Chiropractic Telemedicine or Telehealth is one of the hottest topics in practice management, clinical patient management and billing/coding circles – and it is one that we have been getting many questions about from the chiropractic community.
Because this opportunity to implement chiropractic telemedicine or telehealth in your practice is so new, it’s one that does not have a long track record that we can reliably and definitively answer “yes” or “no” to, but it is an opportunity that chiropractors need to consider carefully.
An Opportunity to Consider
In fact, it’s one that experts outside our profession have been pointing to for years. As the “narrow network” trend increases whereby insurance payers are offering slimmer benefit packages, higher deductibles and increasing reimbursements, some even believe that chiropractic is positioned perfectly to benefit due to its low cost and its ability to keep patients in pain out of more expensive options such as the ER.
Yet, few chiropractors have implemented telemedicine services in their practice.
What Exactly is Chiropractic Telemedicine or Telehealth?
Perhaps its because many chiropractors do not understand what chiropractic telemedicine or telehealth services can entail. Certainly, if your idea of chiropractic telemedicine is adjusting the patient via phone, there is a very small (potentially non-existent) market for that – and certainly no payer reimbursements either.
But if you understand that chiropractic telemedicine or telehealth can encompass a fairly broad range of online consultations and electronic communications between physicians and patients, then the possibility of including telehealth into our chiropractic services becomes more clear.
Outside the chiropractic bubble, medical practices are expanding their services to include various forms of telemedicine and this trend is likely to grow among chiropractors as well.
Numerous surveys indicate that both patients and doctors are interested in telehealth and we are now seeing payers respond to that interest by expanding their reimbursement policies to include telemedicine services.
According to the American Telemedicine “Gap Analysis” report, all 50 states have some type of coverage for state Medicaid programs. In addition, 31 states now have Telemedicine “Parity Laws” for private insurance and 26 states have coverage under one or more state employee health plans.
Again, while chiropractors are obviously not going to provide their primary service online (the adjustment), Telehealth consultations are a potential area of benefit to the patient, the practice and the provider. These could occur in between visits, addressing issues or questions that the patient has, without requiring a physical appointment in-office. If the patient gets helped and the provider gets paid, this is certainly win-win.
Before you begin billing for various Telemedicine or Telehealth services, take these points into consideration:
- There are no specific codes for Chiropractic Telemedicine or Telehealth, but there are codes that chiropractors can potentially use to bill these services; chiropractors would simply utilize the same telemedicine codes as other physician providers do (within their scope, of course)
- Because Telemedicine is so new, different payers have established “preferences” for the way Telemedicine can be billed and for what is covered. For example, some payers simply require the modifier – GT attached to the service, to indicate that this was a Telemedicine service. Others prefer specific codes in the “Non-Face to Face” Service series (such as 99441-99449). Still others require specificity as to the type of Telemedicine services; for example, if it happened literally over the Telephone, they may require that the service is billed with the Telephone Assessment series (98967-69) if performed by a non-physician.
- Many state laws that governing telehealth have different rules on whether or not your telemedicine services can extend to new patients (vs only existing patients), so don’t immediately broadcast your Telemedicine services to everyone
- Many Blue Cross Blue Shield (and other private payers) distinguish Telehealth from Telemedicine by definition and by reimbursement. For example, in their policy on “Virtual Care,” Regence BS (of Washington, Oregon, Idaho, Utah) provides separate and distinct benefits and criteria to Telemedicine vs Telehealth. In other words, do not assume that reimbursement coverage for one means reimbursement for the other.
- Since Medicare only reimburses chiropractors for spinal manipulation, there is no Telehealth or Telemedicine benefit available from Medicare yet.
- Personal Injury payers represent the “wild card” here, as chiropractors report that many PI payers seem to have no defined policy on the use of Telemedicine. And we’ve seen examples of chiropractors getting paid and having these claims denied.
To summarize, this can be a legitimate benefit for your patients and your practice, but proceed with caution and do research in your local market prior to establishing these services in your office.
If you want to dive deeper into insurance changes such a Chiropractic Telemedicine – and many more private payer insurance changes as well – get the RECORDING of our Chiropractic Insurance Billing, Coding & Documentation MASTERY seminars so you don’t miss out!