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Billing, Insurance Carriers, and Payers

 

Please listen to our podcast on COVID-19, telehealth, reimbursements, billing, and our response.  

LISTEN HERE

Download our summary of coding and reimbursement during the COVID-19 pandemic:

COVID-19 Coding/Reimbursement Summary

For a comprehensive summary of the changes to telemedicine, including billing changes, applicable during the COVID-19 public health emergency, please download the following bulletin:

COVID-19 TELEMEDICINE BULLETIN

 

Billing 

New information from the AMA on new CPT codes for COVID-19.
Q:  Can I get paid by Medicare for counseling patients to self-isolate when testing is ordered?

A:  Yes, if certain criteria are met. Follow these links for additional information: 

Q:  When testing and treating uninsured individuals for COVID-19, what option is available for reimbursement?

A:  To provide support to health care providers for COVID-19 testing and treatment for uninsured individuals with a COVID-19 diagnosis, the U.S. Department of Health and Human Services will provide reimbursement,  generally at Medicare rates. For more information about how the program works go to https://www.hrsa.gov/CovidUninsuredClaim.

Q:  Can 99211 be billed for COVID-19 specimen collection?

A:  According to the April 30, 2020 Interim Final Rule with comment, if the services described by code 99211 are provided to assess for COVID-19 and specimen collection, 99211 can be billed. The code can be billed for both new and established patients. Direct supervision for the specimen collection can be met by virtual presence of the supervising physician or practitioner with interactive audio or video technology.

Q:  Has the “typical time” definition for E/M level selection furnished via telehealth during the public health emergency changed?

A:  Previously “typical time” was defined as all of the time associated with the E/M on the day of the encounter. The “typical times” were available in a public file and were not the times listed in the office/outpatient E/M code descriptors. These discrepancies were causing confusion. Now “typical times” for the selection of an E/M level will be the times listed in the code descriptors.

Q:  Do we need to resubmit claims for Audio Only Telephone E/M Visits (99441, 99442 and 99443)?

A:  CMS has instructed the Medicare Administrative Contractors (MAC) to make claim adjustments, and there is no need to resubmit. Claims, for dates of service March 1, 2020 and after, that were submitted and not covered, will be reprocessed by your MAC. If the claim was paid at the lower rate, they will reprocess with the increased allowance. These claim adjustments will take place in stages.

Q:  What are the telehealth requirements for modifier usage during the Public Health Emergency?

A:  Please see the CMS document regarding modifier usage.

Q:  Does CMS have FAQs about Medicare Fee-for-Service (FFS) Billing related to COVID-19?

A:  Issued on May 27, 2020, CMS compiled a comprehensive list of their FAQs in one document.

Q:  Is there CLIA guidance on different types of COVID-19 tests and what they should be billed as?

A:  On April 30, CLIA issued comprehensive guidance that includes types of tests, where to order and perform tests, and how to bill COVID-19 tests.

Q: Can I get reimbursed for phone calls?

A:  This CMS document shows under the header “Virtual Check-Ins & E-Visits” the appropriate billing codes to use for patient engagements via the telephone. For telephone evaluation and management services provided by a physician (CPT 99441-99443) and telephone assessment and management services provided by a qualified nonphysician healthcare professional (CPT 98966-98968). These codes are only available to established patients but may be furnished using audio-only devices.
CMS is broadening that list to include many behavioral health and patient education services. CMS is also increasing payments for these telephone visits to match payments for similar office and outpatient visits. This would increase payments for these services from a range of about $14-$41 to about $46-$110. The payments are retroactive to March 1, 2020.

Q:  Is there updated coding advice available during the public health emergency?  

A:  Coverage, rules, and guidelines for telehealth are continually evolving and are benefit- and payer-specific. We recommend you check with your payers on their specific telemedicine payment and policy guidelines.  These AMA documents provide some helpful coding advice. 

Q:  When should modifier CS be used for Medicare patients to waive cost-sharing for COVID-19 testing-related services?

A:  See Cost-sharing at the bottom of page 3 for specific modifier use: https://www.cms.gov/files/document/se20011.pdf.  Also, continue to look at specific payer sites for billing updates.  

Q:  Where is the ICD-10-CM information on COVID-19?

A:  This link provides the latest information for properly billing for COVID-19 related healthcare services.  The World Health Organization (WHO) established a new diagnosis code U07.1 for COVID-19. The original effective date was set for October 1, 2020. Given the urgent need to capture reporting of this condition, the Centers for Disease Control (CDC), changed the effective date of the new diagnosis to April 1, 2020.

 

 

Insurance Carrier Links

        

BCBS       Cigna

CMS       Humana

Medicaid       UHC

 

 

 

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