How Do I Get Paid for Telemedicine?
Anjali and Mary Jean will present on the changing landscape of telemedicine reimbursement what it was in the past, where it is now during the National Emergency, and probable future outcomes based on her experience and insight. Additionally, she will provide practical guidance on coding to avoid fraud and abuse issues to avoid post-pandemic audits and investigations
- Allowable Telemedicine Reimbursement Past, Present, Future
- Telemedicine Reimbursement Codes and How to Example
- Considerations for Practicing Across State Lines and Documentation
- Avoiding investigations: Fraud & Abuse
There are three modifiers that are available to indicate a service is provided via telehealth
- CPT Modifier 95 = Synchronous Telemedicine Service Rendered Via a Real-Time Interactive Audio and Video Telecommunications System,
- HCPCS Modifiers GT = Via interactive audio and video telecommunication systems,
- HCPCS GQ = Via asynchronous telecommunication systems.
One of these would be appended to your CPT code for the service to indicate that it was provided via telehealth. Some payers prefer you use 95 and others prefer you use GT – you’ll need to know your payers and what their preference is for reporting these services. Currently, CMS is asking us to use Modifier 95 for services to Medicare patients. However, Anthem Blue Cross CA is allowing the use of any one of the three modifiers and Blue Shield CA is requiring 95 for synchronous and GQ for asynchronous. Your staff will just have to check with each of your payers to see what their reporting/billing requirements are. That is why the grid I gave as an example of a good idea for your staff to use as a reference.
Modifier 96 is for reporting habilitative services and does not relate to billing for telemedicine services.
POS 02 is used to identify telehealth – the location where health services and health related services are provided or received, through a telecommunication system. Currently, some commercial payers want you to use this as the POS for any service delivered via telehealth. However, CMS has adopted using POS 11 (office) or whatever the “usual place of service” is for services delivered via telehealth. This may be just for the period of the PHE and may change once we are out of the emergency period. Again, you just have to check with your payers to see what their guidelines are for reporting POS. A number of them have elected to adopt the CMS policy at this time, while others like our Blue Cross and Blue Shield of CA want 02 reported as the POS for these services.
Here are the links to Anthem Blue Cross of California and Blue Shield California that I use. Also, I’m attaching a copy of their most current guidelines for all things COVID 19 related and also telemedicine.
- Blue Shield CA :
2. I’m unclear as to what you mean when you say you are “resubmitting” claims based on current guidelines: a) are these claims you have already received payment on and are adjusting because of the new guidelines, or b) are these claims you are submitting for the first time, just based on whatever the current guidelines are?
Ans: If it is a claim that has already been adjudicated and you are correcting, then I think that is fine, as long as you keep track and make sure there is an adjustment made (if needed) and you are not paid twice for the same claim. If it is a claim that you are just submitting for the first time, but submitting differently based on current guidelines, then that should be no problem; no red flag. If you have something denied because of the way it was submitted, and need to appeal it with a new submission based on different guidelines then, certainly do that – but that would likely be an appeal and not a regular claim submission. If you want to clarify for me a bit more, then maybe I can answer more definitively.
Anjali is a known for her healthcare expertise in many areas, but her passion is telemedicine and physician issues. She works tirelessly to assist independent physician and surgical practices across the nation succeed financially and adopt technology solutions to enhance their workflow and revenue.
Mary Jean Sage
Mary Jean Sage of The Sage Associates. Her lecture engagements have included the AMA, CMA, many local medical associations and Medical Group Management Associations. She is recognized for her expertise in coding, billing, healthcare compliance and Medicare audit response.