With an increasing number of healthcare facilities utilizing telehealth, patients and providers alike are questioning the insurance coverage offered. As providers offer telehealth services become a more common mode for providing healthcare services, insurance companies are expanding coverage for these services. With its increased safety and convenience, telehealth is the optimal option for many kinds of healthcare services in 2020: 74% of patients in the U.S. would use telehealth services and about 67% of patients said that using telemedicine somewhat or significantly increases their satisfaction with medical care.
Here, we’ve compiled our best practices for verifying patient insurance coverage for telehealth services and ensuring reimbursement for your business.
Why is Verifying a Patient’s Insurance Important?
Telehealth reimbursement is impacted both by state regulations and by individual insurer policies. While this makes it challenging to know if your client is covered for telehealth services, helping patients verify their insurance can be beneficial for both parties.
First, it allows your client to make the most of their insurance benefits so that healthcare services are not a financial burden. By confirming coverage, your client is more likely to book sessions and continue with care, without the fear of receiving large bills from their insurer.
In addition, for healthcare providers, confirming coverage upfront will prevent any delayed or denied, ensuring timely reimbursement for your business. As insurance coverage varies both by insurance payer plan and policy, it’s important that benefits are verified for each client. Doing so will also allow you to communicate insurance payment terms with your client, preventing any misunderstanding in the future.
Telehealth Across Healthcare Professions
Along with technological advancements that have enabled rapid growth in telehealth capabilities, the rising demand for telehealth services has allowed more healthcare specialties to gravitate towards telehealth than ever before. However, telehealth coverage still varies greatly depending on each provider’s field.
Prior to verifying your patient’s insurance, be sure to spend some time researching telehealth coverage for your profession. Some providers, like dietitians and lactation consultants, have more universal coverage as long as they use proper modifier codes in their CMS-1500 forms. While still a new practice, chiropractors and physical therapists may be able to get insurance coverage in certain circumstances for telehealth appointments.
How to Verify a Patient’s Insurance Eligibility for Telehealth
✓ Check if patient information is up to date
If you see patients consistently, it is likely they will keep you up to date on any change in personal information. However, occasionally you may run into patients who have moved since their last visit or have changed their number. Having updated basic information on the patient would give you the upper hand when tracking them down and verifying their insurance. This would also be valuable when contacting the insurance companies directly.
✓ Ask the patient if their insurance is active
When a client’s insurance renews annually, they may receive a new insurance card. The ID number may be the same as the previous year, but it may have been updated. It’s imperative you verify if the insurance is active. Once you verify, make a copy of the card to keep it in the patient’s EHR for future references. Not only should you check their primary insurance, but their secondary one as well (if applicable).
✓ Call representative of insurance carrier/company to see if policy covers
One way to verify a patient’s insurance coverage for telehealth is by making a call directly to the insurance. Although this is a time-consuming method, you will have an accurate picture of your client’s insurance coverage. You can easily find the service number on the back of the insurance card. When you call, make sure you specify that you are calling as a provider. This method requires confirmation of you as a provider, as well as information of the patient. Once all confirmation is complete, the insurance company will be able to relay to you if their policy covers telehealth services.
✓ Verify online through their insurance database
An easier way to confirm a patient’s insurance coverage for telehealth is online. As a provider, you can easily check on the insurance’s database on their individual websites. However, sometimes this feature may not be available depending on the insurance. Instead, you can use an online clearinghouse, such as Availity. These databases may require some basic patient information such as:
- Patient’s Name and Date of Birth
- Insurance ID and Group Number
- Name of Primary Insured and Relationship to Patient
- Social Security Number
- Insurance carrier, phone number and claims address
One thing to note is that you must either be a contracted provider of the insurance company or a subscriber of the clearinghouse to be able to access the patient’s insurance information.
How to Leverage Healthie for Telehealth and Verifying Patient Insurance
As both a telehealth and practice management platform, Healthie has all of the features you need to host your virtual appointments and subsequently bill insurance for them.
- Telehealth: Healthie’s integration with Zoom allows providers to determine how each appointment can be conducted: in-person, via phone, and/or via video call. Within telehealth, Healthie has a multitude of programs that make it easy to verify a patient’s insurance, as well as starting a bill.
- Insurance billing: Generate CMS-1500 claims that can be batch-downloaded and submitted to your clearinghouse of choice. Easily track claim statuses and reimbursement within Healthie, or invoice patients for non-covered amounts.
- EHR: Leverage Healthie’s HIPAA-compliant electronic health record allows you to keep patients’ personal health information secure, and track client progress using custom-built chart notes.
- Packages and Invoices: Create custom package offerings and authorize client payments using our integration with Stripe, which is PCI-compliant. Easily generate invoices and receipts for payments.
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