Necessity is the mother of invention – or perhaps in these times, a reinvention of your practice. There are rapid changes being made at the federal and state levels to expand options for telehealth in the Behavioral Health and SUD space so that patients can continue to receive essential healthcare during this crisis. With technology, it’s possible to continue your life-saving programs and we’re here to help you through the transition.
Please keep in mind that these are suggestions based upon our experience with many of our Addiction Treatment Center clients, however you shouldn’t rely on these recommendations only 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.
Implement Changes to your Patient Intake and VOB Processes
If you’re considering offering telehealth services, you’ll want to implement changes to your patient intake processes. First, you’ll want to update your VOB process to include some specific questions to payers related to the patient’s plan and telehealth. 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.
NOTE: If you are an Avea customer using our Behavioral Health billing software, please see below for how to configure AveaOffice for SUD Telehealth services.
Recommended VOB Script for SUD Telehealth Authorization:
You should be calling every patient’s insurance company to approve for telehealth – this will insure 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 number for providers (Note: Sometimes there is a separate number for mental health)
- Choose the option for checking eligibility for outpatient mental health benefits
- Provide NPS, Tax ID and location
- Provide patient name, birthdate 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, rep name and reference number in your notes
Apply the Correct Modifiers
Second, based on the scenarios, you’ll want 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.
NOTE: For Avea customers, you’ll want to update your AveaOffice configuration for this as well. We are available to help you through this process to ensure AveaOffice is set up correctly.
For Professional Claims:
It’s 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.(See Source).
Modifier 95 is meant to represent “synchronous telemedicine service rendered via real-time interactive audio and video telecommunications system.”(See Source )
Most insurance plans use the 95 modifier, however there are exceptions which is why it’s important to call and verify for each patient’s plan.
For Institutional Claims:
Place of Service is not on a UB-04, the most common requirement for telehealth on Institutional claims is to add a modifier of GT.
How to Update the AveaOffice Configuration for Telehealth:
Here are the most common configuration updates to make in order to accommodate telehealth. However, please don’t hesitate to reach out to the Avea support team for a customized recommendation based on your specific situation.
For Professional Claims:
- New Service billing profile for existing services that will change the form to Professional, add Place of Service 02, add a professional service line and reference the service at the facility.
- Setup a Claim Service Grouping Rule to select that billing profile for a particular payer.
For Institutional Claims:
Since you don’t need to update a place of service on a UB-04, you’ll just need to add the GT modifier to the line items on the claim. In AveaOffice, it’s easy to accomplish this using a Claim Line Item Rule that’s based on a particular payer and revenue code.
Avea users can find instructions in our help file for all the Claim Rule types referenced in this article here.
Again, these are suggestions based upon our experience with many of our Addiction Treatment Center clients. The best way to ensure the claims are billed correctly is to verify the payer’s billing requirements during the VOB check.
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