Telebehavioral Health Insurance Reimbursement Index
Highlights: This section is focused on the overall financial issues related to telebehavioral health, telepsychiatry and telemental health.
There are many ways to obtain a positive return on investment for telebehavioral health. Reimbursement for telebehavioral health is widespread and growing. But focusing solely on one type of reimbursement can result in missed significant opportunities.
Cost Reduction: Telebehavioral health solves many logistical barriers to accessing care. In some cases, telebehavioral health reduces costs by:
- Reducing or eliminating provider travel costs
- Leveling labor distribution across a network
- Reducing readmissions
- Triaging emergency room patients and route patients to a more appropriate level of care
- Fulfilling mandatory evaluation requirements at lower costs by using on-demand remote providers.
In an ACO environment, the use of a telepsychiatrist or telenurse practitioner saves significant costs by maintaining patients with outpatient care.
Revenue Options: There are many options or combinations of options that have been used to fund telebehavioral health services. Each of the following is in use to varying degrees by different organizations:
Cash pay – Just like in-person services, many psychiatrists in private practice accept only private pay for services and are able to maintain a fun practice.
Health Insurance Reimbursement – Medicaid, Medicare, and third-party health insurances all pay for telebehavioral health services in different degrees. HRSA has a handy tool called the Medicare Telehealth Payment Eligibility Analyzer. Telehealth reimbursement is now mandated in a growing number of states for third-party health insurance. Major health insurers, like Optum, are reimbursing for telebehavioral health in non-mandated states to reduce the overall cost of care. It is important to check with each health insurance provider individually prior to providing service to verify submission details.
Federal Grant Funding – HRSA, SAMHSA, and other Federal agencies have historically funded telebehavioral health to increase access to care in rural areas or to address growing issues such as the opioid epidemic.
Local Funding – Many state and county health organizations contract with telepsychiatrists and telebehavioral health counselors to provide services through Medicaid block grant funds or other operational funds. In addition, foundations at the local level often provide full or partial grants to fund or supplement the funding of telepsychiatry to serve under-served populations.
Here are some additional financial and insurance reimbursement resources for telebehavioral health.
Information Relevant to Financial Reimbursement