Tag: Billing
Molina, Claims for Telephone (Audio-Only) 3/23/2020
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Waived Medicare Telehealth Restrictions, MGMA, 3/20/2020
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Medicare Communications-Based Technology Codes, MGMA 3/20/2020
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Add another code to your coronavirus testing list.
AMA drops CPT Assistant fact sheet on new COVID-19 code
Effective March 13, you can turn to the following code:
- 87635 (Infectious agent detection by nucleic acid [DNA or RNA];severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2] [Coronavirus disease (COVID-19)],amplified probe technique)
AMA drops CPT Assistant fact sheet on new COVID-19 code
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Certain Regulations Waived
Governor Abbott Waives Certain Regulations For Telemedicine Care In Texas
Governor Greg Abbott today waived certain regulations and directed that the Texas Department of Insurance (TDI) issue an emergency rule, all relating to telemedicine care for patients with state-regulated insurance plans to help doctors across Texas continue to treat their patients while mitigating the spread of COVID-19. The suspensions and emergency rule will work together to allow telemedicine visits for patients with state-regulated plans to be paid the same as in-office visits for insurance purposes. These actions build upon waivers the Governor issued last week of portions in the Occupations Code to expand provider flexibility in providing medical services over the phone.
“As the State of Texas responds to COVID-19, we continue to work to maintain regular health care services and operations throughout the state, and telemedicine is one of the most valuable tools we have to ensure Texans continue to receive the health services they need,” said Governor Abbott. “Expanding telemedicine options will help protect the health of patients and health care professionals, and help Texas mitigate the spread of COVID-19.”
Doctors will be eligible for payment from insurance plans regulated by TDI for medical visits they conduct over the phone instead of in-person at the same rate they would receive for in-person visits.
Medical providers seeking guidance on the impact of the new rule can expect guidance from the Texas Medical Board to be issued in the coming days, including administrative guidance for billing to ensure that claims are processed smoothly.
Insurers seeking guidance on implementation of the emergency rule should contact TDI or visit their webpage for more information.
This coordinated efforts between the Office of the Governor, the Texas Department of Insurance, the Texas Medical Board, and health insurance plans will increase access to health care for all Texans. Today’s action will expand telemedicine options by giving health care providers greater flexibility to perform audio-only telephone consultations with their patients.
As a reminder, Texans covered by CHIP or Medicaid will not be charged copays for test or telemedicine consults. Individuals covered by Medicare or large employer plans should check with their health plan administrator to determine their specific benefits.
Aetna Telemedicine and Direct Patient Contact, December 2019
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Ease of restrictions for telemedicine.
Another government regulating agency follows up with ease of restrictions for telemedicine.
From OCR ( Office for Civil Rights ) at the Department of Health and Human Services (HHS ) regarding HIPAA use this link.
Notification of Enforcement Discretion for telehealth remote communications during the COVID-19 nationwide public health emergency
During the COVID-19 national emergency, which also constitutes a nationwide public health emergency, covered health care providers subject to the HIPAA Rules may seek to communicate with patients, and provide telehealth services, through remote communications technologies. Some of these technologies, and the manner in which they are used by HIPAA covered health care providers, may not fully comply with the requirements of the HIPAA Rules.
OCR will exercise its enforcement discretion and will not impose penalties for noncompliance with the regulatory requirements under the HIPAA Rules against covered health care providers in connection with the good faith provision of telehealth during the CoVID-19 nationwide public health emergency. This notification is effective immediately.
A covered health care provider that wants to use audio or video communication technology to provide telehealth to patients during the CoVID-19 nationwide public health emergency can use any non-public facing remore communication product that is available to communicate with patients. OCR is exercising its enforcement discretion to not impose penalties for nocompliance with the HIPAA Rules in connection with the good faith provision of telehealth using such non-public facing audio or video communication products during the CoVID-19 nationwide public health emergency. This exercise of descretion applies to telehealth provided for any reason, regardless of whether the telehealth service is related to the diagnosis and treatment of health conditions related to CoVID-19.
For example, a covered health care provider in the exercise of their professional judgement may request to examine a patient exhibiting CoVID- 19 symptoms, using a video chat application connecting the provider’s or patient’s phone or desktop computer in order to assess a greater number of patients while limiting the risk of infection of other persons who would be exposed from an in-person consultation. Likewise, a covered health care provider may provide similar telehealth services in the exercise of their professional judgment to assess or treat any other medical condition, even if not related to CoVID-19, such as a sprained ankle, dental consultation or psychological evaluation, or other conditions.
OIG issues a policy statement
OIG issues a policy statement and a factsheet regarding telehealth cost-sharing during the COVID-19 outbreak.
This is an important piece of the puzzle since the OIG needed to be on the same page with CMS on regulations to keep physicians out of hot water if they choose to waive patient portion for telemedicine.
A report and four enforcement actions are also posted. As always, you can use the links provided to go directly to the new material.
Policy Statement:
- Waiving Telehealth Cost-Sharing During COVID-19 Outbreak https://go.usa.gov/xdtXC
- Telehealth Factsheet https://go.usa.gov/xdtXT
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
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