Telehealth Services Part B Provider Outreach and Education January 2016
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Agenda Telehealth Services Overview Originating Sites Distant Site Coding and Coverage Reminders and Resources January 2016 3
Objective To provide a better understanding of Telehealth coverage, billing and coding for Medicare beneficiaries from the Part B provider community January 2016 4
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 2016 5
Telehealth Services Overview
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 2016 7
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 2016 8
Originating Site
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 http://www.hrsa.gov/shortage/ http://hpsafind.hrsa.gov/ January 2016 10
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 2016 11
Patient s home Sites Not Approved Home Health Services Independent renal dialysis facility Place of Service (POS) 99; for example Telepsychiatry & 92014 (ophthalmological; established) January 2016 12
Facility Fee Originating Site Q3014 - Originating site facility fee 2015 allowable $24.83 Medicare Economic Index increase 0.8% CR9034 2016 allowable $25.10 Medicare Economic Index increase 1.1% CR 9476 Q code submitted without modifier Beneficiary responsibility Unmet deductible and coinsurance January 2016 13
Distant Site
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 2016 15
Coding and Coverage
CPT At-A-Glance CPT Description 90791-90792 Psychiatric diag. interview exam 90832 90838 Individual psychotherapy 90951-90961 ESRD service - monthly capitation 96116 Neurobehavioral status exam 96150 96154 Health/Behavior Assess Intervention (HBAI) 97802 97804 Medical Nutrition Therapy (MNT) January 2016 17
CPT At-A-Glance (2) CPT Description 99201 99215 Office or other outpatient visits 99231 99233 Subsequent hospital care 99307 99310 Subsequent nursing facility care 99406 99407 Smoking Cessation services 99495 99496 Transitional Care Management (TCM) January 2016 18
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 2016 19
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 2016 20
CPT/ HCPCS New in 2015 Telehealth Description 90845 Psychoanalysis 90846 Family psychotherapy w/o patient present 90847 Family psychotherapy with patient present 99354 Prolonged services; first hour 99355 Prolonged services; additional 30 mins. G0438 G0439 AWV; includes PPPS; initial AWV; includes PPPS; subsequent January 2016 21
New in 2016 Telehealth CPT/ HCPCS Description 90963 ESRD service patient under 2 years 90964 ESRD service patient 2-11 years 90965 ESRD service patient 12-19 years 90966 ESRD service patient 20 years and older 99356 Prolonged services; first hour 99357 Prolonged services; additional 30 mins. January 2016 22
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, 90955 90957, 90958, 90960, 90961 January 2016 23
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 2016 24
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 2016 25
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 2016 26
Reminders and Resources
Resources Internet Only Manual (IOM) Publications: http://www.cms.gov/manuals 100-02, Chapter 15, Section 270 100-04, Chapter 12, Section 190 CMS dedicated website: http://www.cms.gov/telehealth Medicare Learning Network Fact Sheet https://www.cms.gov/outreach-and- Education/Medicare-Learning-Network- MLN/MLNProducts/downloads/TelehealthSrvcsfctsht. pdf January 2016 28
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 2016 29
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 https://med.noridianmedicare.com/web/jeb/education/training-events JF https://med.noridianmedicare.com/web/jfb/education/training-events January 2016 30
CEU Process Reminder AAPC members must: Attend entire webinar Take short polling survey After closing out of webinar CEU emailed 3 days after presentation Earned 1.0 CEU today No password or index number needed All providers may use CEU certificate January 2016 31
Questions?? Thank You