Category: Medicare
Humana Support 10/1/2020
Information from Humana “September 2020 Provider Communication”
Did you know that we have Electronic Funds Transfer, or EFT, available for provider payments? EFT eliminates the need for paper checks. Payments will occur automatically, saving time, reducing mail, and giving you peace of mind. For information on how EFT works or to set up your account on EFT, please send an email to [email protected].
A schedule of upcoming web-based training sessions is also available in the BBS Documentation folder (under Simple Resources and tools>Training Opportunities). Sessions are created from the provider’s perspective and intended to meet the needs of new users as well as those in a more established organization.
Documentation and resource materials are available in the Service Fund Download section of Availity.com. For those with direct FTP access, this information is contained within each unique folder. Materials are located in the following sections under “Documentation”:
- Data File Layouts – Both current and updated layouts are included. Highlighted text indicates either a new or revised field.
- Humana Notices to Providers – A copy of this letter is available.
- Simple Resources and tools
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- Training Opportunities – 2020 webinars
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For questions regarding Service Fund or Service Fund processes, or to request Service Fund training, please send an email to [email protected]. Be sure to include identifiable information such as your provider or organization name, address, Humana ID number, etc.
Humana PPO (POET) Plan Breakout
Humana PPO Plans have National Network Reciprocity, allowing members to travel with the comfort of knowing they can use any Humana ChoiceCare PPO Network Provider across the county for in-network services.
From CMS MLN Connects
From CMS MLN Connects, two resources for telehealth see links below
Key take aways:
Question: Is any specialized equipment needed to furnish Medicare telehealth services under the new law?
Answer: Currently, CMS allows for use of telecommunications technology that have audio and video capabilities that are used for two-way, real-time interactive communication. For example, to the extent that many mobile computing devices have audio and video capabilities that may be used for two-way, real-time interactive communication they qualify as acceptable technology. The new waiver in Section 1135(b) of the Social Security Act explicitly allows the Secretary to authorize use of telephones that have audio and video capabilities for the furnishing of Medicare telehealth services during the COVID-19 PHE. In addition, effective immediately, the HHS Office for Civil Rights (OCR) will exercise enforcement discretion and waive penalties for HIPAA violations against health care providers that serve patients in good faith through everyday communications technologies, such as FaceTime or Skype, during the COVID-19 nationwide public health emergency.
Q: How does a qualified provider bill for telehealth services?
A: Medicare telehealth services are generally billed as if the service had been furnished in-person. For Medicare telehealth services, the claim should reflect the designated Place of Service (POS) code 02-Telehealth, to indicate the billed service was furnished as a professional telehealth service from a distant site.
Q: How much does Medicare pay for telehealth services?
A: Medicare pays the same amount for telehealth services as it would if the service were furnished in person. For services that have different rates in the office versus the facility (the site of service payment differential), Medicare uses the facility payment rate when services are furnished via telehealth.
Q: Are there beneficiary out of pocket costs for telehealth services?
A: The use of telehealth does not change the out of pocket costs for beneficiaries with Original Medicare. Beneficiaries are generally liable for their deductible and coinsurance; however, the HHS Office of Inspector General (OIG) is providing flexibility for healthcare providers to reduce or waive cost-sharing for telehealth visits paid by federal healthcare programs.
https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet
https://edit.cms.gov/files/document/medicare-telehealth-frequently-asked-questions-faqs-31720.pdf
From the Patient Side of Medicare
E-visits
Medicare Part B (Medical Insurance) covers E-visits with your doctors and certain other practitioners. Be sure to check the above link for the latest changes!!!
Your costs in Original Medicare
You pay 20% of the Medicare-approved
amount for your doctors’ services, and the Part B deductible applies.
What it is
E-visits allow you to talk to your doctor using an online
patient portal without going to the doctor’s office.
Practitioners who may furnish these services include:
- Doctors
- Nurse practitioners
- Physician assistants
- Licensed clinical social workers, in specific circumstances
- Clinical psychologists, in specific circumstances
- Therapists, in specific circumstances
| Note |
| E-visits can be used for the treatment of the Coronavirus (COVID-19) from anywhere. |
Medicare Learning Network (MLN) Learning Management System (LMS) FAQs 8/2019
The Medicare Learning Network® (MLN) offers free educational materials for health care professionals on Centers for Medicare & Medicaid Services (CMS) programs, policies, and initiatives. Find a complete list of MLN educational offerings in the MLN Catalog at http://go.cms.gov/mln-catalog.
For a complete “HOW TO” guide on the MLN and LMS System, including how to set up an account: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/LMPOS-FAQs-Booklet-ICN909182.pdf
CMS issues final rules for 2020
Physician Fee Schedule: Finalized Policy, Payment, and Quality Provisions for CY 2020
from CMS MLN Connects:
On November 1, CMS issued a final rule that includes updates to payment policies, payment rates, and quality provisions for services furnished under the Medicare Physician Fee Schedule (PFS) effective on or after January 1, 2020.
Payment Provisions:
- Ratesetting and conversion factor
- Medicare telehealth services
- Evaluation and management services
- Physician supervision requirements for physician assistants
- Review and verification of medical record documentation
- Care management services
- Medicare coverage for opioid use disorder treatment services furnished by opioid treatment programs
- Bundled payments under the PFS for opioid use disorders
- Therapy services
Other Provisions:
- Quality Payment Program
- Ambulance services
- Ground ambulance data collection system
- Open Payments Program
- Medicare Shared Savings Program
For More Information:
See the full text of this excerpted CMS Fact Sheet (Issued November 1).
- Final Rule
- Press Release
- Press Release – Treatment for Opioid Use Disorder
- Quality Payment Program Fact Sheet
- Register for November 6 Call
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