It’s Not Complicated!

Telehealth, telemedicine, e-health, online therapy is a major force in healthcare. As healthcare continues to evolve, one of the primary drivers of healthcare change is technology. Technology has helped cure diseases, increased life expectancy and countless other things. Today, one of the newest and up-coming ways in which technology is changing healthcare is through Telehealth.

According to the AMA, “telehealth has the power to transform health care…” for both providers and patients. In the comfort of one’s own home, a patient can speak to a doctor, receive a diagnosis and treatment at a fraction of the cost of a doctor visit. The cost does not include money; it also includes time, effort, sacrifice. Organizations such as the American Telehealth Association have grown in tremendous size to promote the use of and advance telehealth. From both a cost and efficiency standpoint, telehealth is a “win-win” for both providers and patients.

Telehealth will quickly evolve, and over time be embraced more as a standard practice. As that continues to happen, insurance companies, who today are lukewarm to telehealth will come to embrace it. Certain insurers already allow telehealth to be a “covered benefit” under a member’s plan. It’s important when checking benefits to specifically ask if telehealth is covered.

Telehealth is not a service performed over the phone. It is done through HIPAA compliant platforms that have been approved for its use. This is why insurers will specifically state that as part of their coverage of telehealth services, phone calls do not qualify. There are some great platforms out there, and if you are interested in pursuing telehealth you should make sure to find the best one or consult with someone who actively practices on a particular type of software. I’m not going to get into the specifics of telehealth platforms today; I’ll save that for another blog post.

Hurdles remain to accomplish the end-goal of telehealth being a viable alternative to a doctor’s visit, and one of those hurdles is insurance desire to cover only certain types of procedures. Fortunately, one of those procedures which is seeing more and more insurance coverage is mental health visits. There are numerous examples, including Blue Cross and Blue Shield of Alabama coming out in 2016 and declaring that mental health telehealth is a covered service. Additionally, UnitedHealthcare in the State of Florida covers telehealth, depending on a patient’s plan. More and more insurers over time will follow the lead of these two giants in ensuring that patients seeking mental health treatment have telehealth as an option.

If you are currently on an insurance panel like UnitedHealthcare in Florida and are considering the opportunity to perform telehealth type services, you are probably asking yourself how would you bill? The answer is simple: a modifier. A modifier is a specific code that goes on an insurance claim indicating something unique about the particular procedure that was performed. In the case of telehealth, the modifier is GT. This indicates to the insurer that the service was performed via telehealth, and also ensures that the provider is properly coding their claim when submitting for reimbursement. Why is it important to properly code? Because in the event of an audit, you want to make sure that you are following the policies and procedures of the insurance company. Additionally, improper coding could lead to clawbacks, suspension of payments or even termination from an insurance panel.

Partnering with GreenpointMed for billing telehealth services will guarantee that your claims are submitted properly to the insurance company. Telehealth is an exciting part of the future of healthcare and GreenpointMed will continue to find innovative ways to stay ahead of the curve.

-  Justin