Emergency Telehealth Expansions and COVID-19 Coverage

Effective for services starting March 6, 2020, and for the duration of the COVID-19 Public Health Emergency, Medicare will make payment for Medicare telehealth services furnished to patients in broader circumstances.

·  Beneficiaries may receive telehealth services in any healthcare facility and in their home.

·  The HHS Office of Inspector General (OIG) is providing flexibility for healthcare providers to reduce or waive cost-sharing for telehealth visits paid by federal healthcare programs.

List of Telehealth Services

We are continuing to evaluate the evolving state and federal legislative and regulatory landscape relating to COVID-19 and will continue to update our practices accordingly.

·  In-network professionals will be reimbursed at least the same rate for a telemedicine service when provided in-person.

·  No member cost-sharing for covered, medically necessary medical and behavioral health services delivered via telemedicine or telehealth by a qualified in-network provider.

The MDLIVE physician network provides telephonic telehealth services to Blue Advantage HMOSM, Blue Advantage PlusSM HMO, and Blue Choice PPOSM fully insured members by calling (888) 450-1572 or going to MDLIVE. Some plans may use other vendors for telemedical/telehealth services. Benefits should always be verified before providing services.

Billing Information

• CPT/HCPCS Coding – As stated above, bill with the appropriate – CPT/HCPC codes for telehealth services outlined above and as per the Commercial or Medicare-approved codes;
• Place of Service – In order to receive the highest reimbursement at the non-facility rate, we recommend that you bill with place of service 11;
• Modifier – You must attach a 95, GT, or GQ modifier to the CPT/HCPC Code.

Reimbursement Information

Reimbursement will be paid according to your current agreement with IPA name. Reimbursement will be paid at the non-facility rate as long as you bill with place of service 11; if the claim is billed with any other place of service, the claim will be processed according to the CMS site of service processing guidelines. If the claim has the appropriate telehealth modifier attached or is a telehealth CPT/HCPC code, there will be no copayment applied to the claim.

Pre-Authorization Information

If the member is seeking testing or treatment for COVID-19, prior authorization has been waived.

Medicare

The BCBS Medicare Advantage HMO Programs is continuing to follow the same telehealth covered services as defined by CMS. Recently, CMS has expanded the listing of covered telehealth services at the link provided.

If you have previously submitted an authorization and the services will now be provided via telehealth, you do not need to contact Innovista to change the authorization to indicate that it will be provided via telehealth.  Previously submitted and approved authorizations will continue to be valid.

·  Access provider visits for covered services through telemedicine or telehealth as outlined in your benefit plan.

·  You won’t pay copays, deductibles, or coinsurance on in-network covered telemedicine or telehealth services.

Telehealth Expansion      Telehealth

Approved CMS Telemedicine Codes and Guidelines  
List of Telehealth Services

Claims will be processed consistent with these rules beginning April 6, 2020, for dates of service on or after March 2, 2020, and until at least May 31, 2020.

·  Providers can also bill code G2012 for a 5-10-minute phone conversation, and Cigna will waive cost-share for the customer.

Billing Information

• CPT/HCPCS Coding – As stated above, you must bill with one of the most appropriate CMS-approved telehealth CPT/HCPC codes.
• Place of Service – In order to receive the highest reimbursement at the non-facility rate, we recommend that you bill with place of service 11.
• Modifier – You must attach a 95, GT, or GQ modifier to the CPT/HCPC Code.

Reimbursement Information

Reimbursement will be paid according to your current agreement with IPA name. Reimbursement will be paid at the non-facility rate as long as you bill with place of service 11; if the claim is billed with any other place of service, claim will be processed according to the CMS site of service processing guidelines. If the claim has a COVID-19 diagnosis code, the copay will be waived.

Pre-Authorization Information

Humana has made the following changes to their prior authorization rules:

1. COVID-19 Diagnosis – if the member is seeking testing or treatment for COVID-19 to an in-network or out of network provider, prior authorization has been waived.
2. All Services Performed with an in-network provider – All prior authorization requirements are waived for any services performed with an in-network provider at this time for any service.
3. Out of Network Providers – Prior authorization will continue to be required for services referring to an out of network provider.

If you have previously submitted an authorization and the services will now be provided via telehealth, you do not need to contact Innovista to change the authorization to indicate that it will be provided via telehealth.  Previously submitted and approved authorizations will continue to be valid.

· This includes in-network providers delivering telehealth services through audio or video.

Claims Payment Policy

MDLIVE is Humana’s national urgent care telehealth provider for Medicare Advantage and Doctor on Demand is our national urgent telehealth provider for Commercial.

UnitedHealthcare will waive cost-sharing for in-network, non-COVID-19 telehealth visits for Medicare Advantage, Medicaid and commercial members, with an opt-in available for self-funded employers.

·   Cost-sharing is waived for in-network telehealth visits. According to plan benefits, out-of-network providers also qualify for telehealth.

·   Telehealth services may be delivered with any connection technology

·  Prior authorization requirements for telehealth services will be lifted for dates of service from 03/17/2020 – 06/30/2020