Wiki billing telemedicine

[FGILLILAND]

Good Morning,

We have a cardiology group that will be consulted by our physicians for patients that have been admitted to our facility. The cardiology group would like to do this via telemedicine. Does anyone know if there is a telemedicine facility code we can charge for the origination site for inpatient? Our administration was questioning this and what we have found only applies to an outpatient setting. Thanks in advance for any input given.

What is an Originating Site?

An originating site is the location of an eligible Medicare beneficiary at the time the service is furnished via a telecommunications system. Originating sites include:
The offices of physicians or practitioners
Hospitals
Critical Access Hospitals (CAHs)
Rural Health Clinics
Federally Qualified Health Centers
Hospital-based or CAH-based Renal Dialysis Centers (including satellites)
Skilled Nursing Facilities (SNFs) and
Community Mental Health Centers (CMHCs)

Must the telemedicine provider be in the same state as the originating site?

No. The site at which the physician or other licensed practitioner delivering the telemedicine service is located at the time the service is provided is called the “Distant Site.” The Distant Site may be in a state other than the Originating Site. In those instances, the telemedicine physician or practitioner must be licensed under state law and/or meet the applicable standards required by state or local laws in both the Originating Site state and the Distant Site state.

Does my county/city qualify as an HPSA under Medicare guidelines?

The Health Resources and Services Administration (HRSA) determines HPSAs, and the Census Bureau determines MSAs. You can access HRSA’s Medicare Telehealth Payment Eligibility Analyzer
to determine a potential originating site’s eligibility for Medicare telehealth payment. More information is available online at the CMS’ Medicare Learning Network, including proper CPT codes to use when billing for specific Medicare telehealth interactions.

What type of telecommunications system is required to bill for telemedicine services?

Telemedicine services must use an interactive audio and video telecommunications system that permits real-time communication between the practitioner at the Distant Site and the patient at the Originating Site. This is known as a “synchronous telecommunication system.” Reimbursement for “store and forward technology,” otherwise known as an “asynchronous telecommunications system,” is currently only permitted in federal telemedicine demonstration programs in Alaska and Hawaii.
All other states able to bill telemedicine services must use an interactive audio and video telecommunications system that permits real-time communication between the practitioner at the Distant Site and the beneficiary at the Originating Site.

As the Originating Site, can my facility bill a facility fee for Telemedicine?
Yes. Medicare allows for the facility fee for Telemedicine services for the Originating Site. The appropriate HCPCS code is Q3014 and for services performed on or after January 1, 2017. The correct Place of Service Code (POC) is 02.

When billing for telemedicine Professional Services, do we need to utilize a modifier?
Yes, for Medicare you will need to use the GT telehealth modifier. Please note that for Federal telemedicine demonstration programs in Alaska and Hawaii, a GQ telehealth modifier should be used.

 

[thomas7331]

The facility bills the originating site fee, not the physicians. So the hospital where your cardiologists are evaluating the patient via telehealth will be billing that charge. You're correct that the Q3014 will appear on the facility's bill in the case of an outpatient service. On an inpatient claim, the charge itself will still be on the claim, but the HCPCS code will not appear because HCPCS codes are not used in calculation of payment for inpatient services. The facility's costs, in terms of staff and equipment, for providing the telehealth service will be reported on the claim only as a dollar amount, and are also submitted in the facility's cost reports to CMS for purposes of rate calculation, but aren't used in pricing individual encounters for inpatient stays.

 

[FGILLILAND]

The facility bills the originating site fee, not the physicians. So the hospital where your cardiologists are evaluating the patient via telehealth will be billing that charge. You're correct that the Q3014 will appear on the facility's bill in the case of an outpatient service. On an inpatient claim, the charge itself will still be on the claim, but the HCPCS code will not appear because HCPCS codes are not used in calculation of payment for inpatient services. The facility's costs, in terms of staff and equipment, for providing the telehealth service will be reported on the claim only as a dollar amount, and are also submitted in the facility's cost reports to CMS for purposes of rate calculation, but aren't used in pricing individual encounters for inpatient stays.

Thank you