Telepsychiatry Reimbursement Rates

Telehealth is one of the fastest-growing fields of medicine and one of the centerpieces of telehealth is telepsychiatry. This is one of the cornerstones of telehealth because psychiatry rarely requires physicians to conduct a hands-on physical exam. Therefore, psychiatry is tailor-made for the field of telehealth. Now, states and insurers are starting to take note. It is difficult to progress too far into a conversation about telepsychiatry without asking about reimbursement rates. Reimbursements for telehealth can be complicated and it can be challenging to understand how reimbursement works in the field of telepsychiatry; however, there are a few key points to keep in mind.

Varying Reimbursement Rates from State to State

One of the first points to know is that reimbursement rates in the field of telepsychiatry vary from state to state; however, the good news is that most states are now mandating coverage for telehealth to a certain extent. At the same time, this mandate is not the same across the board. A state’s individual mandate will vary depending on:

  • The extent of telehealth coverage
  • The different payers in the state
  • The reimbursement rates of the individual payers for telehealth services, including telepsychiatry

As a result, there are no two states alike when it comes to telepsychiatry reimbursement rates. Any organization that is planning on using telepsychiatry should follow some helpful advice from the experienced professionals.

Keeping Telepsychiatry Financially Stable

Telepsychiatry provides a valuable service to countless patients who otherwise might not have access to much-needed psychiatry services. With a severe shortage of mental health services across the board, telepsychiatry is incredibly valuable when it comes to patient access. At the same time, for telepsychiatry to remain viable, it is critical to plan appropriately. Some of the critical pieces of advice to keep in mind include:

State Laws: Remember that state telehealth laws are going to vary from place to place. Become familiar with the state’s telehealth laws by visiting helpful resources such as the American Telemedicine Association and the Center for Connected Health Policy.

Payer Policies: In addition to the state laws, it is important to know the reimbursement policies of the various payers. There are a myriad of insurance policies out there and each of them are going to handle telehealth and telepsychiatry reimbursement rates differently. If the answers are not clear, call the payer and ask for clarity.

Choosing a Partner: It is a good idea to reach out to a telepsychiatry partner who has experience in the field. Their expertise is going to be invaluable when it comes to regulatory policies and reimbursement rates in the state.

Understand Leverage: Telehealth and telepsychiatry are still relatively new fields. Some payers might not have policies in place for this field of medicine despite its value to patients. Therefore, understand leverage in the field of telemedicine. Anyone who is willing to provide telepsychiatry services is increasing patient access in the local area. Remind insurance companies that there is a shortage of psychiatry services and use this to negotiate for fair telepsychiatry reimbursement rates.

Fair Telepsychiatry Insurance Reimbursement Rates

When negotiating for telepsychiatry reimbursement rates, there are a few points to keep in mind. Laying out a clear argument can convince payers that telepsychiatry services are not only in the best interests of patients but also the best interests of the payer.

Point to the Experts: First, point to the American Psychiatry Association, which is the arbiter of psychiatry in the United States. Even though 20 percent of adults have a mental illness, only 40 percent of these adults have access to mental health treatment. The wait time for mental health services can take months and telepsychiatry services can improve patient access and reduce wait times. Many organizations that used to average wait times of three months or more have been able to provide same-day appointments to trained psychiatrists.

Reduced Healthcare Costs: Then, remind payers if adults who need mental health services go without appropriate medical care, they drive up healthcare costs. Without adequate treatment, many patients with mental illnesses end up in the emergency room, which is far more costly to the payers. Severe cases can involve suicide attempts, which might place someone in the ICU and lead to a forced commitment. By providing telepsychiatry services, the number of emergency room visits, hospital stays, and ICU visits are going to be reduced. This saves the payer money.

Medicare and Medicaid Telepsychiatry Reimbursements

The Center for Medicare and Medicaid Services (CMS) has some rules that have been restrictive when it comes to telehealth services and telepsychiatry appointments. In order for an organization to bill Medicare for telehealth services, they must be in a rural area AND be at a CMS-approved facility. There is legislation to bring these restrictions into the modern era; however, this process might take some time. However, many Medicare Advantage plans have updated their policies to be less restrictive and this is worth looking into. In the meantime, it is helpful to work with trained professionals who can help organizations navigate the waters of Medicare and Medicaid telepsychiatry reimbursements.

Trust innovaTel for Navigating Telehealth Reimbursement Rates

It can be a challenge to navigate the world of telehealth reimbursement rates, particularly telepsychiatry. This is where innovaTel can provide assistance. There is a network of virtual mental health professionals who can help healthcare organizations reach patients nationwide. Contact innovaTel today to learn more about telepsychiatry services in your area!