Many mental health professionals are using technology to extend their reach to cleints/patients online, but aren’t being honest with the insurance companies about the types of service when billing. Telehealth services, including telepsych, online therapy, online counseling, Internet therapy, etherapy, webtherapy, teletherapy, email therapy or online crisis work typically require a special “qualifier” code when billing insurance companies. If you are using videoconferencing technology to conduct a session remotely, and the qualifier is not used, you may be committing insurance fraud — regardless of your billing agent’s potential belief that it is acceptable to bill for traditional care when rendering distant services.
When sessions are knowingly mis-billed, that is, when information is intentionally misrepresented, such practice can be prosecuted as insurance fraud, a serious crime that can result in criminal charges being brought against you. Being found guilty of insurance fraud may include penalties that require you to reimburse the monies previously paid to you, and jail time.
As you can imagine, repercussions of such events can be extensive. Imagine your name appearing in the local news as a professional caught in insurance fraud. Of course, nothing will happen if you don’t get caught, much like speeding with your automobile. However, if something goes wrong with one of your clients/patients and your practice is opened to scrutiny by the authorities, you can be facing unwanted repercussions.
As if the above possibilities aren’t enough, being found guilty of fraudulent billing practices can also nullify your malpractice insurance coverage. In some states, inaccurate billing practices can be considered fraudulent. If you enter a state that considers your errant billing practices to be “criminal” in a case involving one of their citizens, your malpractice carrier may enforce a clause in your malpractice insurance contract that allows the denial of your benefits. You will most likely be accused of operating with “criminal intent” and/or broken a law involving “criminal activity.”
While some clinicians think that it is acceptable to respond positively to a plea for help from a former client who recently moved to a far-away location by initiating treatment through Skype and continuing to bill as if the patient were seen in a traditional, in-person setting, the repercussions of such activity can be serious. Many complex issues come into play. State laws differ with respect to billing, licensing, informed consent, standards of care and what is considered to be criminal intent.
While such prosecution is rare, it nonetheless is a looming possibility as we see more and more enforcement of existing laws now impacted by telepractice. Regardless of how archaic and outdated such laws are, juries are unpredictable when a mental health client/patient claims harm.
What to Do about Billing?
- Understand that some insurance companies do not require special telehealth qualifier codes for billing and telepractice sessions of any type (email, telephone or video), but many do.
- Look before you leap. Ask your billing agent to contact each insurer you are billing for videoconferencing. Ask the insurer how they prefer you bill for your videoconferencing sessions.
- Also have your billing agent clarify the location code for billed sessions (home or office). Since services are not technically being delivered in your physical office or the client’s/patient’s home, you may find that your agent is guessing at which location to indicate when billing. Some insurance companies don’t reimburse when you use the incorrect location code. When coded incorrectly, you may ultimately retrieve payment by re-billing, but such a process will most likely delay your payment for months.
- If the contact with insurers is made by telephone, ask your billing agent to document the insurer’s verbatim instructions for both the CPT code and location code needed, add a date and time, and the name of the person they spoke with at the insurance carrier. Have your billing agent sign and date the document as well.
As a professional, you are fully responsible for how your billing agent codes your sessions for reimbursement. If you agent need more information about insurance reimbursement, consider taking our convenient online course for telehealth billing, Reimbursement Strategies: Increasing Authorization & Payment (comes with three (3) CEs or CMEs, if you need them).
States Mandate Telehealth Reimbursement and Our Advocacy Efforts
State laws are rapidly being passed to require insurers to cover telepractice. In fact, 22 states currently mandate payment by insurance companies for telehealth. The Telebehavioral Health Institute maintains a list of these companies on their webpage: States Requiring Insurance Reimbursement for Telehealth & Telemedicine.
You may also want to consider sending insurance carriers a letter asking them to inform you of their policies regarding telepractice, as well as potentially asking your clients/patients to do the same. Consumer complaints will make all the difference.
Please post your questions or comments below.