Medical Reimbursement Consultants since 1988, serving tens of thousands of physicians
USE E&M CODES FOR TELEHEALTH
CODE WHERE YOU NORMALLY SEE PATIENTS!
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
use modifier 95
DEFINITELY FOR MEDICARE PART B
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.
rpm or telemonitoring with don
HELPING PATIENTS STAY OUT OF THE HOSPITAL
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
BE CAREFUL - AUDITS ARE HAPPENING
IT'S NOT A GOOD IDEA TO CHEAT
There are many people giving FALSE information that will get you into trouble if you follow their advice. The ONLY audit that CMS and Medicare is not going to investigate for services performed during this PHE emergency is whether the patient getting a telehealth call or visit is new or established to your practice. They WILL be auditing whether the service was done via audio-video or whether the patient requested the phone call or not. CMS, OIG and DOJ have CMPs (Civil Money Penalties) of $11,000 to $22,000 per claim - so do the math folks.... it is not worth it to commit fraud. If you do plan on committing fraud in your billing, then you better erase your browser history as the fact you KNOW it is fraud will be found out and that makes it criminal on top of civil.
doctor or np or pa working from home
CALLING PATIENTS FROM HOME
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.
