Telepractice Reimbursement – Fall 2018 Updates

November 18, 2018 BY Jenny Peddicord, CCC-SLP

Way back in 2015, we wrote a post about the bewildering world of telepractice reimbursement. It’s definitely time for an update, but where to begin? As with everything, it is tricky to provide basic information for newer consumers as well as more advanced information for more savvy consumers. ASHA’s Special Interest Group for Telepractice (SIG 18) faces this exact issue when deciding how to provide professional development content for its members. How do you teach SLPs and AUDs that are new to telepractice what they need to know, and at the same time be a resource for experienced practitioners? Fortunately, in the domain of telepractice reimbursement, you don’t necessarily need to know all that has gone before. What you do need to know is that it changes frequently and that it’s important to stay current.

Telepractice Reimbursement 2018

If you’re a new practitioner or wanting to get started, you’ll want to check out ASHA’s statement on telepractice reimbursement. In brief (because I can’t help myself), they explain that insurance reimbursement is a checkerboard across states and between state, federal, and private entities. The best way to figure out whether or not any given insurer will reimburse for telepractice services is to call them and ask if they cover the modifier GT or the place of service code 02. This is one constant across time that is unlikely to change anytime soon.

All telepractioners, both new and seasoned, should be aware that the Centers for Medicare and Medicaid Services (CMS) recently released proposed changes to the 2019 Physician Fee Schedule and Quality Payment Program set to take effect January 1st, 2019. These are considered to be big changes in telemedicine and worth taking note of.  

Here’s what CMS said about these changes:

“We now recognize that advances in communication technology have changed patients’ and practitioners’ expectations regarding the quantity and quality of information that can be conveyed via communication technology. From the ubiquity of synchronous, audio/video applications to the increased use of patient-facing health portals, a broader range of services can be furnished by health care professionals via communication technology as compared to 20 years ago.”

While much of the changes do not directly pertain to SLPs and AUDs in the immediate future, it’s a good idea to be aware of them and understand how they might affect your clinical practice. Here are 3 aspects that jump out as being potentially relevant to us:

  1. Virtual Check-Ins, officially titled “Brief Communication Technology-Based Service”
  2. Asynchronous Images and Video, officially titled “Remote Evaluation of Pre-Recorded Patient Information”
  3. Peer-to-Peer Internet Consults, officially titled “Interprofessional Internet Consultation”

I really want to dig into these codes and services and how they might relate to our services, but that’s a whole ‘nother blog.

I’m loving these changes because they reinforce the notion that telepractice is a way we deliver service, not the service itself. It’s common in our field to think of telepractice in one way —  services to schools. However, I find this so limiting. Clinicians in all settings provide myriad services, from consultation to training, diagnostics to treatment, and beyond. The new CMS proposed changes acknowledge that telepractice is not a one-size-fits-all modality. We need these options because we do a lot of different things. We also want parity in the amount of reimbursement for in-person services as for teleservices because teleservices are of equal value to those delivered in-person.

In an effort to get another perspective on reimbursement, I asked our office administrator and billing specialist, Lauren Forgione, for her thoughts on reimbursement. Ever the pragmatist, here’s what she said:

“In the expanse of third-party payers and the policies they uphold, it seems that the only constant is change. The Hello Foundation has been providing online therapy services for nine years, with a focus on providing the best quality services possible using a wrap-around, client-centric approach. Until this past year, we’ve delivered services to folks using strictly a cash-pay model, and with this, we’ve been able to help a lot of people communicate better in the world around them. Thankfully, we are just now beginning to see third-party payers adopt policies that allow for reimbursement of speech therapy services delivered online. We see this acceptance of an alternative care delivery system as a huge win for patients everywhere, who will now have increased access to care.”

Changes to telepractice reimbursement will continue to come, but as Lauren says, anything that increases access to care is a step in the right direction.


Medicare’s New Virtual Care Codes: A Monumental Change and Validation of Asynchronous Telemedicine

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