Tag: Telehealth

Telehealth Waivers that are tied to the PHE

 Author: Seymore Bones  Published Date: March 23, 2022  Leave a Comment on Telehealth Waivers that are tied to the PHE

~Claire Ernst J.D. Government Affairs Director MGMA

On March 15, 2022, President Biden signed the $1.5 trillion omnibus spending package into law, which extended certain telehealth flexibilities related to the PHE. The following waivers will be in effect for an additional 151 days following the conclusion of the PHE:

  • Originating site and geographic location: Patients can continue to be treated via telehealth anywhere, including their homes
  • Qualifying providers: Physical therapists, occupational therapists, speech language pathologists, and audiologists can furnish distant site telehealth services
  • Audio-only services: CMS must continue covering and reimbursing these services
  • Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs): FQHCs and RHCs can be distant sites and be reimbursed

As a reminder, the PHE is in effect until April 16, 2022. It is likely that it will be renewed at least one more time for 90 days. 

Regarding New Telehealth Code

 Author: Seymore Bones  Published Date: January 27, 2022  Leave a Comment on Regarding New Telehealth Code

NOT ALL HEALTH PLANS ARE RECOGNIZING THE NEW TELEHEALTH CODE

TMA staff recommend you check with health plans directly to find out if they recognize the following:

  • POS 10, a new Centers for Medicare & Medicaid Services code that corresponds to telehealth provided to patients at home, set to take effect on April 4.
  • Modifier 93, an American Medical Association CPT code modifier now in effect that corresponds with a real-time medical service delivered by telephone or another audio-only technology.

Also not yet recognized by all health plans are the following Healthcare Common Procedure Coding System modifiers:

  • Modifier FQ (furnished using audio-only communication technology);
  • Modifier FR (supervising practitioner was present through two-way communication technology with both audio and video); and
  • Modifier FT (unrelated evaluation and management during a postoperative period, or on the same day as a procedure or another evaluation and management visit).

TMA reimbursement specialists are keeping watch on insurers’ recognition of codes and modifiers. TMA’s Health Plan News page will post new developments as they emerge; for example, as noted on the Health Plan News page, Humana is recognizing modifier FQ.

Continue to read Texas Medicine Today for updates.

CPT copyright American Medical Association. All rights reserved.

Last Updated On January 20, 2022

"Health Plans Not All Recognizing New Telehealth Code" TMA Article
"CMS Debuts Coding Changes for Telehealth" TMA Article
"New/Modifications to the Place of Service (POS) Codes for Telehealth" MLN Matters
New Telehealth Code

Question Posed Regarding New POS 10

 Author: Seymore Bones  Published Date: December 15, 2021  Leave a Comment on Question Posed Regarding New POS 10

One Person Reaches out to MGMA for Advice: 

“I need confirmation regarding the new POS 10. The new POS code 10 and the revision to POS code 02 goes into effect on April 4, 2022 (Medicare), and January 1, 2022, respectively. After the effective date, POS code 10 will be used if a patient receives telehealth at home, and POS code 02 will only be used for the other eligible originating sites (in other words, other places besides a patient’s home where a patient may be located and receive telehealth services that may be reimbursed by Medicare).

It is my understanding that the POS 10 would only be used for mental health/substance abuse telehealth services as they are the only services that will be covered if provided at home.  

Should practices continue to use POS 02 until the PHE officially ends or should they begin using POS 10 (January 1, 2022 for all payers except for Medicare) and April 4, 2022 for Medicare? “

 

Claire Ernst J.D., Government Affairs Director MGMA, Washington DC. Responds:

“Thank you for your question. When I saw CMS’ notice about the revised POS codes in October, I had the same question. My assumption is that POS 10 should be used for the new mental health telehealth services, but most likely once the COVID-19 PHE ends. The mental telehealth expansion provided in the Consolidated Appropriations Act, 2021 (CAA) and subsequently codified in the 2022 final Medicare Physician Fee Schedule (PFS) allows for mental health services to be rendered to patients in their homes (with some conditions). Although this was covered in the 2022 PFS, the mental telehealth expansion provision in the CAA was meant to allow for providers to continue treating patients for mental health conditions from the home following the conclusion of the PHE. Practitioners can continue providing care to patients in their homes through the end of the PHE and will be reimbursed at the in-person rate if the 95 modifier is used. 

I reached out to the staff at CMS to confirm, but have not heard back yet. I will follow up with them again and provide any feedback in this thread”

News for BCBS Employer Groups

 Author: Seymore Bones  Published Date: September 28, 2021  Leave a Comment on News for BCBS Employer Groups

Sept. 24, 2021 | BCBSTX News

Update to 2022 Telehealth Services

In support of our members and employer groups, in 2022 we will continue to cover the expanded telehealth services that we’ve covered this year. This is our standard coverage.

Federal Government Releases Proposed Rule Related to Surprise Billing, Transparency

The proposed rule provides new regulations to implement sections of Consolidated Appropriations Act of 2021. Topics covered include air ambulance reporting, agent and broker compensation disclosure and reporting, and enforcement of No Surprises Act requirements

Click here to view the full article

Aetna OfficeLink Update 6/1/2021

 Author: Seymore Bones  Published Date: June 7, 2021  Leave a Comment on Aetna OfficeLink Update 6/1/2021
View Important Information For Your Office

UHC Waives Cost Sharing

 Author: Seymore Bones  Published Date: June 7, 2021  Leave a Comment on UHC Waives Cost Sharing

UnitedHealthcare (UHC) is waiving cost sharing for Medicare Advantage plan members for primary care services through Dec. 31. This applies to in-network and covered out-of-network COVID-19 and non-COVID-19 visits, whether they are conducted in office or via telemedicine.

Click to view the full article

UHC Waives Cost Sharing….

 Author: Seymore Bones  Published Date: June 7, 2021  Leave a Comment on UHC Waives Cost Sharing….

Aetna OfficeLink Updates 6/1/2021

 Author: Seymore Bones  Published Date: June 3, 2021  Leave a Comment on Aetna OfficeLink Updates 6/1/2021

[embeddoc url=”https://community.poetllc.org/wp-content/uploads/2021/06/Aetna-OfficeLink-Updates-2021.06.01.pdf” download=”all” viewer=”google”]

THRIVE

 Author: Seymore Bones  Published Date: May 17, 2021  Leave a Comment on THRIVE

THRIVE CareAllies’ Provider Newsletter May 2021

Education inside: Obtain Assistance with Coding Accuracy and Documentation, one-on-one education, coding reference tools. Get set up for remote access, email [email protected].

Resource Material inside: 

  • CoVid Vaccine Flyers
  • Call us first: Poster, Wallet Card, Wearable Button, etc. 
  • NO-SHOW: Poster and Wallet Card (customizable)

Email CareAllies at [email protected] with any topic suggestions for this (your) newsletter.

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THRIVE

PHE Extended

 Author: Seymore Bones  Published Date: April 20, 2021  Leave a Comment on PHE Extended

HHS Secretary Xavier Becerra has renewed the public health emergency (PHE) for COVID-19 effective April 21, 2021. This extension will effectively continue all telehealth waivers and other flexibilities pursuant to this determination. As with previous determinations, the renewed PHE will terminate 90 days after its effective date on Tuesday, July 20, 2021, unless it is further extended. The Biden administration has previously indicated that it intends to continue extending the COVID-19 PHE at least for the remainder of 2021.

MGMA ~ Drew Voytal