Wiki Billing for Telemedicine

[MPhillips77]

I have a question regarding billing for Telemedicine. My primary care health provider is looking at doing Telemedicine. We are looking at doing it for Maryland residents (as we are a Maryland practice) and I have already done some research into which insurance providers do allow billing for Telemedicine. However, I know that not all insurances will cover it, or if they do, they may not cover the full amount, the patient may have a high deductible, etc. (You know how it goes).
My general manager says that patients who do not want to bill their insurance for the Telemedicine visit do not have to - we can just bill them as a cash pay patient. However, I have concerns because I know that in other places I worked, if we had the patient pay as a cash pay, and they had insurance, it was considered fraudulent. I am concerned that if we do just make them cash pay, they (and we) can get in trouble with the insurance company and laws.
If a patient has insurance, and it does cover Telemedicine visits (but may not at the full amount, etc), do we have to bill the insurance or can we make that patient a "cash pay" patient for the visit? If the patient's insurance DOESN'T cover Telemedicine, can we make them a "cash pay" patient for the visit? I want to make sure we are not breaking any medical billing laws before we jump into this. Thank you for your help.

Melannie

 

[thomas7331]

For commercial plans you are only limited in this if you have a contract with the plan, in which case you should review the individual contracts to see if there are any restrictions you've agreed to follow. As a general rule, patients do have the option of not using their insurance benefits if they choose to. And if you're not contracted with a plan, you're entitled to ask the patient to pay for the services and not under any obligation to bill. For the government plans (e.g. Medicare and Medicare Advantage plans, Medicaid, Tricare) it's a different matter and you do need to follow the laws and regulations for each and make sure you're taking the appropriate steps such as obtaining ABNs and advising patients of their options prior to providing the services.