CTP Insurance Coverage and Reimbursement Flashcards
6 cards from real CTP practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 6 CTP Insurance Coverage and Reimbursement flashcards as text
Which federal agency sets national Medicaid telehealth policy while states administer their own specific telehealth coverage rules?
Answer: CMS
The Centers for Medicare & Medicaid Services (CMS) establishes federal Medicaid policy, but individual states determine specific telehealth coverage and reimbursement rules within federal guidelines.
When a provider bills a commercial insurer for telehealth, what must be verified to ensure reimbursement?
Answer: State parity laws and plan-specific telehealth coverage
Telehealth parity laws vary by state and commercial plans differ in coverage, so providers must verify both state parity requirements and the individual plan's telehealth benefits.
What does telehealth 'parity' mean in the context of insurance reimbursement?
Answer: Insurers must reimburse telehealth services at the same rate as equivalent in-person services
Telehealth parity laws require insurers to reimburse covered telehealth services at rates comparable to equivalent in-person services.
Which of the following is typically NOT a covered telehealth service under most state Medicaid programs?
Answer: In-home personal care aide supervision by phone
Personal care aide supervision by phone is generally not a covered Medicaid telehealth service; covered services focus on direct clinical consultation and specialist visits.
What documentation is Medicaid typically required to include for a telehealth behavioral health claim?
Answer: The technology platform used and documentation that consent was obtained
Medicaid typically requires documentation of the telehealth modality used and evidence that patient consent was obtained prior to the encounter.
How should a provider appeal a commercial insurer's denial of a telehealth claim based on lack of medical necessity?
Answer: Cite state insurance commissioner guidelines and submit clinical documentation supporting the service
Providers can appeal medical necessity denials by aligning the appeal with state insurance commissioner guidelines and submitting thorough clinical documentation.