Telehealth has become the fastest growing specialty in the United States. Thanks to a push from an unlikely place, with the rationale being to increase access to care, Medicare has made Telehealth a viable option for the treatment of many different conditions by many different specialists. As new and cutting edge as Telehealth is, the billing is even newer. Knowing how to properly credential and bill for Telehealth services can be overwhelming to even the most experienced executive.
Here are the top 5 key credentialing issues if you are considering Telehealth in your practice:
- What states do you plan to practice in?
Did you know you must hold a medical license in each state you intend to provide Telehealth services in? You must also contact the medical board in each state to find out their specific rules on Telehealth. Some state medical boards forbid it all together. Others have rules stating you must see the patient in-person for the first visit and subsequent visits can be done using Telehealth. Some say you must see the patient in-person for any new problem and you may only use Telehealth for problems you addressed at the in-person meeting. Knowing the rules surrounding Telehealth in the states you practice in is imperative to your success.
- Do you know how to conduct a Telehealth visit?
Do you understand the rules surrounding the origination site and the distant site? Are you in a HPSA (Health Professional Shortage Area)? Do you know how to credential with each payor so you can bill for Telehealth services? These are things you should be aware of and know a great detail about before you begin using Telehealth in your practice. A credentialing expert should be contacted to answer each of these questions in detail for you and also to perform any credentialing with payors you intend to bill.
- Do you know which types of providers are eligible for reimbursement using Telehealth?
Only the following list of providers may claim and receive reimbursement:
Distant Site Providers:
- Nurse practitioner;
- Physician assistant;
- Nurse midwife;
- Clinical nurse specialist;
- Clinical psychologist*
- Clinical social worker*
- Registered dietitian or nutrition professional
Originating Site Providers:
- The office of a physician or practitioner
- A hospital, including a critical access hospital
- A rural health clinic
- Federally Qualified Health Centers
- Hospital-based or CAH-based Renal Dialysis Centers (including satellites)
- Skilled Nursing Facilities (SNFs)
- Community Mental Health Centers (CMHCs)
- Did you know that technology plays an important role in the approval of being reimbursed?
Medicare is quite forward-thinking when it comes to the technology, defining reimbursable Telemedicine as “interactions between a healthcare professional and a patient via real-time audio-video technology” (CFR Title 42, Part 410.78, “Telehealth Services.”). There is no coverage for remote patient monitoring and Medicare only covers “store and forward” for demonstration projects in Alaska and Hawaii.
This definition is in line with the model policy of the Federation of State Medical Boards (FSMB), which represents the 70 state medical and osteopathic regulatory boards. Because the FSMB is considered the ultimate arbiter of quality in medical practice and regulation, its recommendation carries considerable weight, setting the standard for the industry.
- Do you know which CPT and HCPCS codes are eligible for Telehealth reimbursement?
Medicare has a specific list of CPT and HCPCS codes that are covered under Telemedicine services and the list of approved codes change frequently. Do you know about the G1 modifier? Do you know if you can bill a facility fee? These are all very important factors in the decision to adding Telehealth to your practice.
When undertaking any new adventure in healthcare it is always best to consult with a professional who can guide you and ensure you are both successful and legally compliant. Consulting with a credentialing expert and an IT expert before undertaking your Telehealth endeavor is the best plan.
Cynthia Young, the former CEO of STAT, is a national billing, credentialing and practice management consultant. STAT is a U.S.-based, national provider of credentialing, payor enrollment, rate negotiation, and other credentialing related services.