Checking insurance coverage in telehealth

Overview on telehealth

Telehealth refers to healthcare that is delivered to patients via remote video conferencing or phone calls. It utilizes software that is implemented within healthcare businesses to connect patients with their practitioners so that they can receive high-quality care from the comfort of their own homes. Following the impacts of the COVID-19 pandemic, the use of telehealth technology has grown exponentially, and higher numbers of healthcare businesses are becoming interested in using these types of systems. Telehealth has the benefits of improving accessibility, communication, clinical outcomes, and affordability for both patients and practitioners. Although this shift into a new type of healthcare offers broad and exciting opportunities, there are certain operations within your business that will need to be amended. This includes creating appointment checklists for telehealth patients, learning different insurance regulations, and understanding how HIPAA compliance is affected. 

Does insurance cover telehealth?

Understanding healthcare insurance terminologies, in regards to telehealth, is necessary before you begin to offer these services to your patients. Although telehealth is a reasonably new form of healthcare, some of the bigger insurance providers are beginning to offer coverage. Still, most insurance policies vary widely between states so it is imperative that you check the relevant provider and find out how their coverage impacts you and your patients. With regard to Medicare, they will most likely cover specific forms of care, including doctor’s visits, medical supplies, and preventative services. The exact amounts patients will be required to pay depends on whether they have other insurance, the facilities they use, and where they receive their care. In order to ensure the billing process is as transparent as possible, it is important that you have an open conversation with your patients about how telehealth impacts their insurance coverage.

Importance of verifying a patient's insurance

Prior to seeing and treating a patient using telehealth, it is important that you verify their insurance. Because telehealth has changed the way that coverage is applied to healthcare, verifying insurance will allow both you and your patients to feel more comfortable during the treatment process. It will also guarantee you know when and how you will be reimbursed. Knowing exactly how much patients can expect to pay for healthcare services will ensure they are prepared, and financial requirements are not an unnecessary burden. Additionally, verification of insurance policies will help set your mind at ease, as the likelihood of delayed payments is reduced. Insurance coverage can be tricky, and everyone knows how complicated the medical billing process is - so putting in the effort to verify policies will help ease this burden and ensure you get paid in a timely manner. The final thing you need to remember is that every patient’s insurance coverage will differ. This means that you need to communicate with all of your clients and determine how exactly their insurance will impact the billing process. When you run through your EHR evaluation checklist, each patient’s insurance information should convey their policies so that you can deliver healthcare services effectively without worrying about getting paid! 

Tips to check insurance coverage in telehealth

Verifying insurance in healthcare is complicated - especially if you are treating a large number of patients who all have different policies! To help make this process as simple as possible, we have collated some key tips.

Check if the patient's insurance is active

The first step to verifying insurance coverage is to check if it is still active. When an insurance policy renews, the ID number may have changed and it is essential that the right number is in your system. It is always good practice to continuously recheck the active status of your patients’ insurance and encourage them to inform you of any relevant changes.

Check if all patient information is up-to-date

Your EHR system will have all of your patient information recorded, and it is important that this information is accurate. Not only will this allow you to track down your patient faster if you need to contact them, but it helps to ensure your patients are receiving the right kind of care. Any HIPAA compliance checklists for medical practices will reinforce the importance of having accurate patient information - this type of data is central to quality care!

Make a call to the insurance company to check for policy coverage

Although people tend to avoid directly calling insurance companies, especially given how time-consuming this task can be, it is one of the most effective ways to find out important information. When you contact the insurance provider, you should inform them that you are calling as a provider, and identify exactly how their policies impact your patients’ coverage.

Verify online through the insurance database

Another method to verify insurance policies is through an online database. These allow you to submit relevant patient information (name, date of birth, insurance ID, social security number) and determine whether the patient’s insurance is confirmed. Note that this is only an available option if you are a provider of the insurance company or subscribed to the clearinghouse.

Use a special telehealth verification form

A final option to improve your verification process is to create or use a telehealth-specific insurance verification form. These can be customized to suit your own business and the services you offer and will allow you to form a more accurate picture of the coverage that your patients have.

Take home message

Understanding the insurance policies that are related to telehealth services is one of the first things you need to do when introducing telehealth into your business. Although it may seem like a daunting area filled with unfamiliar information, having a good knowledge of insurance policies is one of the best. Additionally, there are certain types of software that can help streamline insurance verification and medical billing processes. When it comes time to create a budget for your private practice, you should definitely consider looking into these systems, so you can save time and money and focus on doing what you do best: treating patients!

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Further Reading:

• Increased Use of Medicare Telehealth During the Pandemic
• Summary of the HIPAA Security Rule