to show minor changes due to various activities, such as the CY 2022 MPFS Final Rule and legislative changes from the Consolidated Appropriations Act of 2021. Another tool that can speed up the licensing process is theUniform Application for Licensure,a web-based application that improves license portability by eliminating a providers need to re-enter information when applying for licenses. Other changes to the MPFS for telehealth Make sure your billing staff knows about these changes. .gov An official website of the United States government For the most current status and detailed state-by-state telehealth parity law legislation, visit theCenter for Connected Health Policywebsite. Read more about the 2023 Physician Fee Scheduleon the Policy changes during COVID-19 page. Telehealth Billing Guide bcbsal.org. To help your healthcare organization achieve its goals and get the most out of your telehealth program, weve identified five critical components that will help you to expand your program and navigate the latest telehealth rules and regulations. If you are looking for detailed guidance on what is covered and how to bill Medicare FFS claims, see: Medicaid and Medicare billing for asynchronous telehealth. Secure .gov websites use HTTPS Reimbursement rates for telehealth services can vary by payer and whether youre receiving payment from a private payer, Medicare, or a state Medicaid plan. In response to the public health emergency, many states moved to broaden the coverage for services delivered via Medicaid for telehealth services. The guide takes into consideration temporary Public Health Emergency (PHE) policies as well as permanent post-PHE policies. Likenesses do not necessarily imply current client, partnership or employee status. ( The U.S. Department of Health and Human Services Office for Civil Rights released guidanceto help health care providers and health plans bound by Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy, Security, and Breach Notification Rules (HIPAA Rules) understand how they can use remote communication technologies for audio-only telehealth post-COVID-19 public health emergency. UPDATED: AUGUST 30, 2022 Page 6 of 12 D0140 May be performed via telephone call (audio with or without visual component). An official website of the United States government. Staying on top of the CMS Telehealth Services List will help you reduce claim denials and keep a healthy revenue cycle. Consequently, healthcare providers are experiencing a surge in demand for Telehealth services. Telehealth Origination Site Facility Fee Payment Amount Update . Due to the provisions of the 2022 Medicare Part B CMS updates and guidelines PA enrollment and billing Split/Shared Telehealth Critical Care NGS E/M billing instructions for PAs and NPs . A federal government website managed by the For more information on telemedicine, telehealth, virtual care, remote patient monitoring, digital health, and other health innovations, including the team, publications, and representative experience, visitFoleys Telemedicine & Digital Health Industry Team. Increase revenue, save time, and reduce administrative strain with our, Online digital E/M service for an established patient for up to 7 days, cumulative time during the 7 days. Medisys Data Solutions Inc. A federal government website managed and paid for by the U.S. Centers for Medicare & Medicaid Services. In addition, the Centers for Medicare & Medicaid Services (CMS) may request review and revaluation of certain codes that are flagged as potentially misvalued services. We make any additions or deletions to the services defined as Medicare telehealth services effective on a January 1st basis. decided that certain services added to the Medicare Telehealth Services List will remain on the List until December 31, 2023. Recent legislationauthorized an extension of many of the policies outlined in the COVID-19 public health emergency through December 31, 2024. K"jb_L?,~KftSy400 T %Xl c7LNL~23101>"Aouo%&\{u/Sts$Txb| y:@ 0 The public has the opportunity to submit requests to add or delete services on an ongoing basis. Rural hospital emergency department are accepted as an originating site. That change did not require the professionals real-time presence at, or live observation of, the service via interactive audio-video technology throughout the performance of the procedure. 357 0 obj <>stream .gov DISCLAIMER: The contents of this database lack the force and effect of law, except as Medicare Telehealth Billing Guidelines for 2022. CMS reasoning was that the virtual check-in codes are meant to be used to determine the need for care and as such, there is not a clear necessity for a longer virtual check-in code. All Alabama Blue new or established patients (check E/B for dental This can be done by a traditional in-house credentialing process or throughcredentialing by proxy. The .gov means its official. Under PHE waivers, CMS allowed separate reimbursement of telephone (audio-only) E/M services (CPT codes 99441-99443), something embraced by many practitioners and patients, particularly patients in rural areas or without suitable broadband access, as well as patients with disparities in access to technology and in digital literacy. CMS Telehealth Billing Guidelines 2022 Gentem. Should not be reported more than once (1X) within a 7-day interval, Interprofessional telephone/internet/EHR referral service(s) provided by a treating/requesting physician or other QHP, Remote evaluation of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related e/m service provided within the previous 7 days nor leading to an e/m service or procedure within the next 24 hours or soonest available appointment, Brief communication technology-based service, e.g. As the public health emergency ends, more resources and guidance will be made available to keep you and your staff up-to-date regarding the latest changes to telehealth policies. responsibility for care read more, Healthcare facilities, payer networks and hospitals require credentialing to admit a provider in a network or to treat patients read more, Recently, Centers for Medicare & Medicaid Services (CMS) upgraded a list of frequently asked questions on Medicare fee-for-service billing read more, CMS announced that the Comprehensive lock Due to the provisions of the Consolidated Appropriations Act of 2021, the CMS continues to evaluate the inclusion of telehealth services that were temporarily added to the Medicare telehealth services list during the COVID-19 PHE (Public Health Emergency). 314 0 obj <> endobj lock Some of these telehealth flexibilities have been made permanent while others are temporary. authorized by law (including Medicare Advantage Rate Announcements and Advance Notices) or as specifically We have updated and simplified the Medicare Telehealth Services List to clarify that these services will be available through the end of CY 2023, and we anticipate addressing updates to the Medicare Telehealth Services List for CY 2024 and beyond through our established processes as part of the CY 2024 Physician Fee Schedule proposed and final rules. You will need to equip your locums with the needed technology, however, as most agencies will not provide this equipment. Telehealth for American Indian and Alaska Native communities, Licensure during the COVID-19 public health emergency, HIPAA flexibility for telehealth technology, Prescribing controlled substances via telehealth, Telehealth policy changes after the COVID-19 public health emergency, telehealth flexibilities authorized during the COVID-19 public health emergency, Temporary Medicare changes through December 31, 2024, Temporary changes through the end of the COVID-19 public health emergency, Federally Qualified Health Centers (FQHCs), telehealth services for behavioral/mental health care, Calendar Year 2023 Medicare Physician Fee Schedule, Health Insurance Portability and Accountability Act of 1996 (HIPAA), Guidance on How the HIPAA Rules Permit to Use Remote Communication Technologies for Audio-Only Telehealth, Families First Coronovirus Response Act and Coronavirus Response Act and Coronavirus Aid, Relief, and Economic Security Act Implementation, FAQs on Telehealth and HIPAA during the COVID-19 nationwide public health emergency. The annual physician fee schedule proposed rule published in the summer and the final rule (published by November 1) is used as the vehicle to make these changes. The services fall into nine categories: (1) therapy; (2) electronic analysis of implanted neurostimulator pulse generator/transmitter; (3) adaptive behavior treatment and behavior identification assessment; (4) behavioral health; (5) ophthalmologic; (6) cognition; (7) ventilator management; (8) speech therapy; and (9) audiologic. This will give CMS more time to consider which services it will permanently include on the Medicare Telehealth Services List. Health Data Telehealth Coding and Billing Compliance By Ghazal Irfan, RHIA, and Monica Watson This article is exclusive to AHIMA members. For telehealth services provided on or after January 1 of each The practitioner conducts an in-person exam of the patient within the six months before the initial telehealth service; The telehealth service is furnished for purposes of diagnosis, evaluation, or treatment of a mental health disorder (other than for treatment of a diagnosed substance use disorder (SUD) or co-occurring mental health disorder); and. Many healthcare facilities use the telehealth capability built into their electronic health record (EHR) system. Payment parity laws, which are legislated at both the state (Medicaid) and federal (Medicare) level, also can affect reimbursement rates. Please Log in to access this content. 93 A new modifier 93 (Synchronous telemedicine service rendered via telephone or other real-time interactive audio-only telecommunications system) became effective January 1, 2022. ECG, blood pressure, glucose monitoring) digitally stored and/or transmitted by the patient and/or caregiver to the physician or other qualified healthcare professional, qualified by education, training, licensure/regulation (when applicable) requiring a minimum of 30 minutes of time, each 30 days, Self-measured blood pressure using a device validated for clinical accuracy; patient education/training and device calibration, separate self-measurements of two readings one minute apart, twice daily over a 30-day period (minimum of 12 readings), collection of data reported by the patient and/or caregiver to the physician or other qualified healthcare professional, with report of average systolic and diastolic pressures and subsequent communication of a treatment plan to the patient, Remote physiologic monitoring treatment management services, Remote physiologic monitoring treatment management services, 20 minutes or more of clinical staff/physician/ other qualified health care professional time in a calendar month requiring interactive communication with the patient/caregiver during the month, Counseling and/or coordination of care with other physicians, other QHC professionals, or agencies are provided consistent with the nature of the problems and the patients or families needs, Domiciliary or rest home visit for E/M of established patient. For details about how to bill Medicare for COVID-19 counseling and testing, see: Avoiding mistakes in the reimbursement process can help implementing telehealth into your practice a smoother experience. Occupational therapists, physical therapists, speech language pathologists, and audiologist may bill for Medicare-approved telehealth services.