Telehealth

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4
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0
I am wondering if anyone has any guidance or recommendation on billing virtual telecommunication visits?
How to bill (codes, modifiers, ect...)?
Payer reimbursement?
Any information would help!
Thanks in advance for any information!
 

Ccdgea08

Contributor
Messages
17
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0
I have been researching this for days!!!!! Medicare has just changed their guidelines. As of March 6 2020 medicare will pay for office, hospital, and other visits furnished by telehealth across the country including patient's home. This applies to treatment of all Dx during the Public Health Emergency. HIPPA has been waived in good faith so you can use video calling such as face time or skype over a smartphone. You have to use an audio-visual telecommunications system that permits real time communication. United Health Care is following Medicare guidelines. BCBS has set up its own telehealth and is encouraging its members to use their system. They have not changed their guidelines. Medicare wants you to use regular EM codes 99201-99215, place of service 02 for telehealth and GT modifier for medicare showing telehealth service and 95 for commercial insurance.

As of 03/20/20: No change with Blue Cross regarding Telehealth, members are still be directed to the Telehealth provided by BlueCare.

https://www.bcbsla.com/covid19

Blue Cross and Blue Shield of Louisiana is closely monitoring the spread of the novel coronavirus and the disease it causes, COVID-19, to determine how it could affect our members, employees and the communities that we serve.
Just as we prepare for weather situations such as hurricanes and floods, we have contingency plans in place to ensure our members have access to the care and medications they need. We will follow U.S. Centers for Disease Control and Prevention (CDC), federal and state recommendations regarding the coronavirus.
Blue Cross will take the following steps to assist our members during this time:
  • Waive Prior Authorizations for Diagnostic Tests and for Covered Services that are Medically Necessary and Consistent with CDC Guidance if diagnosed with COVID-19. Blue Cross will make members of our in-house clinical team of doctors, nurses, pharmacists and others available to address providers’ or members’ inquiries related to medical services. This will ensure we provide timely responses related to COVID-19.
  • Cover the Full Cost of Medically Necessary Diagnostic Tests that are Consistent with CDC Guidance Related to COVID-19. Blue Cross will cover, with no cost share to the member, the appropriate medically necessary diagnostic testing for COVID-19, where it is not covered as part of the U.S. Public Health Service response, and ensure patient testing and any subsequent needed care are done in close coordination with federal, state and public health authorities.
  • Increase Access to Prescription Medications by waiving early medication refill limits on 30-day prescription maintenance medications (consistent with member’s benefit plan) and/or encouraging members to use 90-day mail order benefit. Blue Cross will also ensure formulary flexibility if there are shortages or access issues.
  • Encourage telehealth use for remote care with $0 cost sharing. Effective March 16 and until further notice, Blue Cross customers and dependents covered on their plans can use BlueCare, our service for 24/7 online visits with U.S. trained, board-certified doctors, at no charge. BlueCare works on any device that has internet and a camera, like a smartphone, laptop, tablet or computer and is available in all 50 states. BlueCare is an effective way to get care for routine, non-emergency health needs like fever, colds, allergies, rashes, pink eye, bladder infections and vomiting/diarrhea, and is a good option for people who feel too ill to leave the house or want to consult with a healthcare provider before going somewhere for treatment. BlueCare providers can give prescriptions or refills for most drugs. Using BlueCare for these types of health needs can help minimize foot traffic in providers’ offices, clinics and hospitals, and will allow you to get care while remaining at home, limiting the spread of illnesses.
To create an account, members can go to www.BlueCareLA.com or get the “BlueCare” (one word) app for Android and Apple devices. Once members have created an account, they can simply log in when they need to have a telehealth visit.
PLEASE NOTE: Due to increased demand, BlueCare is experiencing longer-than-usual wait times. The doctors will see you as soon as possible. If you are experiencing symptoms of COVID-19, contact your regular healthcare provider, who can work with you to determine if you need to be seen for testing. If you don’t have a regular healthcare provider, please call 211 to reach the Louisiana statewide information network.


Got this on BCBS just now. Good luck!!!!!
 

khegg

New
Messages
1
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0
I have been researching this for days!!!!! Medicare has just changed their guidelines. As of March 6 2020 medicare will pay for office, hospital, and other visits furnished by telehealth across the country including patient's home. This applies to treatment of all Dx during the Public Health Emergency. HIPPA has been waived in good faith so you can use video calling such as face time or skype over a smartphone. You have to use an audio-visual telecommunications system that permits real time communication. United Health Care is following Medicare guidelines. BCBS has set up its own telehealth and is encouraging its members to use their system. They have not changed their guidelines. Medicare wants you to use regular EM codes 99201-99215, place of service 02 for telehealth and GT modifier for medicare showing telehealth service and 95 for commercial insurance.

As of 03/20/20: No change with Blue Cross regarding Telehealth, members are still be directed to the Telehealth provided by BlueCare.

https://www.bcbsla.com/covid19

Blue Cross and Blue Shield of Louisiana is closely monitoring the spread of the novel coronavirus and the disease it causes, COVID-19, to determine how it could affect our members, employees and the communities that we serve.
Just as we prepare for weather situations such as hurricanes and floods, we have contingency plans in place to ensure our members have access to the care and medications they need. We will follow U.S. Centers for Disease Control and Prevention (CDC), federal and state recommendations regarding the coronavirus.
Blue Cross will take the following steps to assist our members during this time:
  • Waive Prior Authorizations for Diagnostic Tests and for Covered Services that are Medically Necessary and Consistent with CDC Guidance if diagnosed with COVID-19. Blue Cross will make members of our in-house clinical team of doctors, nurses, pharmacists and others available to address providers’ or members’ inquiries related to medical services. This will ensure we provide timely responses related to COVID-19.
  • Cover the Full Cost of Medically Necessary Diagnostic Tests that are Consistent with CDC Guidance Related to COVID-19. Blue Cross will cover, with no cost share to the member, the appropriate medically necessary diagnostic testing for COVID-19, where it is not covered as part of the U.S. Public Health Service response, and ensure patient testing and any subsequent needed care are done in close coordination with federal, state and public health authorities.
  • Increase Access to Prescription Medications by waiving early medication refill limits on 30-day prescription maintenance medications (consistent with member’s benefit plan) and/or encouraging members to use 90-day mail order benefit. Blue Cross will also ensure formulary flexibility if there are shortages or access issues.
  • Encourage telehealth use for remote care with $0 cost sharing. Effective March 16 and until further notice, Blue Cross customers and dependents covered on their plans can use BlueCare, our service for 24/7 online visits with U.S. trained, board-certified doctors, at no charge. BlueCare works on any device that has internet and a camera, like a smartphone, laptop, tablet or computer and is available in all 50 states. BlueCare is an effective way to get care for routine, non-emergency health needs like fever, colds, allergies, rashes, pink eye, bladder infections and vomiting/diarrhea, and is a good option for people who feel too ill to leave the house or want to consult with a healthcare provider before going somewhere for treatment. BlueCare providers can give prescriptions or refills for most drugs. Using BlueCare for these types of health needs can help minimize foot traffic in providers’ offices, clinics and hospitals, and will allow you to get care while remaining at home, limiting the spread of illnesses.
To create an account, members can go to www.BlueCareLA.com or get the “BlueCare” (one word) app for Android and Apple devices. Once members have created an account, they can simply log in when they need to have a telehealth visit.
PLEASE NOTE: Due to increased demand, BlueCare is experiencing longer-than-usual wait times. The doctors will see you as soon as possible. If you are experiencing symptoms of COVID-19, contact your regular healthcare provider, who can work with you to determine if you need to be seen for testing. If you don’t have a regular healthcare provider, please call 211 to reach the Louisiana statewide information network.


Got this on BCBS just now. Good luck!!!!!

As of today BCBS of IA has updated everything and will now pay for telehealth and telephone visits for all providers. My question if anyone knows the answer is if I can use office visit codes 99212-9915 for telephone calls or if I need to use 99441-99443 for these calls. Thank you.
 

mitchellde

True Blue
Messages
13,535
Location
Columbia, MO
Best answers
2
99441-99443 is phone call audio only
Regular office visits with POS 02 is both audio and visual medium on both ends for real-time interaction.
 
Messages
1
Location
Acworth, GA
Best answers
0
I am researching Telehealth Visits as well. It looks like you can bill 99201-99215 for Established Patients for a Video Visit with a place of service of 02 but I thought I saw that they said the modifier was not needed because it was redundant to the place of service. Since this is a video visit you would need to meet the Medical Decision Making Component, and the History. I also read that the documentation must note that the patient consented to the video visit, and mention in the documentation the location of the patient and the location of the MD/NP for the video call. Does anyone know of any other documentation requirements that must be met?
 

cpclori

Networker
Messages
37
Location
Seacoast-Dover NH
Best answers
0
Thank you for all the information you have provided. Is anyone else here billing Workers Compensation carriers for telehealth? My office will begin doing this next week and I am trying to get the coding and documentation requirements we will need. I did read that every patient would need to sign a consent to be treated via telehealth? Is that correct? And for commercial carriers I would use Modifier 95 instead of POS 2? Does anyone have insight on this? My office does not bill Medicare.
 

smootk

New
Messages
1
Location
Newark, NJ
Best answers
0
Hello, does anyone know the code for Behavioral Health telehealth? I am going to use 90832-90837 is this correct? thank you
 

vernal2

New
Messages
1
Location
Ashland, NE
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0
Hello, I'm having trouble with the G0444 on a Medicare Wellness vist..I know it's crosswalked..but what is everyone else using?? Someone told me to use Mod 59 but it still gets kicked back! Any advice would be greatly appreciated. Thanks you
 

kbromley

New
Messages
9
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0
I bill for NP's, I know to bill 98966-98968 for telephone but are there MCR codes for Np's? I am having a terrible time finding a definitive answer. Thank you.
 

csperoni

True Blue
Messages
569
Location
Selden
Best answers
2
I bill for NP's, I know to bill 98966-98968 for telephone but are there MCR codes for Np's? I am having a terrible time finding a definitive answer. Thank you.
For PA/NP, we would use 99441-99443 for telephone services commercial carriers (unless advised otherwise by carrier). Medicare patients, we use G2012.
 

tonyabcarr

Contributor
Messages
13
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0
I understand the guidelines for 99441-99443 that the telephone encounter must be patient initiated, and not a scheduled appointment. If the established patient calls the triage nurse, and the provider decides a telephone encounter is needed, but the provider cannot speak with the patient at that time, can the triage nurse schedule a time for the provider to return the call?
 

mhguizar

New
Messages
2
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0
I see that a lot of this is E/M and physician clinics. I work for a dialysis organization. Has anyone received clarity around how to bill for telehealth services per the recent ESRD Telehealth for COVID guidelines?
 
Messages
7
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0
The following is for Medicare as of today, hope this helps for coding/modifiers:

Final ruling (as of 4/1/2020) per the Federal Register from the Department of Health and Human Services: Section II

A. Payment for Medicare Telehealth Services Under Section 1834(m) of the Act


To implement this change on an interim basis, we are instructing physicians and
practitioners who bill for Medicare telehealth services to report the POS code that would have
been reported had the service been furnished in person. This will allow our systems to make
appropriate payment for services furnished via Medicare telehealth which, if not for the PHE for
the COVID-19 pandemic, would have been furnished in person, at the same rate they would have
been paid if the services were furnished in person. Given the potential importance of using
telehealth services as means of minimizing exposure risks for patients, practitioners, and the
community at large, we believe this interim change will maintain overall relativity under the PFS
for similar services and eliminate potential financial deterrents to the clinically appropriate use of
telehealth. Because we currently use the POS code on the claim to identify Medicare telehealth
services, we are finalizing on an interim basis the use of the CPT telehealth modifier, modifier
95, which should be applied to claim lines that describe services furnished via telehealth. We
note that we are maintaining the facility payment rate for services billed using the general
telehealth POS code 02, should practitioners choose, for whatever reason, to maintain their
current billing practices for Medicare telehealth during the PHE for the COVID-19 pandemic.
 

kstine713

Networker
Messages
31
Best answers
0
The following is for Medicare as of today, hope this helps for coding/modifiers:

Final ruling (as of 4/1/2020) per the Federal Register from the Department of Health and Human Services: Section II

A. Payment for Medicare Telehealth Services Under Section 1834(m) of the Act


To implement this change on an interim basis, we are instructing physicians and
practitioners who bill for Medicare telehealth services to report the POS code that would have
been reported had the service been furnished in person. This will allow our systems to make
appropriate payment for services furnished via Medicare telehealth which, if not for the PHE for
the COVID-19 pandemic, would have been furnished in person, at the same rate they would have
been paid if the services were furnished in person. Given the potential importance of using
telehealth services as means of minimizing exposure risks for patients, practitioners, and the
community at large, we believe this interim change will maintain overall relativity under the PFS
for similar services and eliminate potential financial deterrents to the clinically appropriate use of
telehealth. Because we currently use the POS code on the claim to identify Medicare telehealth
services, we are finalizing on an interim basis the use of the CPT telehealth modifier, modifier
95, which should be applied to claim lines that describe services furnished via telehealth. We
note that we are maintaining the facility payment rate for services billed using the general
telehealth POS code 02, should practitioners choose, for whatever reason, to maintain their
current billing practices for Medicare telehealth during the PHE for the COVID-19 pandemic.


Just to confirm what dsolak1965 is saying, I attached some links and a document for reference:

Offices should bill place of service as if visit was performed face to face (not 02) if they want to receive non-facility reimbursement, and they should use modifier 95.


Please also find attached CMS update and reference pages 14-15
 

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EWOG7286

Contributor
Messages
16
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0
This is the guideline we are using right now if nothing changes. We are still trying to get everything finalized as to which payer is using which POS and which modifier... This is a headache.
 

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