Necessity is the mother of invention – or perhaps in these unprecedented times caused by COVID-19, a reinvention of your practice. There are rapid changes being made at the federal and state levels to expand options for telehealth in the SUD space so patients can continue to receive essential healthcare during this crisis (1,2). With technology, it’s possible to continue your life-saving programs and we’re here to help you through the transition.
If you’re considering offering telehealth services, you’ll want to implement changes to your patient intake processes and AveaOffice configuration. First, you’ll want to update your VOB process to include some specific questions to payers related to the patient’s plan and telehealth – we’ve included a sample call script below. This is the key to success in the transition because telehealth benefits will be different payer to payer and even the authorization requirements may differ from one plan to another with the same payer.
Second, based on the scenarios, you’ll want to update AveaOffice to ensure the claims are billed out with the correct modifiers and/or place of service depending on the claim type and payer requirements. Based on our experience, requirements can differ payer to payer, plan to plan but we’ll be here to help you through this process and get AveaOffice set up to make the process easier.
Please keep in mind that these are suggestions based upon our experience with many clients, however you shouldn’t rely on these recommendations alone as a basis for how to bill claims correctly. The best way to ensure the claims are billed correctly is to verify the payer’s billing requirements during the VOB check.
Step 1: Update Your VOB Practices Including Call Scripts
You should be calling every patient’s insurance company to approve for telehealth – this will ensure you get reimbursed. Here’s a recommended script:
- Get client demographics and insurance information, NPI, and tax ID.
- Review the back of the insurance card to identify the correct phone number for providers. Sometimes there is a separate phone number for mental health.
- Choose the option for checking eligibility for outpatient mental health benefits.
- Provide NPI, Tax ID, and location.
- Provide patient name, birth date, and subscriber ID when prompted.
- If applicable, ask if you are in-network or out-of-network with the plan.
- Ask if they have approval for telehealth sessions. If they do, ask about and write down the required modifier the insurance company uses (95 or GT).
- If they don’t have approval, ask how to obtain approval for telehealth sessions.
- Be sure to confirm claim submission information such as Claims Address and Payer ID.
- Obtain reference number for the call and record the date, time, representative name, and reference number in your notes.
Step 2: Update AveaOffice Configuration
It is considered best practice to continue to use the appropriate CPT codes and then apply a modifier (95 or GT) with correct place of service code (02). Medicare is an exception and only requires the place of service code 02. Source. However, during the declared state of emergency for COVID-19, CMS has advised to submit claims using the place of service where services would have been rendered.
Modifier 95 is meant to represent “synchronous telemedicine service rendered via real-time interactive audio and video telecommunications system.” Source.
Most insurance plans use the 95 modifier, however there are exceptions which is why it is important to call and verify for each patient’s plan.
The most common configuration updates made to accommodate telehealth is to setup a new service so you can track it separately in reporting from your in-person services.
The new service is the telehealth version of the existing in-person service that will set the form to Professional, add Place of Service 02 for Telehealth, add a professional service line with modifier, and reference the service at the facility.
However, it cannot be emphasized more that it's important to research payer requirements for billing/reimbursement.
Place of Service codes are not on a UB-04, so the most common requirement for Telehealth on Institutional claims is to add a modifier of GT. In AveaOffice, it’s easy to accomplish this using a Claim Line Item Rule that is based on a particular payer and service billing profile.
- New Service for the Telehealth version of the existing in-person service that will set the form to Institutional, add procedure code* and reference the service at the facility.
- Set up a Claim Line Item Rule to set the Institutional modifier to 95 or GT.
*IMPORTANT: Keep in mind that if you add a modifier to a claim line item, you will need to include a procedure code.
You can find instructions in our help file for all the Claim Rule types here.