Tag: Medicare
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
More on Medicare MBI
New Medicare Card: If an MBI Changes
From CMS MLN Connects November 2019
Medicare beneficiaries or their authorized representatives can ask to change their Medicare Beneficiary Identifiers (MBIs); for example, if the MBI is compromised. CMS can also change an MBI. It is possible for your patient to seek care before getting a new card with the new MBI.
If you get an eligibility transaction error code (AAA 72) of “invalid member ID,” your patient’s MBI may have changed.
- Do a historic eligibility search to get the termination date of the old MBI.
- Get the new MBI from your Medicare Administrative Contractor’s secure MBI look-up tool. Sign up for the Portal to use the tool.
Reminders about using the old or new MBIs:
Fee-For-Service (FFS) claims submissions with:
- Dates of service before the MBI change date – use old or new MBIs
- Span-date claims with a “From Date” before the MBI change date – use old or new MBIs
- Dates of service that are entirely on or after the effective date of the MBI change – use new MBIs
FFS eligibility transactions when the:
- Inquiry uses new MBI – we will return all eligibility data.
- Inquiry uses the old MBI and request date or date range overlap the active period for the old MBI – we will return all eligibility data. We will also return the old MBI termination date.
- Inquiry uses the old MBI and request date or date range are entirely on or after the effective date of the new MBI – we will return an error code (AAA 72) of “invalid member ID.”
See the MLN Matters Article for more information on how to get and use MBIs.
Medicare Claims Rejected
Special Edition of CMS MLN Connects November 12,2019
HICN Claims Reject
We are 50 days out from the end of the Medicare Beneficiary Identifier (MBI) transition period. Use the MBI on Medicare claims and other transactions now. Starting January 1, regardless of the date of service:
- We will reject claims submitted with Health Insurance Claim Numbers (HICNs) with a few exceptions
- We will reject all eligibility transactions submitted with HICNs
See the MLN Matters Article to learn how to get and use MBIs.
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
Cigna – (HealthSpring) Medicare Advantage Agreement 2005
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