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Review payer requirements

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At the end of the day, the biggest difference between providing cash-pay telehealth services and covered telehealth services (beyond how you get paid) lies in the breadth of remote services you can offer. Even when you’re circumventing payers, you can’t provide any cash-pay service to any patient—you must adhere to specific rules, guidelines, and statutes that may prohibit you from collecting out-of-pocket payment from insured patients.  

Commercial Payers: If your practice doesn’t contract with any local or national commercial payers, then providing cash-pay services is a cinch. You don’t have to answer to any carrier contracts or guidelines—you just have to create a fee schedule. But if you, like the majority of providers, contract with one or more commercial payers, then you have to do some homework before you start providing cash-pay services. Some payers restrict the out-of-pocket amount contracted providers can charge patients. Others outright forbid providers from offering cash-pay services to covered patients—though some payers hide these restrictions inside individual contracts. So, read your contract carefully, and give your payer (or maybe even a legal expert) a ring to ensure you don’t accidentally cross any boundaries.   

Medicare: As of April 30, 2020, the Centers for Medicare and Medicaid Services (CMS) announced that it will cover telehealth services provided by an appropriate provider for the duration of the COVID-19 public health emergency, retroactive to March 1, 2020. Essentially, what that means for your cash-pay model is that you can no longer provide cash-based telehealth services to Medicare beneficiaries because Medicare now covers those services. However, you can still follow normal Medicare cash-pay guidelines when providing any services, in-person or via telehealth, that “are ‘not covered’ by Medicare—either due to statutory exclusion (think wellness and fitness services) or lack of medical necessity.”