Telehealth Resource Center for Revised PHE Coding & Billing Policies Due to COVID-19

Telehealth Resource Center for Revised PHE Coding & Billing Policies Due to COVID-19


Telehealth Resource Center:

The Center for Medicare & Medicaid Services (CMS) expanded the payment guidelines for professional telehealth services provided to Medicare beneficiaries during the Public Health Emergency (PHE) declared for COVID-19 (CMS, 2020). The temporary protocol expansion was deemed necessary to aid healthcare reimbursement, and will be active only during the PHE. To keep coders and auditors up-to-date on the expanded services and reimbursement guidelines, YES HIM Consulting has gathered all the latest updates to form a telehealth resource center.

What is Telemedicine?

There are 3 types of telemedicine services. One type is a “Telehealth Visit,” where the provider uses “an interactive audio and video telecommunications system that permits real-time communication between the distant site and the patient at home” (CMS, 2020). The other 2 types of remote services are “Virtual Check-in” and “E-visits,” which are non-face-to-face visits with a physician facilitated by online patient portals or technology-based communication systems (CMS, 2020). These services can be performed anywhere, but the patient must be established with their physician. For more information about what constitutes a telehealth service, review our article “Medicare Telehealth Services Now Included in Expanded Payment Protocol.”

How do I code & bill Telehealth Services?

During the PHE, E/M telehealth services will be based on MD or time. Code G2010 will be used for the remote evaluation of a patient’s submitted photos or videos (AASM, 2020). Code G2012 will cover technology-based communications between a physician and patient (HCPCS, 2020).

Additional telehealth codes and information about how to make the appropriate code selection is available in our article, “CMS Guidelines for Telehealth Coding & Billing During PHE.”

telehealth resource centerWere there any Policy & Regulatory Revisions?

The PHE caused CMS to lessen many supervision requirements, CMS now allow providers to supervise patients using audio and visual telecommunications equipment. Inpatient rehabilitation facilities (IRFs), inpatient and outpatient hospital services, and teaching facilities are included in this update. Telehealth modifiers have been added aid reimbursement claims, and they are 95, G0, GT, and GQ.

The detailed CMS guidance on telehealth policies can be found in our article, “Review the Temporary Physician-Based Telehealth Policies & Regulatory Revisions for COVID-19.”

What about the Fee-for-Service Response?

Our telehealth resource center includes the updated Special Edition (SE) MLN Matters article SE20011 Fee-for-Service response to highlight the issuance changes to blanket waivers and beneficiary notices (CMS, 2020). To issue notices to patients in quarantine, a hard copy may be delivered by someone who can safely enter the patient’s room, or an email copy may be sent if it is impossible to safely deliver a hard copy.

The list of updated blanket waivers is available here. For more CMS guidance on telehealth fee-for-service response, read our article, “Updates for Medicare Fee for Service (FFS): CMS MLN Matters Special Edition Article.”

Review the 1135 waiver and appropriate codes, types of virtual services and providers, and the reimbursement guidelines on the YES Blog.

Let YES HIM Consulting assist you with any coding, auditing, or consulting needs that you may be challenging your organization and team. Contact YES today for a proposal!

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