Question POS Codes - Do these apply to the patient, the provider, or both?

JessiePan

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Hi there!

My employer is having an issue with our Behavioral Health providers refusing to come back to work on-site. We have patient's with out-of-state insurance that don't cover telehealth services for IOP and are willing to come on-site for care.

My employer is wondering if the patient is in-office at the clinic, but the provider is virtual. Would that be considered telehealth or could it be an office visit because the patient is at the office. It's my assumption that if anyone is virtual (patient or provider) that the visit is telehealth, but we thought maybe there was a loop hole we were unaware of...?

Any advice is appreciated! :)
 

thomas7331

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Hi there!

My employer is having an issue with our Behavioral Health providers refusing to come back to work on-site. We have patient's with out-of-state insurance that don't cover telehealth services for IOP and are willing to come on-site for care.

My employer is wondering if the patient is in-office at the clinic, but the provider is virtual. Would that be considered telehealth or could it be an office visit because the patient is at the office. It's my assumption that if anyone is virtual (patient or provider) that the visit is telehealth, but we thought maybe there was a loop hole we were unaware of...?

Any advice is appreciated! :)
This would still be telehealth, even if the patients are on-site - if the payers aren't covering the service as telehealth, then they most likely still won't cover it just because the patients come on-site. You may be able to fool the payer's system by billing differently, but if they discover the error, it could end up costing your practice.

My recommendation would be that you contact the payers and find out if they will cover it in this situation, and if so, get guidance on how they want you to bill this. Different payers have issued different guidelines on how telehealth is to be billed during the pandemic. The last thing you would want to do is make an assumption about how you can or should bill it and then end up not getting paid, or even worse, getting paid and then later having to pay it all back if it comes to their attention that these services shouldn't have been covered.
 
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