The Centers for Medicare and Medicaid Services (CMS) recently relaxed several requirements for billing telehealth to Medicare and Medicaid to allow providers maximum flexibility for providing care to patients and limiting the spread of the COVID-19 virus during the public health emergency (PHE). Many of these temporary guidelines also make it more feasible than ever to offer telehealth services in emergency departments. Here are 15 things to know about billing Medicare and Indiana Medicaid for telehealth services in the ED during the COVID-19 public health emergency.
Expanded Telehealth Services
1. CMS approved emergency department evaluation and management codes, along with critical care codes, for billing as telehealth services to Medicare beginning March 1, 2020, through the end of the COVID-19 public health emergency. Medicare has updated its list of CPT telehealth codes to include these and other new telehealth codes that are temporarily available.
2. For Indiana Medicaid, coverage of telehealth services during the PHE is not limited to the codes on the Telemedicine Services Codes. However, the following provider types and services may not be reimbursed for telehealth (or what the payer refers to more specifically as telemedicine) by Indiana Medicaid: surgical procedures, radiological services, laboratory services, anesthesia services, audiological services, chiropractor services, care coordination without the member present, durable medical equipment/home medical equipment providers, and provider-to-provider consultation.
3. CMS will allow telehealth services to be offered to both established and new patients for both Medicare and Medicaid.
4. Both Medicare and Indiana Medicaid will pay the same rate for telehealth services as they do for in-person services.
Expanded Places of Service
5. Telehealth services are available in all areas of the country in all settings. Patients can even initiate telehealth visits from their own home.
Relaxed Technology Guidelines
6. Most telehealth services can be conducted on any non-public-facing app and on any device with both audio and video capabilities, including smart phones and laptops using popular apps like FaceTime or Facebook Messenger. CMS has urged providers to elect settings that allow for the most security and privacy on the devices they use. HIPAA federal guidance for telehealth technology has been waived during this public health emergency.
7. Both Medicaid and Medicare have made allowances for certain telehealth services to be offered via audio only telephone calls. Medicare limits those services to CPT codes 99441-99443, available for use by physicians with either established or new patients, and CPT codes 98966-98968, available for use by nonphysician practitioners with either established or new patients. For Indiana Medicaid, any IHCP-covered service – aside from the exclusions listed in IHCP Bulletin BT202022 and speech, occupational, and physical therapies – can be provided through audio-only visits, given that the service can reasonably be provided through audio only communication.
Prescribing Controlled Substances
8. Providers can prescribe controlled substances via teleheath under the following conditions:
- The prescription is issued for a legitimate medical purpose by a practitioner acting in the usual course of his/her professional practice.
- The telemedicine communication is conducted using an audio-visual, real-time, two-way interactive communication system.
- The practitioner is acting in accordance with applicable Federal and State law.
9. When billing telehealth services to Medicare during the PHE, use the place of service code that would have been reported had the service been furnished in person (23 for emergency department). Additionally, the CPT telehealth modifier, -95, should be applied to claim lines that describe services furnished via telehealth.
10. When billing telehealth services to Indiana Medicaid from the IHCP designated list of Telemedicine Services Codes, use POS code 02 and modifier -95, as specified in the IHCP Telemedicine and Telehealth Services Provider Reference Module. For IHCP covered codes not on the Telemedicine Services Codes list, use the POS code most relevant to the member’s location. If the member is located in his or her home, use POS code 12. Additionally, the GT modifier is strongly encouraged when billing these “new” telehealth services to Indiana Medicaid, but it’s not required, especially if there are already four modifiers being used. If the GT modifier is not used on the claim, the provider must maintain and be prepared to provide documentation that notes that the service was provided via telehealth.
11. The HHS Office of Inspector General (OIG) is allowing providers to waive or reduce cost-sharing requirements for telehealth visits paid by federal healthcare programs without violating federal anti-kickback statutes, the civil monetary penalty and exclusion laws related to kickbacks, and the civil monetary penalty law prohibition on inducements to beneficiaries. The guidance does not require provider to waive or reduce cost-sharing requirements for telehealth, however.
12. Indiana Medicaid has eliminated all cost sharing for all services during the public health emergency.
13. Medicare beneficiaries will still have to pay the 20 percent coinsurance for telehealth services unless a telehealth visit was particularly related to a COVID-19 test. In that case, the -CS modifier should be added to telehealth visits to indicate they were
- furnished between March 18, 2020 and the end of the Public Health Emergency (PHE);
- that it resulted in an order for or administration of a COVID-19 test;
- and is related to furnishing or administering such a test or to the evaluation of an individual for purposes of determining the need for such a test.
14. While private payers have been encouraged by CMS to make similar telehealth modifications like the ones that apply to Medicare and Medicaid, “there has not been a broad announcement to that effect,” according to Hart Health Strategies. Many private payers are at least waiving patient cost-sharing for telehealth services during the public health emergency.
15. The American Medical Association has created a Quick Guide to Telemedicine in Practice that offers several pointers for getting set up with telehealth. While this is a general resource for all specialties, emergency physicians may benefit from several of the suggestions.
For more information about billing telehealth in the ED during the COVID-19 public health emergency, check out these resources:
- Medicare Telemedicine Health Care Provider Fact Sheet
- Medicare Telehealth Frequently Asked Questions (FAQs) – March 17, 2020
- Medicare Interim Final Rule: Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency
- Medicare’s List of Approved Telehealth Codes
- Medicare Fee-for-Service (FFS) Response to the Public Health Emergency on the Coronavirus (COVID-19) MLN Matters Number: SE20011
- Medicare Coverage and Payment of Virtual Services YouTube video
- IHCP COVID-19 Response: IHCP responds to telemedicine FAQs as of April 1, 2020
- IHCP issues telemedicine billing guidance for providers during COVID-19 outbreak
- CMS’s 1135 Waivers Web Page
- OIG Policy Statement Regarding Physicians and Other Practitioners That Reduce or Waive Amounts Owed by Federal Health Care Program Beneficiaries for Telehealth Services During the 2019 Novel Coronavirus (COVID-19) Outbreak
- OCR Notification of Enforcement Discretion for telehealth remote communications during the COVID-19 nationwide public health emergency
- EDPMA News Alert: CMS Releases COVID-19 Interim Final Rule impacting Telehealth and EMTALA
- Telehealth Payments in the Response to the COVID-19 Pandemic from Hart Health Strategies via EDPMA
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