Billing, Reimbursement, and Maximizing Revenue for Telehealth Services
Clinicians who offer telehealth services must navigate the complex rules that regulate billing and reimbursement for virtual psychiatric care. Filmed at Psych Congress Elevate 2025, Steering Committee Member Edward Kaftarian, MD, provides an overview of recent developments in reimbursement policies for telehealth services. Dr Kaftarian also offers insight on how providers can maximize revenue while still ensuring they are billing accurately.
For more telehealth insights, visit the Telehealth Excellence Forum.
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Read the Transcript
Edward Kaftarian, MD: My name is Dr Edward Kaftarian, I'm a psychiatrist, board certified in forensic psychiatry and addiction medicine, and I'm on the Steering Committee for Psych Congress. I'm also the chairman and CEO of Orbit Health Telepsychiatry.
Psych Congress Network: What are the most significant developments in reimbursement policies?
Kaftarian: As far as the federal Medicare and Medicaid rules, it appears that the government has become more open to telehealth in that the originating site, which just means the site where the patient is located, it really doesn't matter a whole lot as far as getting reimbursed, whereas it used to be that [the patient] had to be in certain spots, like rural areas and other qualified areas, [to be reimbursed]. Now the government has decided that it's okay to practice telehealth fairly broadly in areas where we weren't allowed to before. Of course, we need to make sure that it's appropriate for patient care and confidential and whatnot, but seeing a patient in their homes is now acceptable and reimbursable.
PCN: How can providers ensure they are billing accurately and maximizing revenue for virtual psychiatric services?
Kaftarian: Sometimes it's very challenging to maximize revenue in particular states that don't have parity laws, especially if you're seeing Medicaid patients. If you have a private practice and you're doing fee-for-service, of course, that's less of a problem, and many insurance companies now have parity rules where they reimburse almost the same or the same as on-site, in-person care.
To maximize revenue, you need to be familiar with the rules of the insurance company because they differ. Some companies offer a great amount of reimbursement and others don't. Something that you can do to maximize reimbursement is a lot of providers think that you can bill only for the originating site, but you can also bill from the provider site, as well, but you have to be very careful about that because you don't want a double bill and so you need to look at the specific rules with that. So in some cases, you can get a small amount of reimbursement both ways.
But again, these are really important laws and rules that you need to make sure to follow, because you don't want to be caught in any sort of situation where it's considered fraud.
Thank you so much for joining me today. I hope that this was very helpful for your clinical practice.
Edward Kaftarian, MD, is a preeminent authority in the field of Telepsychiatry. He holds a distinguished seat on the Telepsychiatry Committee of the American Psychiatric Association and is a member of the Steering Committee for Psych Congress, the United States' largest independent mental health educational conference. Additionally, Dr Kaftarian is a prominent speaker on the rules and regulations governing telehealth. Dr Kaftarian completed his psychiatry training at the prestigious Johns Hopkins University and holds board certifications in Psychiatry, Forensic Psychiatry, and Addiction Medicine.
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