Medical Billing Forum
Billing => Billing => : Mandy1986 December 19, 2019, 04:22:14 PM
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Hello ,
We are going to start telehealth services but i have few question if some one already doing this.
1. Where to bill – whether Facility /Professional billing.
2. Which codes to bill for Facility /Professional billing
3. What cost ?.I have found one person who stated they do telehealth but only as private pay
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1. Where to bill – whether Facility /Professional billing.
I'm not sure what you are asking. Are you asking what the place of service would be?
2. Which codes to bill for Facility /Professional billing
The codes are the same as office billing, just that it's being done remotely.
3. What cost ?.I have found one person who stated they do telehealth but only as private pay
I would say the same fees that you charge for the codes when done in the office.
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Hi There,
I have a question about Telehealth service billing. Your help is much appreciated.
Question # 1 : if a patient was seen for Telehealth service do we need to send the professional claim with 95/GT modifier with E/M code ?
Example : If the patient was seen via telehealth using (Audio/Video) service for a cough so would the billing will be 99213-95 (Dx code R05) for commercial plans and for medicare 99213-GT (Dx code R05) ? Please confirm. Thank you.
Question # 2 : Can we still bill with telehealth code and POS if patient's and physician had a conversation through only telephone service (AUDIO only) not video or we can only bill such service with 99441-99443 ?
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Question # 1 : if a patient was seen for Telehealth service do we need to send the professional claim with 95/GT modifier with E/M code ?
Example : If the patient was seen via telehealth using (Audio/Video) service for a cough so would the billing will be 99213-95 (Dx code R05) for commercial plans and for medicare 99213-GT (Dx code R05) ? Please confirm. Thank you.
I haven't billed any yet but will be this week. What I am reading is that the GT modifier was eliminated when they implemented the 02 place of service. The GQ is for telephone only and the 95 is for video/audio. So in your above example I would do 99213 95 with 02 POS.
Question # 2 : Can we still bill with telehealth code and POS if patient's and physician had a conversation through only telephone service (AUDIO only) not video or we can only bill such service with 99441-99443 ?
Due to COVID19 they are allowing telephone only. I believe the codes vary depending on the insurance. For example, NYS Medicaid is requiring the 99441-99443, but I believe commercial insurance may be allowing the E&M codes.
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Thank you so much.
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So what about medicare and telephone only calls?
I was told I had to use g2012 or something like that and it only pays around 15.00. My physician said he'd rather shut down if that's all he is foing to get from mcare during this
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I just prepared this for our providers. It is in PDF format and is color-coded for easier picking out of terms. For some reason, I cannot attach that PDF to this post so I'm doing this. The information is just as good; it's just harder to read.
These are some definitions, as published in CMS articles
March 17 - 20, 2020.
1. The Coronavirus Preparedness and Response Supplemental Appropriations Act, as signed into law by the President on March 6, 2020, includes a provision allowing the Secretary of the Department of Health and Human Services to waive certain Medicare telehealth payment requirements during the Public Health Emergency (PHE) declared by the Secretary of Health and Human Services January 31, 2020 - to allow beneficiaries in all areas of the country to receive telehealth services, including at their home.
These emergency allowances exist until the emergency is declared to no longer exist.
2. E-Visit: s/b conducted via a Patient Portal (an issue separate from Telehealth)
Telehealth: s/b conducted via an interactive audio and video telecommunications
system that permits real-time communication between the distant site (provider) and
the patient at home.
Note that Telehealth does not require a Patient Portal.
Can be conducted by smartphone, tablet, laptop, etc. (See Point 10 below)
3. Distant site practitioners who can furnish and get payment for covered Telehealth
services (subject to state law) can include physicians, nurse practitioners, physician assistants, nurse midwives, certified nurse anesthetists, clinical psychologists, clinical social workers, registered dietitians, and nutrition professionals.
4. No modifiers - for services performed by private practice providers.
Modifiers - for services performed by Facilities (Hospitals; ASCs; etc.)
5. Patient initiates short phone call to doctor: (Virtual Check-Ins)
Call may be placed over regular land-line phone.
- to refill prescription, ask a quick question, etc. HCPCS code G2012
- to send image for doctor to look at: HCPCS code G2010
6. Patient calls and makes appointment. Doctor calls patient at appointed time: (Telehealth)
Use Office Visit codes 99212 - 99215, and the few other relevant Codes here:
https://www.cms.gov/Medicare/Medicare-General-Information/Telehealth/Telehealth-Codes
Note that these codes can be used only if the person making the return call to the patient
is one of those listed at Point 3 above. The guidelines say that the provider's call to patient
should be done with a smartphone, tablet, laptop, or other audio / visual device. Since
auditing will be lax or non-existant, can probably be done via land-line for those needing it.
7. The provider services allowable for Telehealth are those that the provider can
reasonably accomplish through a long-distance interface. Can take temperature
(so says CMS). Cannot draw blood / do lab tests. Etc.
Medicare pays separately for other professional services that are commonly furnished remotely using telecommunications technology without restrictions that apply to Medicare Telehealth. These services, including physician interpretation of diagnostic tests, care management services and virtual check-ins, are normally furnished through communication technology.
8. Medicare telehealth services are generally billed as if the service had been furnished in-person.
For Medicare telehealth services, the claim should reflect the designated Place of Service (POS) Code 02 - Telehealth, to indicate the billed service was furnished as a professional telehealth service from a distant site.
9. For the duration of the emergency, HIPPA Compliance is being relaxed in areas where
speedy care is essential, and in areas where mistakes are made in good faith.
10. Telehealth communication devices must be non-public facing.
A “non-public facing” remote communication product is one that, as a default, allows only the intended parties to participate in the communication. Non-public facing remote communication products would include, for example, platforms such as Apple FaceTime, Facebook Messenger video chat, Google Hangouts video, Whatsapp video chat, or Skype. Such products also would include commonly used texting applications such as Signal, Jabber, Facebook Messenger, Google Hangouts, Whatsapp, or iMessage. Typically, these platforms employ end-to-end encryption, which allows only an individual and the person with whom the individual is communicating to see what is transmitted. The platforms also support individual user accounts, logins, and passcodes to help limit access and verify participants. In addition, participants are able to assert some degree of control over particular capabilities, such as choosing to record or not record the communication or to mute or turn off the video or audio signal at any point.
In contrast, public-facing products such as TikTok, Facebook Live, Twitch, or a chat room like Slack are not acceptable forms of remote communication for telehealth because they are designed to be open to the public or allow wide or indiscriminate access to the communication. For example, a provider that uses Facebook Live to stream a presentation made available to all its patients about the risks of COVID-19 would not be considered reasonably private provision of telehealth services. A provider that chooses to host such a public-facing presentation would not be covered by the Notification and should not identify patients or offer individualized patient advice in such a livestream.
https://www.hhs.gov/sites/default/files/telehealth-faqs-508.pdf
https://edit.cms.gov/files/document/medicare-telehealth-frequently-asked-questions-faqs-31720.pdf
https://www.hhs.gov/sites/default/files/hipaa-and-covid-19-limited-hipaa-waiver-bulletin-508.pdf
https://www.cms.gov/files/document/general-telemedicine-toolkit.pdf
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Thanks Richard for sharing. This is very helpful information.
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You are welcome Michele.
I'm finding one of the biggest problems is the lack of understanding of definitions. Folks are talking past each other because they don't have common definitions of the words they are using. I put this information together to help everybody get on the same page when talking about what Medicare is doing.
United Health has released information comparable to what Medicare has said in what I posted. When I get a good handle on that information, and any other commercial carrier, I will try to post that here as well. For now, just understand that the commercial carriers usually follow what Medicare does - so whatever they are doing should be similar to what I just posted.
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So for Medicare if it's not a quick check in for refills but their regular 3 month follow up but it is done over the telephone because the patient doesn't have others means do we bill the G2012 or 99213
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See Point 4 of what I posted upthread.
Only facilities are to use modifiers. Private practice does not. Except in three cases, which will not apply to most posting here.
See Point 18 here:
https://edit.cms.gov/files/document/medicare-telehealth-frequently-asked-questions-faqs-31720.pdf
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I think I answered the wrong question - but its a question that is bound to come up, so I am going to leave that response there.
Here is the correct answer:
Note the distinction made at Point 5 above. Quick phone calls initiated by the patient should be coded with the G2012 (voice) or G2010 (digital image transmission) codes. These are called Virtual Check-Ins.
Telehealth is when a patient calls and makes an appointment. In this case, the doctor initiates the phone call to the patient at the appointed time. This call is supposed to be via a device that supports audio and visual (smart phone; tablet; laptop, etc). These would be the instances where the office visit codes are used (new or old patients), as well as the few other codes listed at the link I gave at Point 6 above.
CMS makes it clear that there will be little to no auditing during this period, and they have relaxed the HIPPA requirements - so unofficially I think it is safe for the doctor to use a land-line for those patients who are not computer-savvy and who only have a land-line.
As CMS makes clear in their communications, the objective is to get health-care to the elderly who need it - without forcing them to put themselves at risk by traveling to wherever their provider is located. So understand that CMS will accept whatever is requried to get the health care to these older folks. Unofficially I'm saying use the land-line if that is all the patient has. That is within the spirit of what CMS is trying to do.
Finally - you must use POS 02 for these telehealth calls. Everything else should be coded as though the patient actually came into the office - with the caveat that you should not be coding for drawing blood, etc on a telehealth Claim Form.
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We are being bombarded with memos, etc from all insurance carriers and it's so hard to sort it all out, while handling the phone calls, employee restrictions, etc. This is a great resource. Thanks again Richard.
NYS just issued an order yesterday declaring medical billing businesses as "essential". But we still have to be careful since we are at risk. Thankfully we have space here to separate people, but not all MBBs do.
Stay safe and healthy everyone!
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We have received notice from United Health. They seem to be following what CMS is doing. But it appears that, in addition to POS = 02, they want Modifies. Hopefully I can pay more attention to what they sent over the weekend and put a brief summary together.
I placed the PDF file into Dropbox. Let's see if I can create a link to that now. Feel free to distribute to whoever might benefit from this information.
https://www.dropbox.com/preview/Misc/TeleHealth%20during%20Covid-19.pdf?role=personal
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Why am I not surprised. CMS changes the rules in the middle of the game.
Use POS = place where service would normally have been received. (office visit = 11 for us).
Use modifier 95.
https://www.cms.gov/outreach-and-educationoutreachffsprovpartprogprovider-partnership-email-archive/2020-04-03-mlnc-se#_Toc36815181
For the commercial carriers we use, Blue Shield of California and Cigna require no modifier. All else want GT or 95. Given this is a state by state thing, your mileage may vary.
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Has anyone billed Tricare East (Humana Military) for telehealth services yet? I am a little confused with their guidelines. It states to bill your cpt codes and add modifier 95 with place of service code 02. I understand that part, then it goes on to say use code Q3014 for originating site. That is where I get confused.
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The Q3014 is if you are billing for a facility fee. Most providers are billing for their services, not the facility fee. That is if a place hosts the patient, they are the originating site.
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Thank you. I am just freaking out trying to figure this all out. I have never billed for this type of service.
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Everybody is! Most have not billed this before but we will get thru it. :)
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For those who don't know yet.
From here:
https://www.hhs.gov/provider-relief/index.html
Immediate infusion of $30 billion into healthcare system
Recognizing the importance of delivering funds in a fast and transparent manner, $30 billion is being distributed immediately – with payments arriving via direct deposit beginning April 10, 2020 – to eligible providers throughout the American healthcare system. These are payments, not loans, to healthcare providers, and will not need to be repaid.
Who is eligible for initial $30 billion
* All facilities and providers that received Medicare fee-for-service (FFS) reimbursements in 2019 are eligible for this initial rapid distribution.
* Payments to practices that are part of larger medical groups will be sent to the group's central billing office.
* All relief payments are made to the billing organization according to its Taxpayer Identification Number (TIN). (This is the "who gets paid" NPI#)
* As a condition to receiving these funds, providers must agree not to seek collection of out-of-pocket payments from a COVID-19 patient that are greater than what the patient would have otherwise been required to pay if the care had been provided by an in-network provider.
* This quick dispersal of funds will provide relief to both providers in areas heavily impacted by the COVID-19 pandemic and those providers who are struggling to keep their doors open due to healthy patients delaying care and cancelled elective services.
How are payment distributions determined
* Providers will be distributed a portion of the initial $30 billion based on their share of total Medicare FFS reimbursements in 2019. Total FFS payments were approximately $484 billion in 2019.
* A provider can estimate their payment by dividing their 2019 Medicare FFS (not including Medicare Advantage) payments they received by $484,000,000,000, and multiply that ratio by $30,000,000,000. Providers can obtain their 2019 Medicare FFS billings from their organization's revenue management system.
* As an example: A community hospital billed Medicare FFS $121 million in 2019. To determine how much they would receive, use this equation:
$121,000,000/$484,000,000,000 x $30,000,000,000 = $7,500,000
What to do if you are an eligible provider
* HHS has partnered with UnitedHealth Group (UHG) to provide rapid payment to providers eligible for the distribution of the initial $30 billion in funds.
* Providers will be paid via Automated Clearing House account information on file with UHG or the Centers for Medicare & Medicaid Services (CMS).
* The automatic payments will come to providers via Optum Bank with "HHSPAYMENT" as the payment description.
* Providers who normally receive a paper check for reimbursement from CMS, will receive a paper check in the mail for this payment as well, within the next few weeks.
* Within 30 days of receiving the payment, providers must sign an attestation confirming receipt of the funds and agreeing to the terms and conditions of payment. The portal for signing the attestation will be open the week of April 13, 2020, and will be linked on this page.
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Richard, thank you so much for sharing this information. It is so helpful!
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I am wondering the same about Tricare East......has anyone found out anything on that Q3014 code?
The Tricare manual is VERY confusing about billing this code. I'm not sure if it's a secondary code we need to add to the claim w/the E&M code or if we should be billing it at all.
HELP!
Thanks!!
Jennifer
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Richard, thank you so much for sharing this information. It is so helpful!
You are welcome Michele.
JenniferP - in terms of definitions, the distant site is wherever the physician is. The originating site is where the patient is.
If the patient is at home, it should be obvious that a home has no authority to bill for a facility fee. If the patient is at the park, same thing. But if at a skilled nursing facility or hospital, these do have the authority to bill for a facility fee. Medicare has lifted the requirements for where the patient must be when engaged in telehealth. This means that all of the originating sites listed at the link below qualify for telehealth payment during this Covid19 emergency period. Note that being at home or at the park also qualify - but only during this Covid19 emergency period.
Stated more simply - both the doctor and the patient can be anywhere, and the telehealth encounter will be covered. But only for so long as this emergency exists. Medicare will announce when that end point is, but hasn't done so yet.
That is Medicare's stance on the issue. Your commercial carrier(s) may surprise you with a different stance.
https://www.mgma.com/resources/financial-management/navigating-telehealth-billing-requirements
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Thanks for the responses Michele & Richard P.....
but just so i am clear on Tricare --- we don't have a lot of Tricare pt's ----- but, here's our scenario.
patient calls our office for a telehealth appointment or we have contacted the patient after they or their pharmacy has requested refills on meds, but pt needs to be "seen". pt is scheduled for a telehealth visit and our front desk contacts them to do "check-in". front desk advises the time frame that the provider will call them on whichever service they request (facetime, zoom, duo, skype, etc). our provider is in our normal office location and the patient is at home. we bill our E&M code and necessary modifier or telehealth place of service, depending on the insurance carriers requirements.
now -- my question is do i append the Q3014 for tricare patients or leave it off because we're in our normal location and the patient is at home and NOT in a SNF, hospital, etc.
just want to make sure we are capturing everything we are supposed to and this is the first time that i have ever seen that Q code.
thanks - signed totally confused - aka jennifer p.
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You (the provider) are the distant site and would not be billing the Q3014.
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Thank you Michele ---- beyond grateful. :) :) :) :) :) :) :) :)