MPA update on coronavirus

COVID-19 UPDATE (4/3/2020)

For Medicare AND for other insurance companies (except Medical Assistance and Tri-Care): This should be the final final (as opposed to the Interim Final, as some people noticed we have seen on some of the published regs):

1. Place of Service: 11
2. Modifier: 95

Below is from the4 April 3, 2020 publication from CMS. This is the issue, as I understand it, and it all has to do with the specific factors within the payment system used to determine reimbursement for services by Medicare, known as “Resource-based Relative Value Scale (RBRVS).

(For those who can’t sleep and want to learn more about RBRVS, I have some lengthy documents. But this is the essence: the final payment to practitioners is determined by the resource costs needed to provide them, with each service divided into three components:

• Practitioner “work”
• Practice expense
• Professional liability insurance (PLI)

Payments are calculated by multiplying the combined costs of a service times a conversion factor [a monetary amount determined by CMS] and adjusting for geographical differences in resource costs.)

So, if you want to understand the underlying policy issues:

1. Up until now, Medicare only allowed for telehealth services from an approved facility.
2. Approved practitioner fees at a facility are lower than practitioner fees in an office because the practitioner fees at a facility do not include the practice expense (a factor, above, in the RBRVS) which are costs of running the office – facilities are paid a separate fee for those costs, so the costs are not included in the practitioner fees in a facility.
3. “02” Place of Service has been used by Medicare for practitioners providing telehealth in a facility, because they were the only ones who could provide these services.
4. And, since “02” Place of Service indiciates the use of telehealth, the “95” modifier was not required (because the “95” modifier also indicates the use of telehealth)
5. But, now, since private practitioners are being reimbursed for telehealth services by Medicare, we need a code which allows us to be reimbursed for our practice/office expenses – and these are not included in the “02” Place of Service code reimbursement scheme.
6. Therefore, in order to make sure we are paid for our professional services and office expense services, we need to use Place of Service 11.
7. But, if we use Place of Service 11 without any other modifier, then no one knows we are using telehealth. Therefore, we have to include the modifier “95” to indicate that we are providing telehealth services.

Bottom line:

Many insurance companies want the Place of Service to be coded as: 02

Medicare still wants Place of Service to be coded as: 11

All (except Medicaid and Tricare) want the modifier: 95.

SPECIAL EDITION

Friday, April 3, 2020

News

Billing for Professional Telehealth Distant Site Services During the Public Health Emergency — Revised

News

Billing for Professional Telehealth Distant Site Services During the Public Health Emergency — Revised

This corrects a prior message that appeared in our March 31, 2020 Special Edition.

Building on prior action to expand reimbursement for telehealth services to Medicare beneficiaries, CMS will now allow for more than 80 additional services to be furnished via telehealth. When billing professional claims for all telehealth services with dates of services on or after March 1, 2020, and for the duration of the Public Health Emergency (PHE), bill with:

• Place of Service (POS) equal to what it would have been had the service been furnished in-person
  • Modifier 95, indicating that the service rendered was actually performed via telehealth

As a reminder, CMS is not requiring the CR modifier on telehealth services. However, consistent with current rules for telehealth services, there are two scenarios where modifiers are required on Medicare telehealth professional claims:
• Furnished as part of a federal telemedicine demonstration project in Alaska and Hawaii using asynchronous (store and forward) technology, use GQ modifier
• Furnished for diagnosis and treatment of an acute stroke, use G0 modifier
There are no billing changes for institutional claims; critical access hospital method II claims should continue to bill with modifier GT.

Medical Assistance – Optum – (1) additional information on telephone based services AND (2) clarification that psychologists are included (psychologists were inadvertently left off the March 21^st Memo as a practitioner group who can use telehealth)

HIPAA compliant electronic platforms: The Office of Civil Rights, the enforcement agency for HIPAA, has stated that it will not enforce regulatory requirements that practitioners use HIPAA-compliant electronic platforms during the COVID-pandemic when the practitioner provides “good faith” efforts to provide telehealth services.

Medicare: CMS has officially waived rules regarding the provision of telehealth services. Practitioners who participate with Medicare will now be reimbursed for telehealth services provided from their office or home to a new or existing patient in their home or other location.  The CPT billing modifier for Medicare is GT.

NOTE: Medicare will NOT reimburse for services via telephone.

Medical Assistance (Optum): Medical assistance has officially expanded reimbursable services to include telehealth from therapist’s home or office to patient’s home or other location. Also, Dept. of Health confirmed psychologists are included as one of the behavioral health practitioner groups who can use telehealth (we were left off of a memo dated March 21, 2020.)

1. 1. Will reimburse for telephone-based therapy services. The modifier is “-UB” which identifies the claim as a telephonically delivered service. Providers can bill for audio-only telephonic services that were initiated by the participant.
   2. Place of service code is “11” for “Office”, except for Medicare Dual eligible (see below, 3c)
   3. However, Place of Service Code 02 (Telehealth) should be used for Maryland Medicaid participants who also have Medicare crossover claims to specify services rendered through a telecommunication system for dual eligible participants.
   4. Additional Guidance re: telehealth. “Providers who are not able to meet in-person with a participant should make every effort to use the following technology, in order of priority:
      1. Traditional telehealth technology which meets all formal requirements is strongly preferred. (These services remain unaffected by the measures in this guidance).
      2. If Medicaid participants are unable to access originating sites possessing fully qualified technology (ability to pan/focus camera, multiple views, etc.) this emergency policy will permit the use of notebook computers, smartphones, or audio-only phones. If Medicaid participants cannot access cell-phone based video technology, audio only telephone calls will be permitted.

Note:  Providers may not use the audio-only telephone service option to expand services. Service volumes will be monitored, and outliers will be audited. The Department shall, upon determining that there is a substantial likelihood that a healthcare provider has failed to comply with this guidance…prohibit the healthcare provider from being reimbursed by the State for audio-only telephonic services.”

Services delivered via telehealth using two-way audio-visual technology assisted communication should be billed using the “-GT” modifier.

Additional information: email address for inquiries about telehealth: mdh.telemedicineinfo@maryland.gov

Additional telehealth info: https://mmcp.health.maryland.gov/Pages/telehealth.aspx

Providing Services to patients who reside in other states:

1. 1. DC has announced that it will allow practitioners who are licensed outside the state to provide telehealth services to existing patients in DC for the purposes of continuity of care. DC will NOT allow telehealth services from practitioners licensed out-of-state for NEW patients, except for healthcare facilities.
   2. Virginia has not made any official announcement that I have seen. However, an email from the Board administrator stated the following: “The Governor nor the Department of Health Professions have not  officially waived the regulatory requirements; however, the Board is certainly not going to discipline unlicensed practice for those providing continuity of care with an established Virginia client via telehealth during a state of emergency.”

Specific insurance Company Policy Changes:

1. 1. 1. 1. Magellan*: reimburses therapy via telephone if computer-based platforms are not available
         2. Optum (aka United Behavioral Health)*: reimburses therapy via telephone if computer-based platforms are not available. They have also waived all attestation requirements. See below: https://www.providerexpress.com/content/ope-provexpr/us/en/Important-upates.html

• “Telephonic care: For providers who do not have access to HIPAA-approved technology typically required to conduct a video-enabled virtual session, or video chat platforms as listed below, telephonic services can begin immediately. Providers do not need to attest through our virtual visits process to provide telephonic care. Please refer to reimbursement guidelines below for telehealth billing guidelines as this will allow properly submitted claims to process through auto-adjudication without creating manual work and support timely payment.

• Billing guidelines: Optum Behavioral Health will reimburse telehealth services which use standard CPT codes and a GT modifier or a Place of Service of 02 for both video-enabled virtual visits and telephonic sessions to indicate the visit was conducted remotely.”
  1. FEP BC/BS – waived the requirement for patients to use their preferred vendor, TelADoc.
  2. Aetna* – waived the requirement for patients to use their preferred vendor, TelADoc

For all traditional insurance policies, $0 copay for telemedicine visits until June 4, 2020 for the following:

• • • • Teladoc options through the Aetna Health app
      • Network providers who deliver virtual care, such as live video-conferencing
      • Other virtual care apps or services

*Note: If the health benefits are through the client’s self-insured employer, then benefits must be checked with the employer or insurance benefit plan administrator

• All CEs may be obtained through independent study.
• All psychologists with an active license with an expiration date of March 31, 2020, the expiration will be extended to April 30, 2020.
• All psychology associates with an active registration with an expiration date of March 31, 2020 will be extended to April 30, 2020.
• All renewals must be completed online using the Board’s online renewal system. The site can be found on the Board’s website. Payment must be made by credit card or a debit card. No paper renewals or checks will be accepted at this time.
• You may check online to see when your licensed renewal has been processed by performing a license verification check on the Board’s website (do not panic if you do not see your license updated, keep checking). YOU WILL NOT RECEIVE A NEW PAPER LICENSE OR REGISTRATION FOR SOME TIME.