CTP CTP Insurance Coverage and Reimbursement 2

Question 1

Which federal agency sets national Medicaid telehealth policy while states administer their own specific telehealth coverage rules?

Accepted Answer

CMS

Answer

The Centers for Medicare & Medicaid Services (CMS) establishes federal Medicaid policy, but individual states determine specific telehealth coverage and reimbursement rules within federal guidelines.

Question 2

When a provider bills a commercial insurer for telehealth, what must be verified to ensure reimbursement?

Accepted Answer

State parity laws and plan-specific telehealth coverage

Answer

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.

Question 3

What does telehealth 'parity' mean in the context of insurance reimbursement?

Accepted Answer

Insurers must reimburse telehealth services at the same rate as equivalent in-person services

Answer

Telehealth parity laws require insurers to reimburse covered telehealth services at rates comparable to equivalent in-person services.

Question 4

Which of the following is typically NOT a covered telehealth service under most state Medicaid programs?

Accepted Answer

In-home personal care aide supervision by phone

Answer

Personal care aide supervision by phone is generally not a covered Medicaid telehealth service; covered services focus on direct clinical consultation and specialist visits.

Question 5

What documentation is Medicaid typically required to include for a telehealth behavioral health claim?

Accepted Answer

The technology platform used and documentation that consent was obtained

Answer

Medicaid typically requires documentation of the telehealth modality used and evidence that patient consent was obtained prior to the encounter.

(CTP) Certified Telehealth Practitioner Practice Test

(CTP) Certified Telehealth Practitioner Practice Test

CTP CTP Insurance Coverage and Reimbursement 2