Guide to Medicare Billing and Reimbursement for Patients of Telehealth Psychologists

Telehealth has revolutionized the healthcare sector with its remote access to a wide range of services, including telehealth psychologist support. Telehealth psychologists are crucial to this change since they provide patients mental health care in the comfort of their own homes. This can include people with busy schedules, those who reside in rural areas, or those with mobility issues.

Medicare, Australia’s publicly funded universal healthcare system, recognises the value of telehealth. Medicare covers psychologists telehealth services to ensure that more patients have access to the help they require. Understanding the role and billing procedures of Medicare is necessary to ensure transparent delivery of services and again an insight towards the payment of telehealth psychologists. It helps patients  because it makes the process clear to them, allowing them to be satisfied with any questions they may have about our healthcare system.

Medicare Covered Telehealth Psychologists Services

Medicare has certain regulations for the psychologists telehealth services it offers that are offered using online platforms. These regulations should be known by both the patients and telehealth psychologists in order to ensure that they provide or receive qualified services. It also builds trust between the patient and telehealth psychologists as both become aware of the value of services. 

Medicare covers a wide range of psychologists telehealth treatments, including diagnostic interviews; individual and group psychologist treatment; health and behaviour assessments. Depending on the clinic and the telehealth psychologists, you may be able to recieve additional services.

Medicare assesses patients based on certain criteria:

• You need to be registered with Medicare and have a valid Medicare Card
• You must have a Mental Health Care Plan (MHCP) provided by your General Practitioner
• You must have a referral from your GP
• You must not have exceeded the maxium number of sessions in a calendar year (10)

Guidelines and Billing Codes for Telehealth Psychologists  can be found using the Medical Benefits Schedule (MBS) codes, Medicare bills and categorises telehealth services on the Medicare website. Some of the MBS codes for telehealth psychologists services in Australia are:

Clinical Telehealth Psychologists:

Item 91166: Shorter telehealth consultations by clinical psychologists, typically around 30 minutes.

Item 91167: Telehealth attendance by an eligible clinical psychologist for a session lasting at least 30 minutes.

Items 91181 and 91182: These cover longer telehealth consultations, usually around 50-60 minutes.

Registered Telehealth Psychologists:

Item 91170: Focused psychological strategies via telehealth provided by a registered psychologist. This item covers sessions lasting at least 30 minutes.

Item 91171: This item covers telehealth consultations lasting at least 50 minutes.

It’s important to use these codes correctly. Each code corresponds to a specific type and duration of service. Ensuring the correct use of MBS codes will prevent claim denials and ensure timely reimbursement.

Additional Information for Referral and Review: 

Patients can access these services after being referred by an eligible medical practitioner. A management plan (MHCP) is usually required, and the initial assessment and creation of this plan are covered under specific items (Medicare card holders only). 

In general, patients are eligible for up to ten separate sessions every year, (for which they can receive a Medicare rebate). Patients may choose to have extra sessions using private funding. 

Psychologists Telehealth Service Billing Instructions for Medicare Claims:

Usually, Inner Psych will file this claim on your behalf, and as Medicare to put the money directly into your account within 30 business days.

Some patients choose to file the claim themselves and can do so using the following instructions:

1. Check that the details you have provided is Medicare eligible and that you meet the claim requirements.
2. Keep careful notes on the services provided, along with the nature, duration, and any other relevant information. The receipt Inner Psych provides you with will have a list of all this.
3. Select appropriate MBS codes for the offered services.
4. Utilising the appropriate claim submission method or the Medicare online portal, submit your claim.
5. Watch the claim status and respond promptly to any requests Medicare makes for further information.

Common Issues in Medicare psychologists telehealth services billing and how to fix them:

Medicare billing can raise several problems for patients filing their own claims and telehealth psychologists. Common issues include:

This is usually brought on by incorrect use of MBS codes or lack of supporting documents. Should your claim be rejected, it will often provide an explanation and possible remedies. Common concerns include:

1. Eligibility Issues: Patients not meeting the Medicare rebate criteria or incorrect MBS codes used. Make sure to double check this information with your telehealth psychologists if you are unsure.
2. Technical problems: Errors committed in the submitting process. Just try again later in such situations.

Before submitting your claim, make sure you have verified all documents to avoid facing any challenges. Another way to avoid errors is by staying up to date about the most recent Medicare and telehealth rules. 

Visit the Medicare assistance website for any support you may need or if you have any questions.  Additionally, you can also reach out to one of  the telehealth psychologists at Inner Psych should you have any concerns.  

Payment Schedule and Rates of Reimbursement

Telehealth service reimbursement rates may differ from in-person service reimbursement rates. They are also different for the type of telehealth psychologist, clinical or registered, and the duration of the session. Usually, the Medicare Benefits Schedule serves as their corner stone. The most up to date reimbursement rates are always available on the MBS wesbite.

Medicare Psychologists Telehealth Corrections and Updates Medicare billing regulations are continuously changing, especially with reference to telemedicine. These adjustments could affect the billing processes and reimbursement rates.  While our telehealth psychologists check Medicare announcements and changes on a regular basis, we always counsel our patients to confirm the most recent notifications before submitting a claim. Please use the Medicare website (MBS online) for the latest information. 

Frequently asked questions for psychologists telehealth services medicare claims:

What if my claim is denied?

Verify the rejection reason with medicare, correct if needed/ possible, and resubmit the claim. See Medicare resources if needed or you can also call their helpline. 

Does the rebate for psycholgists telehealth services match that for in-person visits?

Rates of reimbursement are subject to change. Please use the Medicare Benefit Schedule should you wish to compare rates as this will give you the most upto date value. 

What information is available to me regarding changes to Medicare policy?

Look over professional publications, announcements, and Medicare updates. You should be able to find all the information on their website and can also give Medicare a call should you wish to speak to someone.

Resources and Support for Telehealth Psychologists and Patients (regarding Medicare Rebates)  include: 

• Official Medicare website (MBS online)
• Medicare helpline
• Join associations of professionals, like the Australian Psychological Society for announcements