Your head is spinning as you try to recommend remote service solutions to your providers.
To make an intelligent presentation to your doctors, you need to do some homework, so you’re getting the coverage you expect and avoiding hot-water regulations.
Get a jump start with expert practice management and reimbursement tips from nationally-recognized coding and training expert Kim Huey, MJ, CHC, CPC, CCS-P, PCS, CPCO, COC.
6 Ready-to-Ask Queries Form Your Telemedicine Quick Guide
Before you start drafting emergency telemedicine policies to cope with COVID-19, the most important thing to remember is that payers have differing definitions of what they consider telehealth. Check with your top insurers for the most up-to-date information affecting requirements for coding and billing of telehealth services.
Prepare a sheet that you can use to present your findings and guide future policies. Ask your insurance representatives these questions:
- What are the effective dates? Most insurers are limiting this exemption to a specific period of time.
- What services are covered?
- How are those to be billed?
- Do we use telehealth codes or office visit codes?
- What place of service?
- What modifiers are necessary?
Your Max Pay Up Depends on Identifying Waivers, Dates, Modifier Variations
Knowing what some top payers are doing will help you know what to expect. Many insurers are making similar exceptions during the COIVID-10 Public Health Emergency (PHE). United Health Care and Blue Cross Blue Shield are offering many of the same extensions. When you call, if you don’t get similar allowances, be sure to reference what these Alabama major payers are doing – and see if your payer allows the same.
Originating Site Waivers: United Health Care is waiving originating site restrictions for its commercial, Medicare Advantage, and Medicaid plans. The patient may be at home or at another location. All the other requirements for telehealth must be met by real-time audio and video communication system required. Apply place of service 02 and modifier GQ (Asynchronous telecommunications system) or GT (Interactive audio and video telecommunication system). This waiver is only in effect until April 30, 2020.
Telehealth Credentialing Waivers: Alabama Medicaid normally requires separate credentialing for providers performing telehealth; however, that restriction has been waived 3/16/2020 – 4/16/2020 (dates of service). Medical providers may bill established-patient evaluation and management codes 99211, 99212 and 99213 for telephone consultations. Psychologists and behavioral health professionals should bill 90832, 90834, 90837, 90846, 90847 and H2011. A dental provider should bill D0140. Place of service code 02 (zero two) for telehealth and modifier CR are required. Verbal consent must be obtained and documented in the medical record. These visits will count against the patient’s office visit limit of 14 visits per year.
Office Visits Allowed for Phone Calls: Blue Cross Blue Shield of Alabama is allowing providers to bill for phone call treatment of existing patients under the established patient office visit codes from 3/16/2020 – 4/16/2020. They are allowing codes up to 99213 with place of service code 02 (zero two) for telehealth. No modifier is required. Many providers are concerned about reaching that level of service when no examination can be performed. Remember that established patient office visits require only two of the three key components – history, examination, medical decision-making. If the physician documents an expanded problem-focused history and low complexity medical decision-making, 99213 will be supported. This must be the physician speaking with the patient, not the office staff.
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