Claim for Telehealth
Answered
Hello,
I am trying to submit a claim for the first time, but I noticed that the claim form does not have Telehealth or a code for telehealth on it. What should I do? How will the insurance know that this was a telehealth session?
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Hi Natasha, did you do your telehealth session using the integrated Telehealth by SimplePractice platform? If so, the Service Location code should be correctly coded on the claim as 02 for Telehealth.
Additionally, some payers require a modifier code to be entered when you see a client via Telehealth. We recommend reaching out to the payer directly to understand whether or not a modifier code is needed.
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Hi Brenda, if you're not using SimplePractice's integrated Telehealth platform, you'll want to create another Office Location for Telehealth visits under My Account > Settings > Practice Details, with the Insurance Place of Service entered as 02-Telehealth. That way, the Telehealth Place of Service code will populate onto claims. As I mentioned in my previous comment, some insurance payers require a modifier code on the CPT code for Telehealth sessions, so we recommend asking the insurance payers you work with if a modifier code is required.
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After I've set up a second office with the Insurance Place of Service entered as 02-Telehealth, where do I indicate on the client's session record that was the office used? A client switched a session to telehealth at the last minute; do I have to delete and re-enter the appointment with the 02 office location?
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Hi Robin, under My Account > Settings > Practice Details, does the office have a name? If no name has been entered, or if you don't have any Office Locations, your calendar flyout will not have an Office Location section - you can add a name to show this section on your calendar flyout.
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Hi Jennifer, we are actively working on this feature for SimplePractice and look forward to releasing it soon. You can subscribe to updates here: https://simplepractice.uservoice.com/forums/918553/suggestions/36554008
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Hi Jennifer,
It is always recommended to consult with the payers directly regarding their own specific rules and regulations as this can vary from payer to payer but claim filing usually is based on where you, the provider, are providing your services, not where your clients are located.
The following organizations provide resources to help you learn more about your state’s specific policies and regulations:- The Center for Connected Health Policy's (CCHP)
- American Telemedicine Association (ATA)’s State Policy Center
- The National Telehealth Policy Center’s state map
- State Medicaid Websites
In order to find out more your specific state’s Telehealth rules, here are a few additional resources:
- The Center for Connected Health Policy's (CCHP) publishes an annual report that has up-to-date reimbursement policies for all fifty states and the District of Columbia. They also have an interactive map.
- American Telemedicine Association (ATA) also provides a map showing which states reimburse Telehealth services.
- Your local state board will have resources and information on how Telehealth reimbursement policies relate to your specific license type (LMFT, LPC, etc.).
- Centers for Medicare & Medicaid Services (CMS)
- Medicare Telehealth Payment Eligibility Analyzer allows you to check if specific addresses are eligible for Medicare Telehealth reimbursement.
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Hi Lauren, happy to help here! FIrst go to Settings > Billing & Services > Insurance and check the box to enable service code reminders. Then go to the client's file > Edit > Billing and Insurance, scroll down to the Default Service Code section and add the service code 90834 as the client's default service code. Finally, enter the modifier, 95, in one of the small text boxes below and save the changes made. Any appointments, with the 90834 service code, you schedule for this client in the future will automatically have the 95 modifier attached to it. This will also be reflected in Superbills and claims you create for the client. Note: if you've created appointments, or have a recurring appointment already scheduled for this client, then those appointments won't retroactively include the modifier you just added. Delete these future appointments and recreate them so the modifier auto-populates! Here's more on Adding Modifiers to Services in SimplePractice.
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