FREE TELEHEALTH WEBINAR

We  taught another LIVE webinar on Telehealth-Telemedicine & Telemonitoring and we recorded it.  You can download the webinar, along with the pdf file and the quiz download page here.

https://donself.sharefile.com/d-s659d84c5e9c4cb1a

There IS a reason to watch this one as there were some MASSIVE CHANGES that occured in this one due to the April 30th updates from CMS for providers, PTs, RHCS, Hospitals and everyone else that we went over in this webinar.  I hope it helps and feel free to share this with others to help them optimize their income and keep them out of trouble.   

CMS has repurposed an old modifier that we've used in different circumstances before.  This time, it is to be used for COVID-19 testing related visits or services during the PHE.      If your medical provider is ordering or administering  or even evaluating an individual for the purpose of determining whether the test should be ordered, use CS modifier, IF A TEST WAS ORDERED!    On April 16 in the CMS Office Hours call, CMS dropped a bombshell on folks and said - "only use the CS modifier if the test was ordered or is ordered.    If no test was ordered don't use the CS modifier".   On the 17th - half of the call was about that with people arguing - and CMS said "we will get new guidance on that.    The call on Apr 21 repeated "we still do not have new guidance so follow the current rule that a test is required before using CS".   The call today (ended 5 minutes ago) on April 23 - "no change and no new guidance"

This prompts Medicare to pay 100% of the service instead of their normal 80% and it also means you will not be collecting anything from the patient for described outpatient E&M services that have the CS modifier.

This modifier is now active dating back to March 18 and will be used to the end of the PHE.  

For professional claims, physicians and practitioners who did not initially submit claims with the CS modifier must notify their Medicare Administrative Contractor (MAC) and request to resubmit applicable claims with dates of service on or after 3/18/2020 with the CS modifier to get 100% payment .For institutional claims, providers, including hospitals, CAHs, RHCs, and FQHCs, who did not initially submit claims with the CS modifier must resubmit applicable claims submitted on or after 3/18/2020, with the CS modifier to visit lines to get 100% payment.   CMS has repeatedly said "not for inpatient E&M codes!"

Let's start with Medicare Part B. There have been some that have said that you can bill Medicare Part B for E&M codes when the patient does not have access to an audio-video type communication. 

THAT IS FALSE - when we are discussing MEDICARE Part B. 

(It is true with some Part C Advantage plans that we'll discuss later). Medicare requires the audio-video live interactive communication between the provider (not the nurse or MA) in order to bill the office visit codes for telehealth. If anyone tells you differently today (it may change in the future),  slap the snot out of them and remind them that the CMP is $11,000 for false claims per claim - AND THEN let them listen to this recording from CMS made April 7 and published by CMS: https://www.cms.gov/fi…/audio/covid19officehours04072020.mp3

EXAMPLES:   

OFFICE BASED FAMILY PHYSICIAN, NP OR PA – DOES NOT GO TO HOSPITAL, NURSING HOME OR PATIENT HOMES….

*   USE POS 11 – BILL OFFICE VISIT CODES 99201-99215 WITH MODIFIER 95 ON 

*   EVERY TELEHEALTH PERFORMED WITH PATIENTS VIA AUDIO-VIDEO

     *     REGARDLESS WHERE THE PATIENT IS    

     *     REGARDLESS WHERE THE PROVIDER IS

OFFICE BASED INTERNAL MEDICINE – DOES OFFICE, HOSPITAL & NURSING HOME, DOES NOT GO TO PATIENT HOMES: (Audio-Video visits only)

*    USE POS WHERE PATIENT IS – WITH APPROPRIATE E&M VISIT FOR THAT LOCATION.

      *    POS 11 – OV CODES FOR PTS AT HOME WITH 95 MODIFIER

      *    POS 21 – HOSPITAL CODES FOR PTS AT HOSPITAL WITH 95 MODIFIER

      *    POS 31 – SNF CODES FOR PTS IN SNF WITH 95 MODIFIER 

HOME VISIT PHYSICIAN, NP OR PA   (audio-video visits only)

*     USE POS 12 – BILL HOME VISIT CODES 99341-99349 WITH MODIFIER 95 ON                

      EVERY TELEHEALTH PERFORMED WITH PATIENTS VIA AUDIO-VIDEO

Yes - Medicare Part B has said that modifier 95 means it was done via a synchronous (audio-video live) means, so use 95 with Part B Medicare.   Obviously, if you did a phone call only (99441-99443), you would not need the 95 modifier as the phone call is not via audio-video.   On a call with CMS on April 9, CMS said "for all services during the phe we are asking providers to use 95 modifier".     They had just been discussing what modifier to use with the Office Visit codes, but that is a direct quote.   No - I do not believe you should use the modifier CR or DR with Medicare Part B claims.   

I also do NOT recommend you use place of service 02 with Part B claims, although I am told that some commercial carriers like you to use 02.

You should also use it with other commercial companies that tell you to.  

USE WHAT THE PAYER TELLS YOU TO USE.  

If Prudential says to bill all telehealth with modifier MB for MA Bell, if you want to get paid by Pru - you will follow their rules.      If Aetna says use modifier TT telehealth calls made on Tuesday - then do it if you want Aetna's money.   Follow the rules the payer gives you.    

Wow - our telemonitoring service has taken off and we are adding on new clients constantly and helping practices and patients. Between that and our Chronic Care Management program - we are helping keep patients OUT OF THE HOSPITAL and helping practices increase income at the same time! If you want information on these, reach out to us or just click on my schedule link here to have a one-on-one appointment with Don. This is not for webinars as this is a consultation with Don individually: DON'S CONSULTATION SCHEDULER

You do not have to spend tens of thousands of dollars and buy monitors with our system.  It is on a month to month rental basis and most of our clients start with 10 or 20 monitors, give those to patients and then let us know how many more they want and we help them.  Your profit margin per patient ranges from $56 a month to $75 per month on an average basis and the work can be performed by your staff instead of the doctor.   This helps keep patients out of the hospital and out of the ER - which saves the payer (Medicare) a lot of money, helps the patient and improves patient care for your clinic.   We have clients who have been using our service for the past 15 months who love it - so talk to us.  You can also visit WWW.TELECARE-USA.COM

One question that pops up often is "the patient is quarantined and the doc is out the hospital room door treating the patient. How do we bill?  That question was asked April 7th in a CMS phone conference. CMS said "both the doctor and the patient is in the same place of service, so it will not be telehealth - but there is no reason that the doctor cannot bill a normal hospital visit as if they were in the same room. 

Remember, a non telehealth subsequent visit code only requires 2 of 3 and it's not difficult to document the history and medical decision making.

The question also arises about one doctor in their own office talking to another doctor or nurse or family member wherever the patient is and billing that as telehealth (audio-video) or telemedicine (audio only)    The April 1st update where CMS said “include direct interactions between practitioners and caregivers” when discussing the telehealth visits pretty well leaves that one open for billing, in our opinion.  

Folks have asked "but my doc or NP or PA is quarantined at home for 2 weeks - what place of service do we use?" CMS has repeatedly said to use the same place of service the doc or NP or PA would be using if we did not have the crisis unless your provider plans to permanently do calls from home (permanently means forever - even after the COVID crisis). Make it easy on yourself and use 11 for office if that is where the provider would be if all was still the way it was before COVID became a household word.  Use the normal address you would use in block 34 for these as well.