Simplify Your Sickness Billing Format for Client for Planning

Sickness billing format for client for Planning

so nice that you're spending your precious time with us today so we're going to try to pack as much as we can into this short hour for those of you who don't know me I'm a private practice coach and I'm also author of navigating the insurance maze the therapist's complete guide to working with insurance and whether you should which is now in its ninth Edition I have worked in the trenches of lmft for 33 years actually 33 years working with dozens of insurance plans and so now um I am now providing training to therapists and groups across the country in working with insurance and documentation and practice building so that's my new incantation in life all that stuff you never learned in graduate school right um and my goal is to help therapists feel as confident about their businesses as they do about their therapy and my contact information is at theinsuranceme.com that's my website but we'll be talking about other ways to contact me if you have follow-up questions all right so let's take some of your pre-submitted questions I kind of divided them into different sections the first areas that I took some of the questions is you seem to have a lot of questions about was coding how do you code Telehealth sessions so the questions I got a lot of was what codes and modifiers do you need to use when you're billing for Telehealth well a lot of us have been doing this for three or four years but these are this is not a question that there's a question that is kind of constantly changing in some ways so let's see I put together some slides to help you out so you're going to need three different codes for Telehealth sessions first let's start with the CPT codes we're going to do a really quick review CPT codes are a five digit code that you use to tell insurance plans what kind of service you provided the good news is that they're the same as for Telehealth as they are for in-person sessions so let's go over the most commonly used ones for Psychotherapy the 90791 should be your first session many of us don't even use that one or know to use it so don't this is one that you should be using for couples for families for individuals it's called diagnostic evaluation but it's basically just first sessions for everybody your history taking you're getting information you're kind of trying to formulate a diagnosis there is no time specified on this one so you could have a 15 minute 90791 or you could have a 15 hour one and you'd still use that code unfortunately insurance would pay the same for the 15 minute as they would for the 15 hour okay then we have three what I'm going to call individual therapy codes a 90832 which is technically called a 30-minute individual therapy session but the rate time range is officially 16 minutes to 37 minutes then you have the 90834 which is very popular that's officially a 45 minute but the official time range is 38 to 52 minutes and our favorite one the most popular one out there 90837 which is a individual therapy 60 minutes and that's 53 minutes and above now I've put the word individual in quotes that's not exactly how it's um put in the CPT code manual but there's a lot of confusion about these codes people are uh when they came out back in 2013 they said they said basically your client and or family member so it was very confusing but then they changed it to say no no no family members really it's not supposed to be used for ongoing couples or family therapy these are supposed to you can include informants they called them but the identified client had to be present for the most of the session or all of the session so basically you can only use the you can only use these codes for individual sessions or if you're doing individual therapy you've got your individual therapy hat on you're seeing somebody ongoingly let's say a child and once in a while you bring in mom once in a while you bring in dad maybe at the end of every session you bring in mom for 15 minutes but it's all in the service of ongoing individual therapy you bring on in an informant to that care but for ongoing couples or family therapy you should not be using these codes and I can't stress that enough I've seen in audits um insurance plan sees that you've used these for a couple's ongoing couples therapy sessions and ask you to give the money back so you don't want to be doing that what code should you be using 90847 is a couples or family therapy code that's officially a 50-minute code but can be used for any session 26 minutes and above 90846 is a couple's therapy or family therapy without the client present so that would be like if I saw mom alone I'm seeing a child individually but I just see mom alone for one session individual clients not there again that's a 50-minute code and it's officially 26 minutes and above now you're all going to say but Barbara I do 90 minute sessions I do 120 minute sessions I Do gottman I Do It EMDR I need more time um and how do I get paid for that more time well billing for longer sessions could take up a whole nother webinar but basically what happened is as of the of January 1st 2023 they took away all the codes that could be used for extended sessions those prolonged service codes 99354-99355 um so as of today when I'm doing this talk um in September of 2023 there are no current codes for longer sessions however they're kind of trying to figure out new options for billing whether insurance is going to go along with them or not is something else but I've put a article on what I'm going to call our landing page about billing for longer sessions now let me stop and talk about what's the landing page all throughout this webinar today I'm going to talk about different resources instead of giving you 95 different links I'm going to put them all on one page for this webinar and you just go to that page you enter your email address and then you will be instantly taken to the the landing page which I'm calling it where all the links all the handouts the the slides for this for this webinar handouts and freebies that I'm going to talk about all the resources are going to be on this one page so please take a moment and write this down the insurance maze.com forward slash TBC which stands for Telehealth billing and coverage which is the name of our webinar today so TBC so write that down now you don't think you'll need it but as I go through you're gonna I'm gonna give you all kinds of great stuff that's going to be on that page for free okay what are some other codes you're going to need for Telehealth you're going to need modifiers when you do Telehealth because basically the insurance plan doesn't know the difference between a CPT code for in person or Telehealth they need to know so a modifier tells them this was a Telehealth session so in addition to the CPT code you're going to add a modifier you don't need it for offices it's only for Telehealth now for Telehealth you're going to generally use the modifier 95 that tells them 95 tells them it was a Telehealth session the plan may also accept an older one GT those are both video sessions um that's fine most plans except both of those regions if you work with Regents they actually require GT and to my knowledge will not accept 95 so they're the only one I know that won't accept 95. if you don't know it's good to check with the plan but 95 is probably the safer one now there's a new phone session modifier that's just coming out because of course they constantly want to change everything to keep us on our toes to make our lives miserable um and if you're doing Audio Only and phone sessions 93 would be the new modifier that's coming out now it seems like Medicaid is seems to use that but that make sure before you use it Medicare is now accepting that and I understand they're going to require that after the first of 2024. plans like Aetna are are accepting 93 and fq or fq is their old the older one so you can check with them to see that I think Cigna is accepting it so double check with the Health Plan before you use if you're doing audio only phone sessions now the third type of code that you're going to need is a place of service code now you need place of service codes for all your therapy but the place of service code tells the the insurance plan where the client is at the time of the session now there's tons and tons of codes that I'm going to tell you put the most common is 11 if the client is at office now if you put nothing on there they're going to assume that it was it office so in the old days if you gave out super bills you didn't have a place of service code they just assumed it was in person but nowadays we kind of have to spell it out the client was at your office you want to put 11 and that means it was an in-person session now for many years they came up with a new Telehealth session code which was zero two yay that was easy right but then they had to make it hard then they split that a couple years ago and said oh we're going to make it 10 for Telehealth if the client's at their home whatever they consider their home and zero two is only going to be Telehealth when the client's not at their home now many of you will be like what I've been using zero two for all my Telehealth clients well they're paying the same from from and I don't think it's going to be an issue but if you're strictly going to use what's right um and you can check with always check with your plan that you're billing but this is the technical right use of the place of service codes and um 10 would be for when the client is at home and zero two would be the client is not at wherever they consider their home now again to make it more complex Medicare uh is saying wait wait yes I know you're doing Telehealth but don't put down the 10 or the zero two yes we will process it yes we will pay it but we're going to pay it at a lower rate because we haven't basically got our computers fixed so if you've been billing Medicare A 10 or a zero two in the last three years or so you probably have been underpaid you probably were paid at What's called the facility rate instead of the professional rate so go back look at your what you were paid by Medicare and you'll you may find out you were underpaid resubmit your claims and you they may owe you a bunch of money you what they're telling us is to all at least until the end of 2023 use 11 the in-person even if it was a Telehealth session you're welcome to check that out but a lot of people have contacted me after seeing my presentations and said oh my gosh I got thousands of dollars back from Medicare thank you so I hope I can help you with that now there's a whole complete place of service code list is on the landing page the link to that again that's my landing page the insurancemase.com forward slash TBC there you can get the whole place of service code list in case you met with somebody in the hospital or somewhere different than the ones I've listed here and I also have a sample sample super bill in case you aren't so all these codes need to go on a super Bill if you are an out of network provider and I have a sample super built in my practice forms packet again more information about that on my landing page so let's look at what a sample super Bill looks like so at the top Circle there you'll see is going to have your name uh your contact information then it's going to have your client name in the middle there that Circle Maria von trap her date of birth Her diagnosis I mean this is just a sample of what information needs to be on a super build doesn't need to be in this order or anything but this is how I lay out my super Bill you've got the date of service you've got the first Circle there the place of service code CPT code modifier you want it to be really nice and neat and really clear and then under service description you can see I'm very clearly spelling out it was a video session so I'm telling the insurance plan a thousand ways that this was a video session and the charges right and then you have down below there your information your EIN or tax ID number your NPI number your license number all that good stuff all right how about some coverage that's a lot of cover of building questions we shoved into a coding question we've shoved into a lot of slides there all right how about coverage questions what changes do you see coming with Telehealth billing and compensation will Insurance start denying coverage I think this was the single biggest question that I got asked in your pre-submitted questions so I put together a couple fonts here this I could talk about for a long time but let's so obviously it's no news to you that the covid public health emergency LED to an explosion of Telehealth coverage right unfortunately it has led us to believe one of two myths won now Telehealth is always covered people are constantly contacting me and saying well of course all my clients are have Telehealth so they're it's always going to be covered I can do whatever I want basically it'll be covered or I have the other people saying the sky is falling I'm sure all my clients are going to be losing all their coverage now that covid emergency is over and so it's not you know I think we really have to realize that the truth is that the coverage is going to vary depending on your state on your health plan and most of all your clients account you could have three different clients who have Blue Cross of California um insurance and one of them could have you know coverage one could have minimal coverage one could have no coverage um one could have coverage with a very high deductible or co-pay no co-payment and one could have it with high co-payment so I think we have to stop thinking of is Telehealth going to be covered or not and we have to just be going what is the coverage for this particular client I will say some overall predictions I think I think my overall prediction is that Telehealth will generally continue to be covered and my phrase is that the American public basically uh has just gotten something wonderful that that um it'll be like taking candy from a baby I mean uh it's going to be very hard to take back this benefit once they have all been benefiting of from it for years right um and I think it's going to be difficult not impossible but difficult My overall prediction is that probably almost all your clients will continue to have Telehealth coverage however there may be caveats um I think after a shaking out period we still don't really know what's going to be covering what isn't going to be covered but I think the two areas of highest vulnerability are going to be these number one phone coverage I think is going to go first I think for those of you who are doing phone sessions these may be the ones that lose coverage first um for example and again this is a little shaky I don't know 100 about this but I just got in the mail this week um a policy forwarded to me by somebody um that was on the availity website that they s that Aetna is saying that they will not cover Audio Only sessions after uh 12 1 20 23. um I'm trying to verify that but I looked at the policy it's written up it's on their website so this uh and I know somebody who tried to get a waiver to for her client particularly and she was deter she was denied so this is something that we need to check on obviously this would have the biggest impact on elderly minority low-income clients clients who don't have access to video um or can't come to your office if you do do audio do document why you need to do it and that the client was offered video but the patient was able or unable or unable to use it so that would be my recommendation is if you are doing audio only phone be sure you're documenting why that's necessary uh and that if if you were able to offer a video that can that was recommended on a Medicare website that I saw the other um highest area of vulnerability I think is going to be out of network therapists um it may be that insurance plans Retreat to Yes uh our members can have Telehealth but they have to see a network therapist that may be kind of their next way of offering it but not offering it to everybody so if you are an out of network therapist and you find I would try to encourage that you check coverage repeatedly have your clients routinely check coverage make sure they don't lose their coverage and if you find out that you are not going to be continued to be covered you the client might want be able to make some special arrangement to continue to see you because they were previously seeing you um and you might want to make some kind of single case agreement with the health plan before you do that you might want to schedule a consultation with me there's pros and cons of doing single case agreements and you might want to really think about that so that's something I can help you kind of determine all right how do I know if my client will continue to have Telehealth coverage well number one I strongly recommend you check benefits by phone before seeing any client and this is a Telehealth client an in-person client I've been singing this song for for 20 years basically and then again in each January most clients have benefits that start again every January and I can tell you on January 3rd or 4th after I kind of come back after partying on January 1st uh I'm usually on the phone all day checking everybody's benefits because it's amazing how many people have different benefits in the beginning of a new year but definitely um the best thing you can do is is to constantly check with the insurance plan or at least check from time to time to see if a client has Telehealth coverage or will continue to have health coverage now what should you ask when you call it seems very daunting maybe but don't worry I have you covered on my landing page which I described earlier I'm giving away a freebie if you don't have it already this is my checking coverage handout it has the 13 essential questions that you should ask they'll give you six questions to ask the their the client on the phone or whatever up front and then when you help call the health plan what should you ask to be sure you're asking every possible question now a lot of us say I'll just let the client tell me what their coverage is or they can call that Health Plan well if you're a network provider I can't encourage you enough this is your your money you're trying to get paid by this Health Plan you need to make sure that um that you've asked all the right questions up front so many times people contact me for a consultation oh Barbara I want was I'm not going to be paid for dozens and dozens of sessions and time and time again if they had called up front they would have known that um so I can't encourage this more to avoid pain and suffering and lack of payment down the line take the time I know it's time consuming but I always make that call personally frankly I know there's other ways to check but uh phone in my mind is actually you can ask questions there's more details it's much better than checking online it's much more thorough and much more accurate all right will Medicare continue to cover Telehealth I had a lot of questions about that so really quick summary of what what's going on with Medicare and Telehealth as as of September 2023 as we record this so my understanding is that phone sessions for mental health and substance abuse are now permanently covered by Medicare but again document the reason that you use the phone and that you offered them video sessions now this could change but that is my understanding also it is my understanding that mental health is now permanently covered you hear a lot about Medicare trying to decide what whether or how much to support Telehealth but if you read between the lines there a lot of that is about medical and not mental health my understanding is mental health is permanently covered and clients can continue to get Telehealth wherever they're located that's new in the last couple years with no Geographic restrictions now also in 2022 the end of 2022 President Biden signed the Omnibus spending bill which extended other Medicare Provisions for two years so we have all the way till 12 2024 basically all to the start of 2025 to extend all kinds of Provisions around Telehealth so we've kicked it down the road a bit for other things and Advocates are hoping that this two years is going to give Congress time to make coverage permanent right now for example the request there's a requirement that that clients be seen in person within six months of the first session and every 12 months afterwards but that's been waived until 12 31 2024. so people have heard about this don't worry about it for now and there's two bills in Congress that are seeking to remove this now Medicare Telehealth has been paid at the same rate as in person but that that probably is the first thing that we're going to see changed rates may be reduced at the end of 12 in 2023 unless lawmakers act so again a lot of this is moving we don't really know now I did post on the landing page medicare's current Telehealth billing guide they came out with a brand new one and you can go through that and see all the details it's it's very helpful to read through that and again that's on our landing page at theinsurancebass.com forward slash TBC Telehealth billing and coverage TBC there's lots of good stuff on that page all right will it be paid less for Telehealth sessions okay let's talk about this there are two types of parity this is called parody when you're paid the same for in person and uh not when you're paid sorry uh parity means equal okay so there's two types of parity Telehealth service parody and Telehealth payment parity service parity means it's a law that says hey insurance plans if you offer this service um in person you have to also offer it via Telehealth to your members so many states have Telehealth service parity laws in fact most of them do but then Telehealth payment parity laws say you have to pay the same for those two services in states with no payment parity law yes insurance plans could start paying less as of May of 2023 only 24 States required private plans to pay the same doesn't mean they will won't make many plans are paying the same for for in person as Telehealth but only 24 States mandate that now if you want to see a state-by-state breakdown of what plans require that um excuse me what states require that again I've posted that on the landing page now just a quick reminder sometimes people write to me and say oh you know it's why why does my client have different um payments for in person as Telehealth well a client might have a co-pay to see to be seen in person um but none when they do Telehealth but at the end the therapist should be paid the same so it's it's that's still covered by the parity law but remember a client could have a different copay all right let's talk about Interstate Telehealth there are tons of questions about this and there's so much confusion even after all this time about Interstate Telehealth will insurance cover it if I see a client in another state okay first let's review the laws related to Interstate tele therapy and a lot of us are still confused about this generally you must be licensed to practice in the state where the client is located at the time of the session or you have to have permission from that State's licensing board for that session to be legal what many of you are the lines are blown like this yes if I want to see somebody in Texas and my client's feet are in Texas at the time of the session and I am not licensed in taxes I would be practicing illegally to see the client in if she is in Texas and I am not licensed to practice there now what's the second half of that or if I have permission from that State's licensing board I could have gone to the Texas licensing board for my license to their website or called them up and seen do they have temporary permissions do they have temporary uh licenses that I could get what is what are their rules about Interstate practice but many the one thing to keep in mind is it doesn't matter where the client resides it doesn't matter that that person might be a a California resident and I reside in Resident I reside in California maybe even that client is going off to college in Texas but their parents they're using their parents insurance and the parents are Californians and they're Californians but they're just going off to school in Texas doesn't matter it's where the client's feet are am I licensed there because you're considered to be doing business in that state right and many states do not allow Interstate practice of any kind others may require some kind of registration others may allow some kind of temporary practice but you would need to sign up take a test whether there's all kinds of different rules depending on all kinds of things and it may depend on the state and it may depend on your license don't ask your friends about this area because first of all friends are out there with a lot of misinformation friends are out there practicing legally because maybe they're a psychologist and they're they're able to practice in that state because psychologists have some maybe in that particular State your state and that state have the psychologists have an interactive agreement but maybe you're a LCSW and the LCSW boards don't have an interactive agreement so it may depend on your license don't ask your friends check yourself with the licensing board I on the on the um landing page is a list of all the contact information for the licensing board in every state for every license so again cool stuff you're getting for showing up here today um otherwise keep in mind it may be illegal it probably is illegal for you to practice across state lines and whenever you're practicing that way it will not be covered by your malpractice if anything goes sour goes south so this is a big risk are people all doing it yes they're all doing it does that make it right no no does it make it very risky yes it does and yes have there been lawsuits about this yes um what if you're seeing a couple of family members and they're in different states again you need to be licensed in every state where a client is appearing on your screen what about International big topic I'm not a um got a lot of questions about that I'm not an expert on this area but it again depends on the um on the country certain countries I know have rules and regulations about who can practice and who can't practice other states are very quiet about it don't don't have laws about interest but one thing about International that I do know is you should check with your malpractice coverage it is my understanding that when you practice and see someone in another state in another country year malpractice may not cover you and I'm pretty sure they don't so check check on that case all right what if you're or the client are just out of state temporarily are there circumstances when it's okay to see that client so you know this is a huge topic and I just want to touch on it because a lot of you asked questions about this if I'm out of my state temporarily and my clients feet are still in a state where I'm licensed it's usually okay it's usually fine there's a couple States out there that it's you would want to check with the state that you're going to because certain States I heard that Nevada and I think Alaska you are considered also doing business out of the state where the therapist is so you probably want to check with the licensing board in that state in both States let's put it that way but it's usually okay if you're the one going out of state if the client is one going out of state again you're you are technically practicing um illegally so I would probably avoid it the only circumstances that I would say it's still illegal but you might still respond to that client is if the client is in an emergency they're in a um you know they're on vacation in in Las Vegas and suddenly they have a meltdown I'm never advising you to say oh they're out of the they're out of state so you shouldn't even respond to them you know you always have to weigh would I rather um always put crisis intervention uh above probably I would say but above this type of thing you want to respond you want to help them get seek crisis help but you don't want to be seeing them for you know 20 uh months ongoingly or so definitely I I don't say that the client being in a in a um emergency makes it legal it's still illegal but it's probably something that I would rather take that risk to respond than uh risk client abandonment so if it's legal for me to see a client in another state does that mean insurance will cover it ah guess what even if it's legal even if you're licensed in that other date or you have permission Insurance might not cover it I want you to think of it that way that there's the legal and then some insurance plans have a higher standard health plans may require you to be physically in that client State they may require you to be fully licensed in that other state or in both States they may require you to be in network in both States they may and they may Pay Less in that other state so they may require you to be in the country Medicare requires you to be in country so coverage is going to depend you're going to have to on whether you're in network or out so these are all questions that you need to check on so my advice consider getting or maintaining an office address in a state where your client's located if you're going to be out of state confirm where to file claims if your client is out of state many Blue Cross plans for example require that you send the bill to where the client clinician is located not where the client's located so these are things you need to check on always check with state and local clients plans excuse me and remember that Interstate practice laws apply whether the client uses insurance or not my client just moved to a state where I'm not licensed to practice therapy can I just continue to work with her and call it coaching very common question the answer is probably not um there's lots I can say about this but what I'd rather do is have you read my article on coaching versus therapy people are doing this they're saying oh you moved to South Carolina we'll just call it coaching from now on this is a big mess you can still be sued you can still be um accused of malpractice lots of problems can ensue here so I would get legal counsel and start by reading my article which on coaching versus therapy which is on our landing page at the insurancemaze.com forward slash TBC okay some other grab bag questions I'm thinking of giving up my office will insurance plans be okay with this oh this is a big one so policies are going to vary widely between plans of course I just did a July 2023 survey of 525 therapists and 38 said they don't have an office or don't use the one they have so this is becoming The New Normal I think we're going to see this more and more now nine percent said a plan had already told them you need a physical non-home office address that you need to be giving us a you need to maintain a non-home office address so 10 we're being told by a health plan that you can't go all Telehealth basically now remember a PO Box on a claimer super bill could be rejected and the NPI enumerator who gives out your NPI number they require a physical address as a service location so what is this leading us to 17 said they were using their home address on claims and super bills but this is a little risky right we're dealing with a very difficult population sometimes um not sure that we always want to have our home address out there on our claims and super bills for our clients to see or their angry Partners to see 21 so that almost a quarter we're now using some kind of a virtual address like Regis or I postal one these are these are virtual addresses where you're able to get a office address um or they were using some kind of a colleague's address or an old office address but all of these people or not all these people but many of these people worried about the ethics of giving out an address where you're not actually practicing right so I have some articles about this um I posted one of the article links on the insurancebase.com forward slash TBC if you want to read more about giving up your office contact the plan ask them don't tell them I've given up my office say I'm thinking of giving up my office um what should you ask them again I'm giving you another freebie which is what to ask the plan when you give up your office when you move out of state or when your client has left the state so this freeway covers three different topics that have to do with going all Telehealth or moving out of state or client and that again is on the landing page how should my session notes be different for a Telehealth session see you next slide all right let's go over this quickly mostly your notes are going to be the same as in person but for some states like California they now require that all Telehealth notes document some special things and um these are just best practices for those of you in other states too if the session was video or phone the client's location or address now if the client was just at home and you have that address on file you can just write client at home if they're anywhere else you are mandated in California and some states to write the actual Street location like client at 12 Main Street Topeka Kansas why two reasons one you're trying to tell them that uh you know where to you have an emergency address in case the client melts down during the session you can send help two you're also documenting that you are legally there are clients in a place where you're legally able to treat them it's also good to write or mandated that you write client was deemed appropriate for Telehealth in many states you're supposed to be assessing that in every session and documenting that you did Telehealth consent obtained something like that even if you have a Telehealth consent on file I asked the attorney California attorney I spoke to I said hey if I just have a Telehealth consent on file do I have to write that in every session and he said yep that's part of the law the law so um verified client identity was even oh it's supposed to be identity um that's also in the law I don't know that you need to do this but I would just write verified client identity especially if uh it's a phone session you can just use a word with the client like guacamole or something if that's your secret word and um you that way you know it's them and Medicare may require the name of the HIPAA compliant platform that you use the Telehealth platform that you use this is kind of a new thing that I'm kind of sussing out to see if they seemed like they might need that now I also two pieces of documentation I highly recommend I highly recommend a Telehealth consent that's in writing um 44 states require a Telehealth consent as of um 823 I also recommend a credit card agreement many of us are taking our clients credit cards but we don't have a formal credit card agreement so definitely do that I have both of these available for purchase in my practice forms packet and the link to that is on my on our landing page there at theinsurancebass.com forward slash TVC all right I've heard California has a new law requiring Telehealth training yes I'm trying to help spread the word about this as of July 1st 2023 all California Masters level therapists are required to take a one-time three-hour Telehealth law and ethics class before their license application or their next renewal this should be able to double count as part of your mandatory l e hours for all of you this is not for California psychologists but this is brand new I'm trying to spread the word out there I have one of these courses available in my online store I'm not sure if simple practice has a three hour one but make sure it's a three hour one okay bonus slides what other predictions do you see coming for Telehealth here's some predictions about the future as of 1124 many of you know that Medicare has now opened uh will now be opening to mfts and counselors my prediction is that they're going to be flooded by applications by therapists around the country my guess is that my last thing I heard about that is that if those applications are probably going to be starting to open in like November maybe of 2023 and I just think uh if you want to become a Medicare provider and you're an mft or counselor it may take several months and and you need to be really patient and you shouldn't be like telling clients hey any day now kind of thing I I think you just need to be really patient it may take many months I don't trust Medicare to be up and running on this quickly so um I but again that's a great thing more therapists are going to be on Medicare um and so that's good um more of us are going to be licensed in other states I'm already seeing that that many many therapists are now getting licensed in other states which is wonderful more clinicians are joining multi-state groups like Headway talk space Alma which will credential you with health plans and Bill for you they take care of all the billing they also can work um sometimes to get you higher reimbursement rates with insurance plans um because there is such a big group there's downsides um what I see is that a lot of people join these um groups and really love the fact that they don't have to take care of the billing and they don't have to take care of the credentialing and they get higher paid but there's a loss of control that I'm concerned about sometimes there's a loss you know if something happens and for example that a client get it turns out that the insurance plan doesn't pay as much as is expected the one of these groups might turn around to the client and try to say okay now you owe us more money whereas if you were the only one handling that you might say never mind client we'll just I'll just eat that there's there's just ways when there's a third party involved you lose a bit of your control also trying to resolve problems when there's a third party involved it sometimes becomes harder so something to really think about [Music] um and uh I'm kind of hesitant about these third parties um more Network clinicians will resign I am seeing a that happening my survey showed 24 that's like a full a quarter plan to leave at least one plan this year and only 11 said they have attended intended to apply so I think we're seeing a steady flow out away from working with insurance plans and a smaller number moving toward working with insurance so um a couple of things that you might hear about that I just want you to have have her understand when you hear it plans may start asking you to sign a Telehealth attestation um what is this this is where they say to you hey if you want to be a Telehealth provider for us you need to attest that you understand the laws of our state related to Telehealth and that you understand our policies related to Telehealth and it's usually a very simple thing um or they may ask you to create a Telehealth policies and procedures TPP um this is basically just create what are your policies related to Telehealth what are your emergency policies what if a client gets cut off during a session what about uh HIPAA what steps are you taking for security so you this is a this is not something you tell give to the client it's just something you have in your file cabinet somewhere where you outline Telehealth policies and procedures and you're able to take it out if needed and show it to somebody I have one of these Telehealth policies and procedures that you can purchase in my online store again the link is on our landing page and just so you know 33 percent of therapists in my survey so that's one-third had already been asked to sign either a Telehealth attestation or had been asked to put together a Telehealth policies and procedures by a health plan so this is something that's probably coming I'm thinking of moving out of the state let's this will this be a problem for the insurance plans I work with let's see is that the one I want to take yeah let's take that one and then we'll go to live questions all right how do Health Plans feel if you move out of state um policies are going to vary by Health Plan and state again you're going to need to contact the plan uh they may be fine but you may need to be licensed or credentialed in both States and my understanding is Regions for example does require you to be licensed and credentialed in both States now the reasons I want to bring this up before we take live questions is for example Blue Cross of California told providers they must be physically in state to be on the panel and I heard from many providers that they immediately terminated contracts when they learned the clinician had moved out of state so this is scary they had these these clinicians had contacted Blue Cross and said hey I just want to let you know I have a new address a new and all of a sudden the contact contract was terminated that day leaving all their clients hanging so this is why I told you when you call the health plan to tell them don't tell them you've already moved out of the state particularly Blue Cross I hear they are much more um more difficult about this one Blue Cross provider was told by the Blue Cross rep just keep it in state billing address don't let us know that you've moved out of state okay what can I tell you all right so let's go forward here I have some bonus slides um the slide handouts are are on you can download them on the um landing page so there are some bonus slides um and again they're all on this web page here um TBC the insurance maze TBC um and here's the ask a biller what out of network therapists should know about billing that's our next one in November so we're going to be talking about what you out of network folks should know about billing often we think we don't need to know if we're not contracted with insurance plans but there's so much you do need to know so um that will be um coming up in November you can register now registration is open and our entire series of these askabillar videos it are free and they're at simplepractice.com askabillar series and then my next webinar that I sponsor is called show me the money understanding reimbursement rates raises and resigning and that's on September 23rd and the information is there and on the landing page uh about that event and how to register it if you're watching this after September 23rd that recording will be available in my store and the recording for this webinar well you're going to be emailed a copy when they're recording of the recording when it's ready Cheyenne you wanna talk about pollen or you want me to yeah I can hop back in um so just as a reminder please sign up for pollen this is where you'll get the latest industry news we have a ton of resources uh PDFs that you can download and then we have weekly articles so if you just go to simplepractice.com pollen you can enter enter your email and subscribe that way and you'll also get all of our latest webinars and things like that and now oh do you want to cover the freebies Barbara no I just now we're going to take live questions and I'm just going to leave it on this slide while we talk um perfect yeah let's go over to live questions Ruth or I can start with our first one okay first question comes from Hillary can you go over whether it is still okay to use non-hippo compliant platforms that were allowed during covid and which platforms are allowed right um no it is not still okay as of August 8th I think it was um you can no longer use I mean we were never it was never okay to use non-compliant but we were there was not enforcing any penalty for using them so anyway now we are not a lot we we must be using HIPAA compliant Telehealth platforms um which which platforms are allowed um the best thing to do is to contact I I mean I have a list but I didn't include it um and I can only basically go by what Telehealth platforms say they are HIPAA compliant so the best thing to do is reach out to different ones but you know they include the paid versions of Zoom not the free version of Zoom so if you're paying any if you're using Zoom that's a very popular one simple practice of course um just make sure it has a baa and that you download the baa for whatever docsi me um I think the ones you want to stay away from are uh free uh what I'm totally blanking now um anyway just when you contact the name of the the platform just ask them if it's HIPAA compliant and whether it comes with a baa and that's the business associate agreement that makes it HIPAA compliant thank you Barbara next question comes from Valerie one of our providers does help Telehealth two days a week from her home office we're wondering what address we need to enter on insurance claims can we use our office address yeah again it's not where the client the therapist is sitting not again but um that's a great question um you can be at home the whole time if you have an office address use your office address that's your official business address and that's your service location it becomes dicey when you don't have an official physical office address that's more where it becomes problematic it's not though it doesn't have to be where the client where you're sitting I actually rent an office one day a week I'm never there so I can do all my Telehealth from home but I'm going to use that address on all my um on all my bills all my claims next question comes from Sarah how does Insurance know if the client is yeah yeah is this more of an ethical issue than anything else no it's a legal issue basically you are treating someone who is physically in another state you are not licensed to practice you are practicing beyond the scope of your license so right Insurance isn't going to know you're probably just going to put down the their home address so yes Insurance isn't going to know but it it's a legal issue and if if anything happens to that client and it comes up that you're treating somebody in another state thank you next question from Lori if you live in a state that requires Telehealth payment parity I'm in Illinois but see clients outside of state scipact will the parity laws changing in other states impact my rates since I'm paid at the local Blue Cross Blue Shield PPO rates it's a great question um I would guess that the payment parity laws only apply to the state that the service is taking place and if the client so I would think if uh it would have to be that the payment parity would have to be the state that you're seeing the CL that the client is in but that's a it's a guess next question comes from Desiree client not at home does this mean for when they are in the car or let's say on vacation in another state well if you're talking about place of service codes client not oh oh no you're thinking about documenting um so client I think I think this person's asking about how I document in the session so client at home means that I've already got their address on file somewhere if they're not at home basically I need to just write the actual physical address so if they're in their car I'm going to write uh at Starbucks parked in front of Starbucks but on Hamilton at um you know Winchester in San Jose California um so I'm going to give as much detail as I can so that if again keep thinking if I needed to send emergency help how would they be identified if there's a vacation in another state first of all I'm going to ask myself and my license to practice there and sometimes a client has appeared on screen and they tell me oh I'm at my grandma's in Florida and I'm like I can't I can't see you but second thing is if I can if I am legally able to see them then I'm going to write that they're at you know 223 Main Street in Tuscaloosa Florida whatever so yeah actually put down where to send help keep that in your mind next question from Gina are these codes for all disciplines or just Psychotherapy just psychotherapy okay that was an easy one next question from Maxine what is t101 for is this valid and billable still or only under the phe yeah I I don't know and I be very careful with t codes mostly we don't deal with those yeah okay probably have time for two more just FYI next one from Dina I always get confused with code 11. how is client in person if I'm meeting them via Telehealth yeah you never use 11 for uh for Telehealth that's in those for those of us who are still seeing clients or are seeing clients in person the only time you use 11 these days is going to be for medicare who's telling us yes I know it's Telehealth but we want you to use in the 11 for all of our folks so that you get paid at the higher rate the same rate as in person but they're basically telling you to use the wrong code but other than Medicare you shouldn't be using 11 for a Telehealth session 11 is only to be used for in person next question from Julia I work in group practice and we do supervisor billing for insurance companies that allow it the supervising doctor is licensed in New York and New Jersey the other clinicians are only licensed in New York can we do supervisor billing for New Jersey clients for the other clinicians no I'm afraid that's too into the weeds I couldn't really answer that you'd have to ask Within your licensing board and your insurance plans involved okay no problem I think we are at time yeah I just wanted to say again thank you so much for everyone for joining um I'll Pace Barbara's link down below for the insurance maze.com TBC it's also pinned if you go to the pinned comments um as always thank you so much Barbara this was clearly so so helpful um I wish we had time to cover all the great questions that we received but unfortunately we ran out but you can join Barbara at her next webinar and then also the one we're having with Barbara in November so we hope to see you all there thank you again Barbara we really really appreciate it bye everybody and get this you can get