Jill 5 years ago in Billing/Electronic Modules • updated by Richard Sethre, Psy D , L P. 5 years ago • 21
I have heard from several people that Zoom meeting is HIPAA compliant and insurances cover Zoom sessions. Does anyone know if this is accurate and how to go about billing for these sessions?
Thanks & have a great week!
Customer support service by UserEcho
Would this be considered Telehealth? Can Zoom be used for Telehealth sessions? Are they synonymous? Is Zoom part of Procentive? Do we have access to Zoom within Procentive? Right now we are using doxy.me for doing our Telehealth sessions. It is separate from Procentive, but I have sent a help ticket asking if there is a way to do Telehealth within Procentive...?
Telehealth platform providers basically "self-attest" that they are HIPAA compliant. Here is Zoom's document:
Jill - while zoom may be HIPAA compliant, and insurance covers telehealth and telemedicine, with modifiers; telehealth does require training and signing attestation statements indicating formal training in telehealth. Additionally, telehealth is to be delivered from office to office, not office to home or home to office if billing insurance.
Just a tip - there are different versions of zoom, and encryption is not turned on by default in all versions. If you decide to use it, you may want to set standards for its use, and/or force your staff to use an agency account so your IT folks can control the privacy/encryption settings.
Here is another link to a helpful and very reliable resource about video therapy platforms, with reviews of 3 free ones and discussion of the pros and cons of free platforms.
Thank you all for your feedback! Very helpful! Susan, you mentioned that telehealth can only be billed when it is done office to office? We were hoping to be able to bill therapy sessions from clinician's office to client's home. Does anyone else know if this is possible? If it is only available office to office it likely would not be worth it for us.
Jill, the insurance companies have pretty strict guidelines when billing telehealth and it is not acceptable to bill office to house if you intend to use insurance. The rules are clear and you must also attest, have risk management policies, have the ability for clients to sign informed consent, treatment plans, etc. It is not as easy as signing up for a zoom account. Have you studied the insurance company requirements? You could charge cash for office to home, but then you still have confidentiality issues and need to do the other things I have mentioned. If you have additional questions, you can reach out. I would strongly discourage you from doing as you indicate. In an audit, and there will be one as soon as you begin using telehealth modifiers, you will be subject to 100% payback, plus whatever penalty they assess.
Here is another high quality, reliable online resource, the American Telebehavioral Health Institute website.
Following up on Jill's comment, I also was not aware that telehealth services are restricted to office to office situations. The MN DHS guidelines for telemedicine include:
Refer to the following when billing for services provided through telemedicine:
• Services provided via telemedicine have the same service thresholds, authorization requirements and reimbursement rates as services delivered face-to-face.
• Bill for mental health services delivered via telemedicine with modifier GT.
• Use the place of service code that identifies the location of the recipient when the service was provided.
Line 3 appears to indicate that DHS allows for various places of service - DHS usually is very specific about service, and billing restrictions, so if telehealth services were restricted to office to office, it seems likely that DHS would specifically state this.
Commercial plans may be more restrictive, but I am not aware of any local plans that restrict telehealth to office to office. It would be very helpful to have specific references for this restriction.
Healthpartners defines Telemedicine in the Minnesota Health Care Programs section in the Provider Manual as:
Telemedicine – means the delivery of health care services or consultations while the member is at an originating site and the provider is at a distant site.
This will be my final comment. Read MN Statue 147.033 - telemedicine means the delivery of health care services or consultations while the patient is at an originating site and the licensed health care provider is at a distant site.
I suppose you could interpret this as client home, I wouldn't recommend it.
HP PMAP https://www.healthpartners.com/public/coverage-criteria/policy.html?contentid=ENTRY_184922 lists Home as an acceptable originating site but HP commercial plans says:
Definition of Originating Site (referring provider) – an office/clinic, hospital or skilled nursing facility where the member is located.
Also for commercial HP it says:
Practitioners eligible to provide Telemedicine services are licensed and have one of the following designations:
I happen to have gone through all insurance companies telehealth policies and thought I'd just share what I have found and give everyone the links for verification- and as requested by another commenter.
BCBS Policy: patient definitely has to be at an office, not their home...
Televideo consultations are
interactive audio and video communications, permitting real-time communication between a
distant site physician or practitioner and the member, who is present and participating in the
televideo visit at a remote facility.
You are all behind the times on this issue. I have done extensive research over the past several months and up and running offering this service. It is a lot of work to get it off the ground. But it is possible and working. My hope is that Procentive will get on board soon so that it can be a part of our database to be able to do sessions (still wanting to know if Zoom meetings are something we have access to as Procentive Customers) within Procentive so we can have session, billing and clinical charting all in one place. Right now we are using www.doxy.me for the session itself and doing billing and clinical charting within Procentive.
Thanks Alyson; exciting news to hear that you are providing this service! Can you share some details like;
1) Do both provider and patient need to be in an office setting? Can patient be at home? Can provider?
2) Do you bill insurance and if so have you found each insurance has their own requirements? For ex, it appears that MA and the PMAPs allow the client to be in their home but the commercial plans do not.
3) Can only certain licensures provide telemedicine? For ex, HealthPartners says only Clinical Psychologists and Social Workers can perform telehealth sessions.
Thank you for any insight you can give!
I recommend you reach out to each of your individual insurance representatives to seek pertinent information from each. This has been a 3-4 month long project for me. Very time consuming. This way you will ensure you are getting exactly what you need from them and can hold them accountable for information instead of me...lol:)
I agree with Alyson's advice.
FYI, I called DHS Provider Services today, and was told by staff that the MHCP guidelines allow for telehealth for behavioral services to be provided to a patient/client in the home (of course, not including excluded services, such as day treatment - but these services are not provided in the home, anyhow). The staff also advised me to use the "place of service" code 2.
Hi Richard - thanks for this. I actually called DHS to ask the same thing today, but my call was disconnected. Did they say anything about the licensure of the treating Provider? Does it need to be a Psychologist or LICSW?
From the MHCP telehealthguidelines:
Providers currently authorized to provide mental health services may conduct the same services via telemedicine, except for the following services:
Alyson, I find it sad that you use this listserve to tell us we are behind the times on an issue, which we are not, and then refuse to offer another professional assistance for a process you say you have figured out.
I too have done extensive research and while I do not know whom you have spoken to at the different insurance companies, there are many variables. More than one insurance company restricts who can provide telehealth and there is very clear data stating that there must be 2 sites with others.
All the best to you in your endeavors
StephC, on this email chain, give me a call and I am happy to share with you what I know. 612-991-7666
Following up on this thread, I am contacting local insurance companies to find out whether they cover telehealth, and if so whether they cover it when the patient participates from home. I just talked to Cigna, and was told that Cigna covers telehealth for psychologists (didn't think to ask about other licenses) and they do cover it when the patient is in the home.