Tag: Telemedicine

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.

Texmed.org Article

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.

We asked the TMA if they could shed any light on the subject. This is their answer:

TMA is pushing from both directions, insurers and the Texas Dept of Insurance,  to come up with a coherent payment scheme for telemedicine and telephonic visits. 

We expect to meet with TDI this week and hope to make progress.  So, far United Healthcare is the only insurance to release a statement:

https://www.uhcprovider.com/en/resource-library/news/provider-telehealth-policies.html

Visit TMA’s coronavirus resource page and TMA’s telemedicine resource page. I hope this information is helpful to you! Please don’t hesitate to contact me if I can be of further assistance!

Sincerely,

Claire Duncan
Director, TMA Knowledge Center
Texas Medical Association

This post was pinned to the top of all other new posts. I have now removed the pin. We are updating this as information comes in. Be sure to click the links for the most up to date information from the plan:

Aetna – Check below links for updates. ” Only telemedicine at this time. Self- funded plan sponsors can choose to not waive member cost share.”

Link for providers – https://www.aetna.com/health-care-professionals/provider-education-manuals/covid-faq.html

Link to members information from Aetna- https://www.aetna.com/individuals-families/member-rights-resources/covid19.html

BCBSTX – “This service is a benefit level and not all members have this benefit. Most employer plans are required to use MD Live.”

Check the below link for the most up to date from BCBSTX

https://www.bcbstx.com/provider/covid-19-preparedness.html

March 19th info from BCBS: New patients can be seen by telemedicine.

You will need to check eligibility and benefits as all groups will not have telehealth benefits.

CIGNA – has provided the following link: www.Cignaforhcp.com

They did not specify if Commercial only however it was from our commercial products contact.

CIGNA/HealthSpring – Letters are being sent to physicians regarding the situation. HealthSpring will be following CMS guidelines. Further details have been provided by HealthSpring. There was an update of the details on March 26th.

UPDATE – As of April 1, 2020 accepting 360s performed via telehealth(must be audio and visual). See April 2,2020 post for details.

March 31, 2020 find the latest by going to https://medicareproviders.cigna.com/ look for the blue box with a exclamation point and click on Billing Guidelines and FAQs

Molina – March 23 – Update and additional information can be found in COVID tag

March 19 – “We would expect that the visits would be covered based on the modifier and POS noted below:

Modifier 95* , POS 2* and document in their medical records that it was audio only *these are intended for visits with both video and audio,but we will also instruct providers to code for audio-only visits.”

Nexcaliber (Brookshires) – Will be working with Brookshire Brothers Employee Health Plan to allow reimbursement for robust telephone calls between physician and patient. This will be effective through April 30, 2020.

Superior – Will follow state regulations. Working to get better details.

The Governor’s release states:

“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. “

United Healthcare – “You will find all information concerning COVID-19 for providers on the UHC Provider Service website.” The website describes how they will reimburse providers for telephone calls to existing patients based on type of product. https://www.uhcprovider.com/en/resource-library/news/Novel-Coronavirus-COVID-19.html

By Steve Levine,

texmed.org/TexasMedicineDetail.aspx

Much of America, Texas included, is engaged in a big “what if” conversation about what happens next with the coronavirus disease, COVID-19.

• What if a lot of cases show up in my town?
• What if schools must close?
• What if I have to stay home for a week or longer?

The Texas Medical Association and organizations like the U.S. Centers for Disease Control and Prevention (CDC) and the World Health Organization are encouraging physicians to consider how they will respond to big surges in sick patients needing care; critical staff becoming ill or unable to come to work; and protecting non-infected patients from exposure to the virus from other patients in the office.

Could telemedicine be part of the solution for your practice?

“Shifting practices to triaging and assessing ill patients (including those affected by COVID-19 and patients with other conditions) remotely using nurse advice lines, provider ‘visits’ by telephone, text monitoring system, video conference, or other telehealth and telemedicine methods can reduce exposure of ill persons with staff and minimize surge on facilities,” CDC says in a recent guidance document. “Many clinics and medical offices already use these methods to triage and manage patients after hours and as part of usual practices.”

The laws and rules concerning telemedicine (members only white paper) in Texas have changed considerably to expand access over the past several years, in large part due to TMA’s efforts. In 2019 alone, the Texas Legislature passed a bill to streamline Medicaid’s telemedicine requirements, and another measure allowing physicians to choose the best platform for providing telemedicine services rather than having health plans dictate the platform.

For physicians looking to ramp up their telemedicine capabilities, TMA offers a 37-minute webinar, Telemedicine: The Changing Shape of Care, free to members thanks to the sponsorship of TMA Insurance Trust. TMA members are eligible for a free technology contract review from Coker Group, including a contract review of telemedicine vendor services, and TMA has created a free telemedicine vendor evaluation tool.

Texas Medicaid now can pay for services provided via telemedicine to patients who are in their homes under certain circumstances. Medicare Advantage plans can cover those services in patients’ homes for the first time this year; traditional Medicare cannot. Analysts tell TMA that, even in an emergency, the secretary of Health and Human Services (HHS) lacks the authority to waive the prohibition against paying for telemedicine services to patients who are in their homes; it requires an act of Congress. And this week, Congress acted.

The U.S. House of Representatives on Wednesday included authorization for HHS to take such actions in a declared national emergency as part of the coronavirus-response legislation that passed overwhelmingly. The Senate passed an $8.3 billion spending bill Thursday, and President Trump signed it Friday.

For up-to-date information on COVID-19, check TMA’s Coronavirus Resource Center. And turn to the TMA Telemedicine Resource Center for links, resources, and a look at TMA advocacy on telemedicine in Texas.

Last Updated On

March 09, 2020

Related Content

Coronavirus

Steve Levine

VP, Communication

(512) 370-1380

steve.levine[at]texmed[dot]org

A former statehouse reporter, political press secretary, and state agency spokesman, Steve Levine has directed the Communication Division at TMA since 1997. He oversees Texas Medicine, Texas Medicine Today, TMA’s media and public relations activities, and the TMA Knowledge Center, website, and social media activities.

This is the question of the week! POET is working on getting some sort of definite answer. We are posting web links and information provided by health plans when asked the question.

So far it appears most are easing policies on telemedicine (audio and visual) but no changes for telephone. We are in hopes there will be reconsiderations as events unfold.

We will keep you posted on what we learn. If anyone gets a definitive answer in writing, we would love to see it!

Effective immediately, UnitedHealthcare is expanding their policies around telehealth services for our Medicare Advantage, Medicaid and commercial membership, making it even easier for patients to connect with their health care provider

To view UHC policies follow this link.

For UHC Provider’s Resource Library on CoVID-19, Corona Virus https://www.uhcprovider.com/en/resource-library/news/Novel-Coronavirus-COVID-19.html

---