Episode Overview

Title: Telehealth and Insurance Billing
Podcast: Private Practice Startup
Hosts: Dr. Kate Campbell & Katie Lemieux
Guest: Kim Toalson
Date: June 6, 2020
Episode: 189

This episode dives into the essentials of setting up and running an insurance-based telehealth private practice, featuring telehealth therapist and digital nomad, Kim Toalson. Kim shares her journey from brick-and-mortar to fully online practice, offering concrete strategies and decision-making frameworks for clinicians considering telehealth, particularly in the wake of the COVID-19 pandemic. The discussion addresses common pitfalls, insurance billing nuances, marketing strategies, and the practicalities of maintaining compliance and workflow efficiency.

Key Discussion Points & Insights

Kim Toalson’s Telehealth Journey and Digital Nomadism

• Background

  • Kim transitioned from traditional brick-and-mortar practice in Virginia to a fully online, insurance-based telehealth practice. Her move coincided with learning the intricacies of insurance billing for telehealth.
  • She now enjoys a digital nomad lifestyle, living and practicing remotely, most recently from Miami.
  • Quote:

    “We just kind of packed up everything, we sold a bunch of stuff and now we're just kind of moving around the country and the world and living as digital nomads. And I could still be a therapist and bill insurance.” (03:17)

• Impact of COVID-19

  • The pandemic temporarily stalled her travel plans but reinforced the value of remote practice flexibility.
  • Quote:

    “It’s been on hold. It’s totally on hold right now. So the beach has just opened up again… so we're going to just hang out here for a while.” (04:56)

Decision Tree: Should You Practice Telehealth, Brick & Mortar, or Hybrid?

• Kim created a decision tree to help clinicians align their personal needs with their professional model.
• Key considerations:
  • Preference for in-person energy/interaction
  • Financial feasibility of office rent
  • Lifestyle considerations (e.g., flexibility, travel)
  • Importance of serving underserved communities via insurance
• Quote:

  “I just feel like that's really important to figure out in the beginning if you do want to take insurance because...it's going to influence which panels you get on. So some are really good about telehealth and some don't cover telehealth at all.” (06:13)

Why Choose Insurance-Based Practice?

• Benefits:
  • Larger referral base: Most clients prefer to use insurance.
  • Insurance companies often refer clients directly.
  • Access to underserved populations unable to afford private pay.
  • Niche specialties can be marketed via insurance directories.
• Quote:

  “Almost everybody that calls me wants to use their insurance...it is a big draw...insurance companies, they also send a lot of referrals your way...” (07:23)

Getting Started with Telehealth & Insurance

1. Market Research and Networking

• Use platforms like Psychology Today to find telehealth providers who accept insurance and match or complement your niche.
• Approach potential referral partners for “virtual coffee” to share insights about insurance coverage and payer experiences.
• Leverage local/state-based therapist Facebook groups for insights on top-paying and most reliable telehealth panels.
• Quote:

  “...ask them which insurances are you finding that are covering telehealth the most consistently? And would you recommend like a top three as far as like highest payers go?” (10:37)

2. Referral Networking

• Regular outreach to colleagues monthly to build mutual support.
• Connect with clients' primary care physicians with consent, fostering an interdisciplinary referral network.
• Quote:

  “[I] always try to get a client to sign a PCP form...reach out to that physician and introduce myself...[ask] what do they see a need for?” (12:48)

3. Navigating Licensure as a Digital Nomad

• Use virtual business addresses in your state of licensure for administrative compliance.
• See clients physically located in your licensed state, regardless of your current location.
• Quote:

  “I've got an address in Virginia that I use. They're called virtual addresses...I use that as my mailing address and my practice address. So it looks like a suite, like a suite number.” (13:44)

Managing the Workflow: EHRs, Billing, and Automation

• Kim uses Simple Practice for electronic health records and billing.
• Transitioned from relying on a third-party biller (who failed to collect appropriately) to managing billing herself for improved oversight.
• Once systems and modifiers are established, billing becomes streamlined and relatively low-maintenance.
• Quote:

  “Once you get it figured out, it's pretty streamlined. It's literally the click of a button once you figure out who covers telehealth, what modifiers to use, what location code to use, how many sessions are covered...” (16:29)

COVID-19 and Changing Insurance Billing Rules

• Insurers altered codes and requirements for telehealth, leading to confusion and inconsistencies (e.g., location codes, modifiers, waiving of co-pays and deductibles).
• Kim's Facebook group became a key support forum for clinicians navigating these real-time policy changes.
• Quote:

  “It's weird right now because all the insurance companies, they've changed everything. So it used to be like location code 02 for telehealth and now they want you to use location code 11 for telehealth and different modifiers...a big mess for people.” (18:44)

Kim’s Telehealth Insurance Billing Facebook Group

• Provides peer support, updates on policy changes, and collective troubleshooting.
• Search “telehealth insurance billing” on Facebook or check show notes for the link.

Building a Sustainable Telehealth Practice

• Kim created a comprehensive online course addressing:
  • Decision-tree planning
  • Billing/coding for telehealth
  • Setting up virtual addresses
  • Understanding state parity laws and multi-state practice considerations
• Estimated timeline for setting up a new telehealth insurance-based practice is approximately six months (allowing for credentialing and system development).
• Quote:

  “I was like, I want to put a course together for people. So I made a course that literally like walks you through that decision tree I told you about all the way to the end where you're...streamlined with all your systems.” (21:01)

Memorable Moments & Notable Quotes

• “You can see clients, you can bill insurance and do whatever you want to do.” (05:22, Kim Toalson)
• "I love to travel. We used to travel about eight weeks a year. So doing it this way, I can still work and I'm not having to, like, take time off without pay." (15:13, Kim Toalson)
• “My goal, I'd like to get down to 25 [clients a week], especially now that I'm not having to, like, take off vacation time and pay rent and all that stuff.” (15:45, Kim Toalson)
• "I was shocked with like a $12,000 back balance. Yeah, it was a nightmare." (21:06, Kim Toalson)

Timestamps for Key Segments

• 00:48 – Introduction of guest Kim Toalson & her background
• 03:30 – Kim’s move to telehealth, digital nomad lifestyle
• 06:13 – The importance of choosing your practice model (telehealth vs. brick & mortar)
• 07:23 – Pros of accepting insurance, serving more clients
• 10:17 – Marketing strategies: research, networking, building referral base
• 12:48 – Building relationships with primary care providers
• 13:44 – Digital nomad logistics: licensure, virtual business addresses
• 15:42 – Numbers: client caseload, target workflow
• 16:29 – Systems: EHR benefits, streamlining insurance billing
• 18:44 – COVID-19’s effect on insurance billing, support via Facebook community
• 21:01 – Kim’s comprehensive telehealth insurance billing course
• 22:20 – Realistic timeline for building telehealth insurance practice
• 23:47 – Key takeaways & encouragement for clinicians

Final Takeaways

• Evaluate carefully whether insurance-based telehealth fits your desired lifestyle, values, and market demands.
• Begin credentialing and system development early, as processes can be slow and complex.
• Rely on professional networks and communities for up-to-date insights, especially as telehealth regulations fluctuate.
• Streamlining via EHR and established billing practices is critical for sustainability and work-life balance.
• Embrace flexibility and technology; remote private practice can be both personally and professionally rewarding.

Resource Links:

• Kim Toalson’s Telehealth Insurance Billing Facebook Group
• Private Practice Startup Free Paperwork Course