Tag: Billing
Coronavirus (COVID-19): new telehealth rules and procedure codes for testing
From American Academy of Family Practice
Getting Paid – A Blog from FPM Journal
Tuesday Mar 10, 2020
Coronavirus (COVID-19): new telehealth rules and procedure codes for testing
Last week, Congress passed the Coronavirus Preparedness and Response Supplemental AppropriationsAct.(www.congress.gov) The legislation will allow physicians and other health care professionals to bill Medicare fee-for-service for patient care delivered by telehealth during the current coronavirus public health emergency.
In particular, the legislation gives the U.S. Department of Health and Human Services (HHS) secretary the authority to waive or modify certain telehealth Medicare requirements when the President has declared a National Emergency, or the HHS Secretary has declared a Public Health Emergency, as Sec. Alex Azar did in January(www.phe.gov). For instance, the legislation gives the HHS secretary the authority to waive the originating site requirement(www.cchpca.org) for telehealth services provided by a qualified provider to Medicare beneficiaries(www.cms.gov) in any identified emergency area during emergency periods. The legislation also allows telehealth services to be provided to Medicare beneficiaries by phone, but only if the phone allows for audio-video interaction between the qualified provider and the beneficiary. This expansion is limited to qualified providers who have furnished Medicare services to the individual in the three years prior to the telehealth service (or another qualified provider under the same tax identification number that has provided services within three years). The patient must initiate the service and give consent to be treated virtually, and the consent must be documented in the medical record before initiation of the service.
As noted, the waiver of the originating site requirement and expansion of telemedicine modalities is limited to emergency areas identified by the President and HHS Secretary during emergency periods. Accordingly, as a practical matter, this expansion of payment is very limited. Further, health care providers must still comply with state telehealth laws and regulations, including professional licensure, scope of practice, standard of care, patient consent(www.cchpca.org), as well as other payment requirements for non-Medicare beneficiaries.
The codes that will be billed for what Medicare actually defines as Medicare “telehealth services” will typically be evaluation and management (E/M) codes (for example, 99213, 99214) along with a telehealth Place of Service (POS) code(www.cchpca.org) and potentially a modifier (if required by commercial payer). However, there are additional services available for payment that are not ever restricted by originating site and other Medicare telehealth regulations. The Medicare “communications-based technology” codes(www.cchpca.org) (e.g. G2012) are not deemed by the Centers for Medicare & Medicaid Services (CMS) to be Medicare “telehealth services,” which means they are not subject to the statutory restrictions regarding originating site and rural geography. These services can be furnished even when patient are in their homes, regardless of a national emergency declaration. There are also time-based, online digital E/M codes (99421, 99422, 99423) for established patients. Similar codes (G2061, G2062, G2063) are available for online patient-initiated assessments provided by qualified non-physician health care professionals.
Last week CMS also announced that Medicare Part B would cover a test to determine if beneficiaries have coronavirus for dates of service on or after Feb. 4, 2020. But providers of the test will have to wait until after April 1, 2020, to submit a claim to Medicare for the test. Most physician offices will not have access to the test to perform it themselves, but may be ordering it for their patients or collecting specimens (e.g. nasal swab or sputum) for testing. In general, if the patient is in the office for an E/M service, the specimen collection is bundled in that service. Otherwise, many contracts don’t include specimen collection. You will need to check with the payers in your area on this point.
CMS has created two Healthcare Common Procedure Coding System (HCPCS) codes to report testing for coronavirus. Labs that test patients for the new coronavirus using the Centers for Disease Control and Prevention (CDC) 2019 Novel Coronavirus Real Time RT-PCR Diagnostic Test Panel may bill for that test using the new HCPCS code (U0001). This code is used specifically for CDC testing laboratories to test patients for SARS-CoV-2. The second HCPCS billing code (U0002) allows laboratories to bill for non-CDC laboratory tests for SARS-CoV-2/2019-nCoV (COVID-19). On Feb. 29, 2020, the Food and Drug Administration (FDA) issued a new, streamlined policy for certain laboratories to develop their own validated COVID-19 tests. This second HCPCS code may be used for tests developed by these additional laboratories when submitting claims to Medicare or health insurers. Diagnosis coding for coronavirus is also available.
What is happening in the private health insurance sector remains unclear and may vary from payer to payer. An industry trade group, America’s Health Insurance Plans, issued its own statement last week(www.ahip.org). CMS also issued a fact sheet on “Information Related to COVID–19 Individual and Small Group Market Insurance Coverage.”(www.cms.gov)
For more information, please see CMS’s frequently asked questions(www.cms.gov) for health care providers regarding Medicare payment for laboratory tests and other services related to the 2019 novel coronavirus. CMS has also provided related fact sheets pertaining to Medicare(www.cms.gov) and Medicaid and the Children’s Health Insurance Program(www.cms.gov).
Coverage, payment, and other aspects of getting paid for services related to the coronavirus are continuously evolving. Stay tuned to the “Getting Paid” blog for further updates. AAFP has more information about how to prepare for COVID-19 here: https://www.aafp.org/patient-care/emergency/2019-coronavirus.html
— Kent Moore, AAFP Senior Strategist for Physician Payment
Posted at 04:30PM Mar 10, 2020 by Kent Moore
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. |
NEW CPT® CODE ANNOUNCED TO REPORT NOVEL CORONAVIRUS TEST
The American Medical Association (AMA) announced that the CPT® Editorial Panel approved a new addition to the Current Procedural Terminology (CPT®) code set that will help streamline data-driven resource planning and allocation in the battle against the novel coronavirus (SARS-CoV-2) as the number of confirmed COVID-19 cases continues to rise. |
For quick reference, the new Category I CPT code and descriptor are: |
l 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
The code is effective immediately for use as the industry standard for reporting of tests for the novel coronavirus across the nation’s health care system. In addition to the long descriptor, CPT code 87635 has short and medium descriptors that can be accessed on the AMA website.
Please note that, per the standard early release delivery process for CPT codes, you will need to manually upload this code descriptor into your EHR system. This CPT code will arrive as part of the complete CPT code set in the data file for 2021 later this year. To read the full press release click here.
CPT © Copyright 2020 American Medical Association. All rights reserved. AMA and CPT are registered trademarks of the American Medical Association.
New TMA Telemedicine Resources 3/16/2020
As COVID-19 cases rise across the state, physicians have been asking the Texas Medical Association about getting started with telemedicine.
That’s why TMA staff has added new tools and information to the TMA telemedicine resource center, including:
- Numerous policies, procedures, and forms;
- A chart of payer policies that includes which Current Procedural Terminology (CPT) codes can be billed for telemedicine; and
- A list of telemedicine vendors, including electronic health records (EHRs) vendors with integrated telemedicine products, and pricing when it was listed.
Additional resources on the telemedicine page include a white paper detailing Texas’ telemedicine
laws and regulations.
TMA will be working with health plans and the Texas Department of Insurance to clarify billing procedures and payment. Look for updates in Texas Medicine Today and the TMA telemedicine resource center.
We know these are uncertain times, but TMA is here to help. Do not hesitate to reach out to TMA’s Health Information Technology Department at (800) 880-5720 or via email.
TMB Responding to Gov. Abbott’s State Disaster Declaration
FOR IMMEDIATE RELEASE March 14, 2020
Media contact: Jarrett Schneider, 512-305-7018
Customer service: 512-305-7030 or 800-248-4062
Following Governor Greg Abbott’s state disaster declaration, the Texas Medical Board, with direction and assistance from the Governor’s Office, is implementing procedures to waive certain requirements to help the state’s physicians, physician assistants and other health care professionals respond to COVID-19.
Texas Medical Board Press Release 3/14/2020, Response to Gov. Abbott’s State Disaster Declaration
[embeddoc url=”https://community.poetllc.org/wp-content/uploads/2020/03/TMB-Responding-to-Gov.-Abbotts-State-Disaster-Declaration-03142020.pdf” download=”all” viewer=”google”]
Acronym Guide for Coding by Just Coding
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UnitedHealthcare Out-of-Network Referrals: Prior Approval, Patient Consent By Ellen Terry
[embeddoc url=”https://community.poetllc.org/wp-content/uploads/2020/02/UHC-OON-Referrals_-Prior-Approval-Patient-Consent-By-Ellen-Terry-02062020.pdf” download=”all” viewer=”google”]
UnitedHealthcare Out-of-Network Referrals: Prior Approval, Patient Consent
By Ellen Terry, An Article by TMA
If you are a UnitedHealthcare (UHC) participating physician referring a patient out of network in a non-emergency, you’re now required to first obtain either (1) prior approval from UHC; or (2) the patient’s written consent.
To review the entire article follow this link.
Texas’ New Surprise Billing Law
ARE YOU READY?
By Joey Berlin (TMA)
Taken from the TMA Website.
It’s almost first-pitch time for the state’s new ballgame on out-of-network bill disputes.
Texas’ baseball-style arbitration law takes effect for certain out-of-network medical care beginning Jan. 1, 2020. It’s a big change from how disputes on out-of-network medical bills have been handled in the past – and you need to know how to navigate it. There are nuances to consider, and disciplinary action from the Texas Medical Board (TMB) may await you if you balance-bill in violation of the law.
That’s why the Texas Medical Association has produced a digestible, seven-page summary of the surprise-billing law, passed during this year’s session of the Texas Legislature as Senate Bill 1264. TMA’s overview explains topics such as when the law applies, and how the arbitration process works.
More details are available in the summary, but essentially, under SB 1264, certain out-of-network physicians can request arbitration if the physician isn’t satisfied with the health plan’s initial payment. The arbitrator – selected either by mutual agreement of each side or by the Texas Department of Insurance (TDI) – will determine which of two amounts is the closest to the reasonable amount for the services: the billed charge, or the payment made by the health plan, “as those amounts were last modified during the health plan’s internal appeals process, if the physician chooses to participate, or the informal settlement teleconference” that’s required prior to arbitration.
As in an offseason baseball arbitration proceeding between a team and one of its players, the arbitrator makes a binary choice: Either the physician’s billed charge or the health plan’s payment is the closest to the reasonable amount, and thus becomes the ordered payment. A claim that goes through the full arbitration process must be decided by the arbitrator within 51 days after the initial request.
As a result of the new system, balance billing will be prohibited for practitioners providing the out-of-network services to patients in the plans SB 1264 covers – with an exception, as explained in TMA’s overview. The law gives TMB latitude to take disciplinary action against a physician who violates the law by billing patients more than their applicable copayment, coinsurance, and deductible.
The summary also details which state-regulated health plans are covered by the arbitration process, as well as which out-of-network services and supplies fall under the new law. It also explains the required steps following an arbitration request and which factors arbitrators will consider in making their decision.
TDI is planning an information session on SB 1264 at 1 pm Dec. 30 in Austin. More details on the information session and SB 1264 in general can be found on the TDI’s website.
Last Updated On
January 29, 2020
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