Telehealth Services. Part B Provider Outreach and Education January 2016

Transcription

1 Telehealth Services Part B Provider Outreach and Education January 2016

2 DISCLAIMER This information release is the property of Noridian Healthcare Solutions, LLC. It may be freely distributed in its entirety but may not be modified, sold for profit or used in commercial documents. The information is provided as is without any expressed or implied warranty. While all information in this document is believed to be correct at the time of writing, this document is for educational purposes only and does not purport to provide legal advice. All models, methodologies and guidelines are undergoing continuous improvement and modification by Noridian and CMS. The most current edition of the information contained in this release can be found on the Noridian website at and the CMS website at The identification of an organization or product in this information does not imply any form of endorsement. CPT codes, descriptors, and other data only are copyright 2016 American Medical Association. All rights reserved. Applicable FARS/DFARS apply. January

3 Agenda Telehealth Services Overview Originating Sites Distant Site Coding and Coverage Reminders and Resources January

4 Objective To provide a better understanding of Telehealth coverage, billing and coding for Medicare beneficiaries from the Part B provider community January

5 Helpful Acronyms CAH CMHC FQHC HPSA MCP MLN MPFS MSA RHC Critical Access Hospital Community Mental Health Center Federally Qualified Health Center Health Professional Shortage Area Monthly Capitation Payment Medicare Learning Network Medicare Physician Fee Schedule Metropolitan Statistical Area Rural Health Clinic January

6 Telehealth Services Overview

7 What is Telehealth? Permits real-time communication between physician/practitioner and beneficiaries Use of a telecommunications system substitutes for an in-person encounter Must be an interactive system Patient must be present and participating Asynchronous store and forward technology is permitted only in Federal telemedicine demonstration programs conducted in Alaska or Hawaii January

8 Overview Medicare pays a limited number of Part B telehealth services Furnished by an enrolled physician/practitioner Within practitioner s scope of practice under state law check with individual state Services provided to a beneficiary at an approved originating site Via an telecommunications system Must meet coding eligibility criteria, conditions of payment and billing methodology January

9 Originating Site

10 Originating Sites Eligible Medicare beneficiary location at time of service is the originating site Rural health professional shortage area (HPSA) determined by United States Postal Service (USPS) County outside Metropolitan Statistical Area (MSA) or non-msa January

11 Originating Sites (2) Sites authorized by the program Physician/certain other practitioner s office Hospital/CAH/Hospital-Based Dialysis Center Federally Qualified Health Center (FQHC) Rural Health Clinic (RHC) Skilled Nursing Facility (SNF) Community Mental Health Center (CMHC) Call the Part A Provider Contact Center for more information on Part A facilities January

12 Patient s home Sites Not Approved Home Health Services Independent renal dialysis facility Place of Service (POS) 99; for example Telepsychiatry & (ophthalmological; established) January

13 Facility Fee Originating Site Q Originating site facility fee 2015 allowable $24.83 Medicare Economic Index increase 0.8% CR allowable $25.10 Medicare Economic Index increase 1.1% CR 9476 Q code submitted without modifier Beneficiary responsibility Unmet deductible and coinsurance January

14 Distant Site

15 Distant Site Practitioners Eligible Practitioners: Certified Registered Nurse Anesthetists Psychologist (Billing Independently)* Certified Nurse Midwife Clinical Social Worker* Clinical Nurse Specialist Nutrition Professional/ Registered Dietician Physician Nurse Practitioner Physician Assistant *Psychologists/CSWs can not bill/receive payment for psychiatric diagnostic interview exams with E/Ms or medical services (90792, 90833, 90836, 90838) January

16 Coding and Coverage

17 CPT At-A-Glance CPT Description Psychiatric diag. interview exam Individual psychotherapy ESRD service - monthly capitation Neurobehavioral status exam Health/Behavior Assess Intervention (HBAI) Medical Nutrition Therapy (MNT) January

18 CPT At-A-Glance (2) CPT Description Office or other outpatient visits Subsequent hospital care Subsequent nursing facility care Smoking Cessation services Transitional Care Management (TCM) January

19 HCPCS At-A-Glance HCPCS G0108 G0109 G0270 G0396 G0397 G0406 G0408 G0420 G0421 G0425 G0427 Description Diabetes outpatient Self- Management Training (DSMT) MNT subsequent re-assessment Alcohol/drug abuse assessment F/U inpatient/snf consultation Kidney Disease Education (KDE) Initial inpatient/er/consultations January

20 HCPCS At-A-Glance (2) HCPCS G0436 G0437 G0442 G0443 G0444 G0445 G0446 G0447 G0459 Description Smoking Cessation Services Alcohol screening/counseling Depression screening; annual Behavior Counseling to prevent Sexually Transmitted Infection Behavioral Therapy-Cardio Behavioral Counseling for Obesity Telehealth Pharmacologic Mgmt. January

21 CPT/ HCPCS New in 2015 Telehealth Description Psychoanalysis Family psychotherapy w/o patient present Family psychotherapy with patient present Prolonged services; first hour Prolonged services; additional 30 mins. G0438 G0439 AWV; includes PPPS; initial AWV; includes PPPS; subsequent January

22 New in 2016 Telehealth CPT/ HCPCS Description ESRD service patient under 2 years ESRD service patient 2-11 years ESRD service patient years ESRD service patient 20 years and older Prolonged services; first hour Prolonged services; additional 30 mins. January

23 ESRD-Related Telehealth End Stage Renal Disease (ESRD) related services may be billed as telehealth At least one face-to-face, hands on visit by MCP provider (one who establishes care) Must be furnished each month to examine vascular access site By a physician, NP, PA or CNS Monthly capitation payment codes 90951, 90952, 90954, , 90958, 90960, January

24 Mandatory Modifier for Telehealth GT modifier Via interactive audio and video telecommunications system Certifying beneficiary was present at eligible originating site when telehealth service furnished Required with all telehealth codes Exception Alaska and Hawaii GQ modifier See next 2 slides January

25 Asynchronous Alaska/Hawaii Only GQ Via asynchronous telecommunications system Conducted Alaska or Hawaii- Store & forward Technology permitted only in federal telehealth programs Information reviewed later by physician/practitioner at distant site without patient present INCLUDES: Audio/Video Clips MRI Still Images/Text Lab Results EKG/EEG X-Ray January

26 Asynchronous Alaska/Hawaii Only2 Single media format does not include Telephone calls Fax machine images transmitted Text messages without visualization of the patient (electronic mail) Photographs specific to patient s condition Adequate for rendering/confirming a diagnosis and/or treatment plan Dermatological photographs (e.g., skin lesion); may meet requirement of single media format January

27 Reminders and Resources

28 Resources Internet Only Manual (IOM) Publications: , Chapter 15, Section , Chapter 12, Section 190 CMS dedicated website: Medicare Learning Network Fact Sheet Education/Medicare-Learning-Network- MLN/MLNProducts/downloads/TelehealthSrvcsfctsht. pdf January

29 Endeavor Online Provider Portal Free to providers with Internet Beneficiary Eligibility Claim Status including Reviewer Comments Payment Floor / Prior Checks Issued Single Claim / Entire Remittance Advice Reopening & Redetermination Submission Appeal Status Additional Resources include Self-Paced tutorial for Part B System availability alerts on the Medicare website User Manual; many screen images and guides Workshops and presentations Main Menu page next slide January

30 Part B Webinars Date Time (CT/PT) Webinar Title 1/6/16 1:00 PM/11:00 AM Modifier 59 1/7/16 3:00 PM/1:00 PM 1/8/16 1:00 PM/11:00 AM Understanding Local and national Coverage Determinations Written Correspondence Requirements 1/12/16 1:00 PM/11:00 AM Cardiovascular Disease Services 1/13/16 1:00 PM/11:00 AM Screening Services REGISTER NOW! JE JF January

31 CEU Process Reminder AAPC members must: Attend entire webinar Take short polling survey After closing out of webinar CEU ed 3 days after presentation Earned 1.0 CEU today No password or index number needed All providers may use CEU certificate January

32 Questions?? Thank You