In the Behavioral Health and Substance Use Disorder (SUD) industry, telehealth has become a crucial tool for ensuring patients receive essential care. However, navigating the billing process for telehealth services in Addiction Treatment Centers requires careful attention to detail. This guide provides comprehensive and updated billing guidelines to facilitate accurate claims processing.
Implementing Changes to Patient Intake and Verification of Benefits (VOB) Processes
A. Patient Intake Process Updates
When considering adopting telehealth services, revising the patient intake process is essential. This involves adding specific questions related to telehealth and the patient’s plan into the VOB process. The following questions are essential to gather pertinent information related to telehealth and the patient’s insurance plan:
Telehealth Coverage Inquiry:
- Ask whether the patient’s insurance plan provides coverage for telehealth services.
- Inquire about any specific conditions related to telehealth coverage.
- Determine if the insurance plan requires prior authorization for telehealth sessions.
- If authorization is necessary, inquire about the process for obtaining approval.
Telehealth Benefits Variations:
- Understand that telehealth benefits may differ among payers and plans.
- Ask about any specific requirements or restrictions associated with telehealth benefits under the patient’s plan.
- Inquire about any specific modifiers the insurance company requires for telehealth claims.
- Confirm whether modifiers like 95 or GT are needed and under what circumstances.
In-Network or Out-of-Network Status:
- Verify whether the treatment center is considered in-network or out-of-network for telehealth services under the patient’s plan.
- If applicable, gather information on any variations in coverage or costs based on network status.
Claim Submission Information:
- Confirm the accurate claims submission information, including the Claims Address and Payer ID.
- Ensure that all details align with the insurance company’s requirements for telehealth claims.
- Ask about any specific documentation or information the insurance company expects to accompany telehealth claims.
- Verify whether there are unique requirements for addiction treatment services provided through telehealth.
Reference and Confirmation:
- Obtain a reference number for the VOB call and record it for future reference.
- Document the date, time, representative name, and reference number in the patient’s records for traceability.
B. Recommended VOB Script for SUD Telehealth Authorization
A standardized script for obtaining authorization from insurance companies is crucial to transition to telehealth successfully. This script includes key steps such as verifying demographics and insurance information and obtaining approval for telehealth sessions. It also emphasizes recording essential details like reference numbers and claim submission information.
C. Applying the Correct Modifiers
For professional claims, it’s advisable to use appropriate CPT codes and apply a modifier with the correct place of service code (02) in most cases. The modifier 95 signifies synchronous telemedicine service through real-time interactive audio and video. However, it’s emphasized that modifier requirements may vary among payers, making it essential to verify for each patient.
Several billing codes are relevant to telehealth in addiction SUD treatment services, including:
- 99441: Telephone E/M service for 5–10 minutes of medical discussion
- 99442: Telephone E/M service for 11–20 minutes of medical discussion
- 99443: Telephone E/M service for 21–30 minutes of medical discussion
- 90832: Psychotherapy for 30 minutes with a patient
Place of Service (POS) Codes
Important POS codes for telehealth include:
- POS 02: Telehealth provided other than in the patient’s home
- POS 10: Telehealth provided in the patient’s home
- Institutional Claims
In institutional claims, where the Place of Service is not on a UB-04, adding a modifier of GT is typical for telehealth. This modifier indicates services rendered via telecommunications.
Tips for Successful Billing:
Here are vital tips to ensure compliance with billing guidelines for Telehealth in Substance Use Disorder (SUD) Treatment :
Implement standardized documentation procedures for patient intake and Verification of Benefits (VOB). Consistent and accurate record-keeping is essential for successful claims processing.
Implement the recommended script for obtaining telehealth authorization consistently. Not only this, but you should also ensure that all necessary information, including demographics and insurance details, is collected during calls to insurance companies.
Stay informed about changes in federal and state regulations related to telehealth billing. You should regularly update the internal processes to align with changing guidelines to avoid compliance gaps.
Double-check and verify the correct application of modifiers (e.g., 95 or GT) based on payer requirements for professional and institutional claims. Thereby, the consistent application helps prevent claim denials.
Claim Submission Review:
You should focus on establishing a robust review process for submitted claims. Such a review process will ensure that all required information, such as reference numbers and claim submission details, is accurate before submission to minimize errors.
If utilizing billing software, ensure the system is configured correctly for SUD telehealth services. Leverage available technology to streamline the billing process and enhance accuracy.
Conduct regular internal audits of billing practices to identify and rectify deviations from established guidelines. Proactive monitoring helps prevent issues before they escalate.
How do you ensure Virtual Care Services Billing Compliance?
Failure to adhere to the above billing guidelines for telehealth in substance use disorder (SUD) treatment can have significant consequences for Addiction Treatment Centers. Non-compliance may result in delayed or denied claims, leading to financial losses for virtual centers. Without proper implementation of changes to patient intake and Verification of Benefits (VOB) processes, there is a high possibility of inaccuracies in billing, potentially resulting in claim rejection. Moreover, applying the correct modifiers on professional and institutional claims may lead to claim denials by insurance providers. This impacts the center’s revenue and also disrupts the continuity of care for patients in need of addiction treatment services.
Outsourcing SUD billing processes to experts like 24/7 Medical Billing Services is the optimal solution in such situations. By outsourcing the billing tasks, Addiction Treatment Centers can focus more on delivering high-quality virtual care services with confidence that their billing processes are in capable hands. This collaborative approach optimizes operational efficiency and reinforces the commitment to providing uninterrupted, quality care to those in need of SUD treatment services.