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The pandemic has caused a significant boost in the telehealth industry, but concerns have arisen regarding telehealth reimbursement transparency. Consumer demand is forcing payors to increase telehealth options and be more transparent about the future telehealth reimbursement structures. Consumer demand also forces providers to offer more options to encourage patient loyalty and retention.
A report entitled, The Payment Cure: How Improving Billing Experiences Impacts Patient Loyalty (PYMNTS), sponsored by CareCredit, examined how payment experiences impact consumers’ choices and loyalty to healthcare providers in a sample of 3,546 adults who received healthcare services in the prior year. The study reported that 47% percent of patients with out-of-pocket costs were unaware of whether or not their providers offered affordable payment alternatives.
The PYMNTS study shows that only 31 percent of patients knew whether or not their healthcare providers offered alternative payment plans. The study also reported that 36 percent of consumers paid for their most recent visits using a credit card, and 30 percent used a debit card. Just 9 percent used third-party financing options or payment plans offered by the provider. It may be of note that payment plans may be familiar to medical practices, but underlying issues are more complex when offered by behavioral practices.
Preferences for Telehealth Payment Savings
It may be surprising to know that 63% of patients and clients surveyed in a telehealth industry study reported by Medical Economics would prefer to see their healthcare providers in person. However, 23% of those participants changed their minds about their preferences upon learning that a telehealth appointment would be less expensive.
- In the general healthcare arena, according to a report made available through the CIGNA Newsroom, patients/clients seeking a non-urgent digital care visit can save an average of $93. Specialists’ costs are about $120 less, and urgent care costs can decrease by as much as $141. Telehealth appointments also result in fewer unnecessary lab tests, yielding around $118 in savings.
- In behavioral healthcare, employers grappling with rising costs find that employees can receive care at more affordable rates in a few days rather than a few weeks or months. CIGNA recently released another report titled, “Does Virtual Care Save Money? [PDF],” in which the meaning of virtual care is discussed for employers and their employees seeking the best, most efficient, and most cost-effective health care.
- In the direct-to-consumer market, services run the gambit from low-cost texting companies to services offered to specialty populations funded by states, university research centers, and other specialty organizations dedicated to specific disorders.
Transparency in Telehealth & Healthcare Costs
The PYMNTS study cited above also reported that transparency in healthcare costs led to greater patient loyalty. That is, when faced with the opportunity of changing practitioners, those people who felt as though their current provider had been forthright about options and their associated costs showed more loyalty to those practitioners over time. The transparency of insurance companies was seen as an entirely different matter. Current statistics from the PYMNTS study found that 47% of patients and clients are unaware of healthcare provider payment plans regarding digital health and telehealth appointments.
Low-cost approaches to meeting consumer demand with digital care offerings and telehealth appointments go a long way toward helping the telehealth service prosper. From the provider perspective, telehealth and especially telebehavioral health can dramatically decrease office and operational expenses. Meeting consumer demand for increased patient education, billing, and services will increase patient loyalty and retention. These additional suggestions may also be worthy of note:
- Telehealth providers can offer telehealth reimbursement information before the beginning of treatment.
- Providers can also provide breakdowns of how much the insurance will cover and what consumers will owe out of pocket.
- Whether services are offered online or in-person, consumers who choose to opt-out of insurance plans in the United States are entitled to receive “Good Faith Estimates” as per the No Surpises Act, as outlined by the Federal Trade Commission. Transparency with such information can also increase patient loyalty and retention.
Avoiding Telehealth Reimbursement Fraud
It bears mentioning that professionals and their organizations are fully responsible for telehealth reimbursement coding regardless of reimbursement source. This is true when considering alternatives for telehealth employment or when seeking direct reimbursement. While most practitioners initially successfully collected telehealth reimbursement from insurers during the pandemic, many have received denial notices. To increase the chance of successful reimbursement and be assured of legal compliance, follow these suggestions:
- Understand that some insurance companies do not require special telehealth qualifier codes for billing telepractice sessions of any type (email, telephone, or video), but many do.
- Ask before billing. Directly contact each insurer to ask for their preferences for billing videoconferencing or telephone-based sessions.
- When working with billing agents, clarify which Place of Service (POC) code is used. As of April 1, 2022, the required code will be “10” rather than the previously used “02.” Some insurance companies won’t reimburse if the incorrect location code is used.
- If the contact with insurers is made by telephone, ask billing agents to document the insurer’s verbatim instructions for the CPT code and location code needed, add a date and time, and the person’s name with whom they spoke. Ask the billing agent to sign and date that report as well.
- Professionals facing telehealth reimbursement challenges may also want to consider sending insurance carriers an email asking them to inform you of their telehealth policies.
- Asking employers and, if appropriate, clients/patients to speak with their employers or insurers carriers is yet another strategy that has proven successful. Consumer complaints can make a difference.
- For a quick overview, join Telehealth.org community for a 1.5 hour CME and CE training and discussion session entitled, How Can I Get Paid for Telehealth in 2022? If more in-depth telehealth reimbursement instruction is needed for agencies, clinics, clinicians, or billing agents, consider taking Maximizing Reimbursement Strategies in Telehealth (offers 3 CMEs or CEs).
It may also be worth mentioning that consumer familiarity with digitized payment systems such as PayPal, Venmo & Zelle has proven problematic for many professionals unaware that such popular systems are not HIPAA compliant. See PayPal, Venmo & Zelle: HIPAA Compliant Payment Methods for details. Nonetheless, providers have a range of alternatives, including 0-fee options where processing fees are transferred to the consumer in complete transparency.
The future of telehealth reimbursement will belong to those who offer fully transparent payment information about virtual care. Such fully transparent healthcare professionals will foster trust, strengthen the therapeutic alliance and increase patient loyalty. Transparency and patient satisfaction engender staff satisfaction and vice versa, creating a virtuous cycle, driving their practices, staff, patients, and the entire telehealth industry forward.