Workers’ Compensation Attorneys’ Blog

Does Workers Compensation Cover TeleHealth?

Telemedicine – sometimes called Telehealth or Teledoc – involves evaluating, diagnosing and treating patients remotely using a phone, computer or other electronic device. During the COVID-19 pandemic, many more patients have become familiar with telemedicine, as it is an excellent way to maintain social distancing and patient safety.

Doctors and patients are also using telemedicine to refill prescriptions and conduct follow-up appointments after surgery and medical procedures.  But while telemedicine has been around for a while, using it for Workers Compensation claims is relatively new.

During the COVID-19 quarantine, many of our Workers Compensation clients have reached out to our attorneys and asked if their medical care via telemedicine is covered by Workers Compensation. In this article our experience Workers Compensation attorneys answer this and other questions about COVID-19 and Workers Comp.

The good news is that medical treatment for Workers Compensation patients that is delivered via telehealth is 100% payable under Workers Comp in California. This includes “telerehab” – which is physical therapy treatment offered virtually via digital technology.

But, the longer answer is that providers and patients must be careful to use the appropriate billing codes and support their claims by proper documentation, keeping in compliance with the current guidelines and regulations, in order for telemedicine claims to be approved by Workers Comp insurers.

Why Insures Make Workers Compensation Telehealth Difficult

You would think insurers and employers would love telehealth for the cost saving and convenience alone. Telemedicine visits can accommodate doctor and patient scheduling, and keep both parties safer and socially distanced – also eliminating the patients’ costs associated with traveling for care.

But Workers Compensation insurers are afraid of one thing: fraud. Unscrupulous provider scams often center around services that don’t’ require physical contact – such as exams and testing.  Workers Compensation insurers anticipates that fake telehealth claims could be the next frontier of medical fraud.

How to Get TeleHealth Covered by Workers Compensation

Regulations and specific guidelines have already been issued by California Division of Workers’ Compensation (DWC) for TeleHealth coverage – and more are expected.

In the meantime, to help ensure that your TeleHealth medical care is covered by Workers Compensation, patients and providers should:

1. Understand the correct telemedicine billing codes when filling out forms.

Telehealth Is considered a “Facility” when stating the  “Place of Service”. So, on the CMS 1500 billing form, populate Box 24B with the ‘02’ code for “Facility” place of service.

2. Providers must carefully document telehealth service.

To help ensure proper coverage, providers offering telehealth treatment to Workers Compensation patients should document the technology or “platform” used to render services: telephone call, Zoom, FaceTime, Google Hangouts, or a specific telemedicine App such as TeleDoc.

3. Patient consent must be expressly given and documented.

BPC Section 2290.5 states that “…the health care provider initiating the use of telehealth shall inform the patient about the use of telehealth and obtain verbal or written consent from the patient …The consent shall be documented.”

Patient consent may be verbal or written, but it must be documented for Workers Compensation to cover the tele-service or treatment.

Attorneys Can Help Get TeleHealth Covered by Workers Compensation

If you were injured or made ill in the workplace, and you are having trouble getting your workers compensation benefits for any reason, we recommend that you speak with an experienced workers compensation attorney immediately.

A skilled workers compensation attorney can help you navigate through the process and paperwork, as well as identify minor issues before they become major problems – making sure that you not only receive your benefits now, but for years to come.

Your consultation with our workers’ compensation attorneys is 100% confidential, and neither your employer nor your insurance company will be notified that you requested a consultation with us. Our attorneys will help you understand your rights and work tirelessly to ensure that you receive the maximum workers’ comp benefits for which you qualify.

Workers Compensation Attorneys: 800-964-8047