Providing telehealth/telebehavioral services can be an opportunity to both expand your practice and help people with difficulty getting to your office.  There are, however, a lot of regulatory and authorization details that you need to attend to.  Here is another update from MHConcierge, following up on previous posts, Telehealth, an Overview and Telehealth, Getting Started.

First, MN DHS released an update on the DHS telehealth policy which includes, “Payment for telemedicine services is limited to three visits per calendar week per member.” Obviously, DHS is supportive of not only this service but having it, if needed, be an intensive service (it seems likely, however, that you might need to justify the medical necessity for this frequency of services if you are audited or need to request continued authorization later in the year).  Second, I heard from PreferredOne that they authorize telehealth services in the home.

Finally – and MHConcierge is pretty proud of this one – BCBS has had an obnoxious policy that states that telehealth services provided to recipients in their home is NOT a covered benefit.  BCBS is an outlier on this – all other companies, both local and national companies doing business in MN, cover telehealth when the recipient is in the home.  BUT, BCBS has a contract with DHS for their Blue Plus program, and this program must comply with DHS guidelines.  DHS clearly states that telehealth services provided to people in their home IS a covered benefit.

I had a series of email exchanges with BCBS MN staff, eventually received an acknowledgement that “we probably need to change our policy to be in compliance with DHS,” but no action actually occurred after ½ year of increasingly unproductive email exchanges.  Thinking that this was more than enough patience and diplomacy, I therefore escalated my efforts by contacting DHS – and within 48 hours the problem was resolved!  I talked to BCBS staff, Jill W., (651-662-3128 incase you want to confirm the outcome with her), who confirmed, very polity and diplomatically, that for BCBS Blue Plus members they do indeed need to cover telehealth services in the home.

In addition, I explained that my research has found that all other companies cover this service, even if it is not for a DHS (or PMAP) contract.  She said that it is her understanding that, in spite of the BCBS MN written policy, they actually DO cover this service – but it depends upon the individual contract.  In other words, if you have a patient with a “commercial” (not a government) policy, and you are considering providing telebehaviral services, you need to contact BCBS to find out if the patient’s contract excludes telehealth in general, and in-home services in particular.   This is probably wise do for all commercial plans.

Coming up next:  An update on Medicare policy for telehealth, which is evolving.

Tagged on:

Leave a Reply

Your email address will not be published. Required fields are marked *