Telepsychiatry Reimbursement

Reimbursement for telepsychiatry is something that is becoming more common among insurance providers.

It's is a mandatory requirement, in some states, that telepsychiatry be reimbursed. We do recommend, while exploring the possibility of implementing telepsychiatry at your facility, that you have your billing department contact the insurance providers you work with about their policy on telemedicine.

There are usually two types of events that are billed with a telepsychiatry visit: a provider fee and a facility fee to help offset costs. Telepsychiatry providers can panel with up to 2 major commercial payers as well as Medicare and Medicaid, if beneficial to the program.

You can receive information on telepsychiatry reimbursement guidelines for private insurance providers and Medicaid at the Center for Telehealth and e-Health Law (CTeL) or the American Telemedicine Association (ATA).

Will Medicare Cover Telepsychiatry?

Telehealth and telepsychiatry has quickly become a practical option to traditional face-to-face consultation or examination between providers and patients, as well as means of addressing a nation-wide shortage of mental health care providers across the fields of psychiatry.

The more common means of covering telemedicine or telepsychiatry services in the US is to incorporate coverage into Medicare. Reimbursement for Medicare covered services must satisfy the federal requirements which includes efficiency, economy and quality of care.

As of 2014, the Center for Medicare Services does cover telemedicine and telepsychiatry services in many areas.

Medicare vs Medicaid

Many confuse Medicare and Medicaid with one another below are their differences:

Medicare

Medicare is an insurance program that is run by the federal government. Medical bills are paid from funds which those covered have paid into. It is pretty much the same everywhere in the US and is run by the Centers for Medicare & Medicaid Services, an agency of the federal government.

Medicaid

Medicaid is an assistance program and is run by state and local governments within federal guidelines. Medical bills are paid from federal, state and local tax funds. Patients usually pay no part of costs for covered medical expenses. A small co-payment is sometimes required. Medicaid is a federal-state program. It varies from state to state.

Telemedicine Services Covered by Medicare

Telemedicine services covered by Medicare fall into two separate categories. As of now, these categories are defined by:

Telehealth Service #1: Telemedicine services that are similar to medical consultations, office visits, and psychiatric services that are currently on the list of services. The request is based on the similarities between those services that are already eligible for reimbursement, and the telemedicine services requested.

Telehealth Service #2: Telemedicine services that are not similar to the current list of services. The assessment is based on if the service is accurately described by the corresponding code when delivered via telemedicine, and whether the use of telecommunications to deliver the services produces a clinical benefit to the patient. Supporting documentation is required.

Medicare Telemedicine Coverage

There are some conditions to Medicare covering telemedicine. The first being that the patient receiving telemedicine services must be physically located in an �originating site� that is eligible for Medicare coverage.

The sites included:

• Health Professional Shortage Areas (HSPA)
• Outside a Metropolitan Statistical Areas
• Within a MSA rural census tract determined by HHS�s Office of Rural Health Policy
• Rural areas as defined by the department of health and human services (HRSA)

Find out if your clinic or hospital is covered by these conditions at the Medicare Telehealth Payment Eligibility Analyzer

There are also facilities that are allowed to participate in a federal telemedicine demonstration project approved by or receive funding from the Secretary of the DHS that qualify as an originating site regardless of their location. This will include:

• Physicians or Practitioners Office
• Community Mental Health Clinics
• Hospitals
• Critical Access Hospitals
• Rural Health Clinics
• Skilled Nursing Facilities
• Hospital-Based or Critical Access Hospital-Based Dialysis Facilities
• Skilled Nursing Facilities
• Federally-Qualified Health Centers

All telemedicine visits must take place in real-time using audio and video conferencing equipment at both the patient and provider locations.

Medicaid Telemedicine Coverage

States have the option to decide whether or not to cover telehealth services under the Medicaid program. States may decide the following:

• What specific types of telehealth to cover
• What areas telehealth will be covered throughout the state
• How telehealth services are covered and reimbursed
• What types of providers and practitioners can be covered and reimbursed
• The amount to be reimbursed for telehealth services

Each states is encouraged to use flexibility provided by federal law to create a payment method that incorporates telemedicine.

If a state decides to cover telehealth, but not to cover certain areas or certain providers, then the state must be responsible for assuring access and covering face-to-face encounters by recognized providers in those parts of the state where telemedicine is not available.

If a state decides to cover telehealth, but not to cover certain areas or certain providers, then the state must be responsible for assuring access and covering face-to-face encounters by recognized providers in those parts of the state where telemedicine is not available.

42 states now provide some form of Medicaid reimbursement for telemedicine services. You can visit the National Conference for State Legislatures for more information.

Provider/Facility Guidelines

Medicaid/Medicare require that all providers practice within the scope of each state�s State Practice Act. Some states have legislation that requires telemedicine practitioners have valid state licenses in the state of the originating site. All requirements or restrictions placed by the state are binding under current Medicaid/Medicare rules.