Medical Billing Forum
General Category => General Questions => : DeeMSanti04 July 31, 2020, 05:30:20 PM
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Hi!
I am new to the billing world and reimbursement rates. I was given the project of reading more up on the telehealth/video health reimbursement.
I currently work for pulmonary specialty providers and as the Billing Manager, I have to keep everyone (providers) up to date as the CPT charges changes come along and also now this (reimbursement rates on some services).
My question to any Billing Managers or anyone who deals with reimbursements or who has experience that can share their knowledge and resources.
What resources can I utilize to find out changing rates of E/M levels according to services and payers?
For example:
When providing Telehealth/Video visits, providers can utilize the "standard office visit codes" to get reimbursed for these services provided.
Now my question is:
Is there a resource or resources I can research to find out more on these reimbursement rates or if they will change and if they do, what will be the impact?
At this moment I can use all billing resources available to help me.
Thank you in advance!
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With COVID19 almost all rules involving telehealth have changed. And unfortunately they vary by carrier. The only resource I can point you to is the websites and bulletins that these carriers are putting out. Most carriers are reimbursing telehealth at the regular rates for in office services. Some are even waiving the patient responsibilities and paying the entire portion. They've also changed the rules as things progressed, since this situation is unprecedented. We have had to learn as we go, and be flexible in order to keep up with the changing guidelines. I'm sorry I don't have a better answer for you than that, but right now that's where we are at.
If anyone knows of any resources out there on this, please share!
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Note that there is a distinction between "telehealth" and "telemedicine" for the duration of this relaxing of the rules. Telemedicine requires the use of a patient portal. Telehealth does not. Telehealth can be carried out over smart phone, tablet, or even a plain old telephone that has no video ability (for the sake of the old folks who only have regular phones).
Medicare has stated that a telehealth visit should be coded as a regular office visit, with this one caveat: 99214 and higher require activities on the part of the provider that are pretty much impossible to carry out without the patient standing in front of the provider - so most telehealth codes should be 99213 and lower (according to Medicare).
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Here's a list of POS and Modifiers if this helps anyone:
- BCBS - POS 02, mod 95
- Aetna - POS 02, mod GT
- Tricare - POS 11, mod GT
- Cigna - POS 11, mod 95
- United Commercial - POS 11, mod 95
- Gateway - POS 11, mod GT
- United Community - POS 11, mod GT
- Aetna Better Health - POS 11, mod GT
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:D
thanks for the replies!