CTRC Digital Payment Guide Door 2
Welcome to the California Telehealth Resource Center Digital Health Payment Guide! You are about to enter Door 2, where you’ll access the in-depth details necessary for securing payment for your digital health services. This section is tailored for those who have already built a solid foundation in the basics and are prepared to move forward.
Each section contains a set of PDF documents that break down the topic into key components. The PDFs are best viewed in Adobe Acrobat Reader, a free PDF viewing software.
You can move through the guide in sequential order or select the sections that are most relevant to you.
To return to the section menu:
– If viewing the PDF in Adobe Acrobat Reader, click the “Back to Door 2” button located at the top of each PDF.
– If viewing from your internet browser, use your browser’s back button.
The 6 Basics for Obtaining Payment:
To revisit the basics, see Door 1 to develop a fundamental understanding of digital health payment.
Provider Type
The first stop will introduce you to the various types of providers, such as Federally Qualified Health Centers (FQHCs), Rural Health Clinics (RHCs), Indian Health Services (IHS), Critical Access Hospitals (CAH), and community providers. Each provider type has its own billing and reimbursement processes, and knowing your provider type is the first step toward a successful digital health practice.
Health Plan
You will then explore the world of health plans. Major payors such as Medicare (Original Medicare vs. Medicare Advantage), Medicaid (managed care), and commercial insurance significantly impact coverage and reimbursement. This stop will help you understand the rules and regulations for each payor.
Modalities
As you advance through Door 1, you will encounter various digital health modalities. These are Telehealth Interactive Audio-Video, Telehealth Audio-Only, Store and Forward (Asynchronous), Remote Physiological Monitoring (RPM), Remote Therapeutic Monitoring (RTM), Artificial Intelligence, and eConsult. Each modality has its own set of codes and requirements that must be followed to ensure proper billing.
Coverage
In this section, you will learn about the coverage requirements that differ significantly between health insurers and payors. Understanding these requirements ensures that the services you offer are covered and reimbursed. Coverage is determined by the type of provider and the type of service provided.
Coding
Accurate coding is critical for reimbursement, and here you will learn about CPT/HCPC codes, modifiers, and place of service codes. This step of your journey ensures you can effectively communicate the services provided to the payor, allowing for successful claims processing.
Reimbursement
Finally, you will arrive at the reimbursement section. Making sure you are paid appropriately for your services requires that you are aware of the reimbursement rates and procedures for various payors and modalities. You will learn about the reimbursement rates for FQHCs, RHCs, and other providers.
Remote Physiological Monitoring (RPM)
Medicare RPM: Critical Access Hospitals (CAHs)
COMING SOON
Medi-Cal RPM: Critical Access Hospitals (CAHs)
COMING SOON
Remote Therapeutic Monitoring (RTM)
Medicare RTM: Critical Access Hospitals (CAHs)
COMING SOON
Medi-Cal RTM: Critical Access Hospitals (CAHs)
COMING SOON
Stay tuned for additional digital health modalities – coming soon!
Enter Door 1 to Learn the Basics
Step into Door 1, where you’ll gain a solid grounding in the basics of digital health payment.
This section is specifically for those who need to build or refresh their understanding of key concepts before tackling more detailed information. We use the door analogy to illustrate that there are essential steps to take before you can advance to the next level. By going through Door 1, you’ll be equipped with the knowledge you need to confidently move on to Door 2.
