Any private practice docs having issues with payers over Telepsych?

[MLT2MT2DO]

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My future employer/eventual partner in Private Practice in Idaho is getting push back from some major payers who aren't stepping up and following Medicare's lead in allowing at least temporary full (some refusing any) reimbursement for these visits. Idaho is "deep red" and for the most part has really bucked the trend of telehealth/medicine for far too long in my opinion and this only moderately surprises me that this is happening.

I'm just curious if there are other areas that are running into this issue and what/if any workarounds are you all doing during this time.

 

[Sushirolls]

So far I have gotten EOBs back from two payers that reimburse less than medicare for dates of my GT modifier submissions. They are showing full routine payment, however, the EOBs aren't even reflecting the modifiers. They never really have for previous things either, so I don't know if my billing company did or didn't submit it appropriately. They don't even list the Point of Service code on these EOBs.

I'm still waiting for other companies to come back that have more details regarding the POS and Modifiers. Wish I could be of more help.

 

[Orgone]

I'm sure this varies wildly by state. In my NY private practice the insurers pay no problem and at the same rates as in person. There's a law saying they have to pay for telemedicine, although I'm not sure if the law says the have to pay the same amount. Probably a good time for Idaho physicians to petition for the same.

 

[clausewitz2]

In PA our system's biller just started telling people to go back and add normal E&M codes to telephone visits (we had been billing No Charge) so I am assuming they worked out a way to get at reimbursed by typical rates.

 

[dl2dp2]

I'm sure this varies wildly by state. In my NY private practice the insurers pay no problem and at the same rates as in person. There's a law saying they have to pay for telemedicine, although I'm not sure if the law says the have to pay the same amount. Probably a good time for Idaho physicians to petition for the same.

To what extent GT modifier needs to be added to telemedicine visits is actually unclear. For example, one advisory from CMS states that rather than use the GT modifier, one should use the POS modifier (see below). Many private insurance claims don't have the POS entry, and OON reimbursement receipts typically do not use POS modifiers. There is also very little case law to draw from in case a dispute results. So far to my knowledge insurers have not pursued this as an issue. I have a feeling that if insurance pursued this in court they would lose: i.e. there's no legal basis to reimburse different rates for the same service. This may be another reason that they are just rejecting claims, and not auditing providers to provide evidence that the visit is NOT a televisit.

https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/downloads/MM10152.pdf

 

[Sushirolls]

Just got some EOBs back from a better payer insurance, and they are reimbursing less. Have both GT modifier and POS 02 on the statements.
Looks like a 99213 is getting paid 72% of what they normally do.
Looks like a 99214 is getting paid 74% of what they normally do.

Just wow. This makes weathering the Covid-19 so much harder.
I was going to offer telepsychiatry services after Covid-19, now I question if I will.

 

[randomdoc1]

In WI all the rates are paid as the same as in person. used place of service 02 and GT modifier. Except UMR, they are sketchy, they paid most of them and then on others they said the codes are "not covered."

 

[romanticscience]

Both of my networks are paying the same. I'm using POS 02 and modifier 95. They are also waiving co-pays/insurance, which is nice.


Sent from my iPhone using SDN

 

[Sushirolls]

Just spoke to that insurance company, and they are saying for the time being to do claim correction (re-submission) and just put down POS of 11. They didn't have an answer as far as Post Covid-19 how that would unfold. My state actually had passed some law recently stating telemedicine services are to be reimbursed at parity to office face to face visits. Paranoid to see how that unfolds, considering past parity laws for mental health are still a joke. Especially considering how many insurance companies have carve outs for mental health and addictions to separate insurance companies, that you guessed it, pay less than the parent company...

 

[splik]

telepsychiatry is actually quite well established in Idaho and has been for some years though probably not commonly used in private practice. there is no telemedicine parity there to my knowledge but most insurances (including blue cross, blue shield, optum, select health, pacific source) as well as medicaid already reimburse for telepsychiatry. I'm not sure on what they pay compared to in person visits. private practice physicians who aren't in an IPA are probably in a bad spot right now if reliant on insurance.

 

[MLT2MT2DO]

telepsychiatry is actually quite well established in Idaho and has been for some years though probably not commonly used in private practice. there is no telemedicine parity there to my knowledge but most insurances (including blue cross, blue shield, optum, select health, pacific source) as well as medicaid already reimburse for telepsychiatry. I'm not sure on what they pay compared to in person visits. private practice physicians who aren't in an IPA are probably in a bad spot right now if reliant on insurance.

He is in the valley's IPA and still getting the push-back from some of the carriers you mentioned. At this point I am hoping this is in error, though it looks as though Sushi may be dealing with something similar. This is a bad look, even for insurance companies.

In reference to Telemed being well established in Idaho, I think it is more of a "not well established from the patient's home" as they have to be in a "Qualified patient location". Which is a huge barrier at this time

 

[Sushirolls]

I can't help but wonder why we even have a POS of 02, especially when there is a modifier? It just seems like redundancy to enter 02 and GT.