How Can We Increase the Odds of Retaining Expanded Telepractice Coverage?
May 6, 2020
The COVID-19 pandemic has accelerated insurance coverage of telepractice, at least temporarily. This expansion of coverage—an ongoing ASHA advocacy priority—helps ensure that patients access medically necessary services, while reducing the risk of transmitting the virus.
State Medicaid programs and commercial payers have been at the forefront of the movement to cover telepractice services by audiologists and speech-language pathologists.
In a more recent development, Medicare expanded telehealth coverage for audiologists and SLPs, but only for specific procedures codes in private practice. ASHA is seeking clarification on telehealth coverage in facilities, such as skilled nursing facilities and hospital outpatient departments. We also continue to advocate for the expansion of the codes covered.
This new flexibility provides a chance for us to demonstrate to payers and patients how valuable telepractice is to patient care—and to possibly secure telepractice coverage permanently.
(ASHA uses the term “telepractice,” which is equivalent to the term “telehealth” used in most licensure laws and payment policies.)
The more that providers use, code, and bill telepractice according to payer specifications, the greater the chances that the new benefits endure. Here are some key considerations to guide providers on doing that.
Coding and documentation stay the same
When you provide a telepractice service, you bill a CPT (Current Procedural Terminology) code—like 92507 (speech and language treatment) or 92603 (cochlear implant programming)—regardless of whether the service is in person or online.
All the coding rules still apply, including same-day billing and time requirements, for those codes. For example, if you provide a brief check-in via telepractice for 15 minutes, that can’t be billed as a full evaluation or treatment session.
CPT code coverage differs
Payers may cover a limited list of CPT codes authorized for telepractice for each profession. To determine the particular telepractice services that a payer will cover, refer to the coverage policies for each payer. Use ASHA’s updated tracking resources for commercial plans and state Medicaid programs and emergency orders to research COVID-19 telepractice policies in your area.
Telepractice isn’t appropriate for every patient
Audiologists and SLPs recognize that telepractice should be provided only when clinically appropriate for the patient and when the quality is equal to in-person service delivery. Clinical judgment is the most important consideration in deciding whether or not to use telepractice with any particular patient.
Local advocacy is critical
You can approach local payers directly to expand telepractice coverage, especially during the public health emergency. ASHA provides telepractice coverage coding recommendations to payers—including commercial insurers, Medicaid programs, local education agencies, and Medicare–to promote robust and clinically appropriate telepractice coverage policies. These recommendations include CPT coding with supporting clinical vignettes.
You can use ASHA’s template letter to send your own recommendations to payers.
ASHA also encourages clinicians to carefully document outcomes for clients you are treating via telepractice. These data help advocacy efforts to extend telepractice coverage beyond the pandemic.
Privacy requirements may vary
Although the federal government waived many Health Insurance Portability and Accountability Act (HIPAA) requirements during the pandemic, payers and other entities may still expect compliance with privacy protections or require specific telepractice platforms.
In addition, school-based clinicians need to comply with student privacy requirements governed by the Family Educational Rights and Privacy Act (FERPA).
A window to expand coverage
Payers have started developing claims processing edits and auditing protocols to monitor telepractice services and identify potential abuses.
Complying with coverage parameters and delivering services according to state regulations, clinical best practice, and established coding and reimbursement guidelines will help demonstrate to policymakers what many states, Medicaid programs, commercial insurers, patients, and clinicians already know: Telepractice services should be covered, and audiologists and SLPs are qualified to provide them.
ASHA will continue to advocate across all settings to obtain permanent coverage and reimbursement of clinically appropriate audiology and speech-language pathology telepractice services. Find updates for health care and school telepractice coverage on the ASHA website’s continually updated coronavirus center.
Sarah Warren, MA, is ASHA’s director of health care policy, Medicare. firstname.lastname@example.org
Neela Swanson is ASHA’s director of health care policy, coding and reimbursement. email@example.com