TELEMEDICINE REIMBURSEMENT:MEDICAID AND PRIVATE PAYERS

Oklahoma Telemedicine Conference 2014: Telehealth TransitionOctober 16, 2014Cynthia Scheideman-Miller, MHSAHeartland Telehealth Resource Center

Who we are

Heartland Telehealth Resource Center is an independent and impartial resource center that is here to assist in the development of sustainable telehealth programs and networks.

Heartland is the regional TRC for Kansas, Missouri and Oklahoma.

HTRC activity is supported by grant number G22RH20214 from the Office for the Advancement of Telehealth, Office of Health Information Technology, Health Resources and Services Admin, DHHS.

Who pays for Telehealth?

Federal and state programs Medicare - with restrictions Medicaid/ CHIP (SoonerCare) – with

restrictions

Private Insurance Programs

Contracted Services

Distant vs Originating

Distant Site:Where the provider is

Originating Site:

Where the patient is

Medicare Medicaid

Hospital

Office of a physician or practitioner

Critical Access Hospitals (CAH)

Rural Health Clinics (RHC)

Federally Qualified Health Centers (FQHC)

Hospital or CAH-based Renal Dialysis Centers (including satellites)

School

Outpatient Behavioral Health Clinic

Community Health Center

Indian Health Service facility, a Tribal Health facility, or an Urban Indian Clinic (I/T/U)

Authorized originating site

Medicare MedicaidPhysician

Advanced Registered Nurse Practitioners

Physician Assistants

Genetic Counselors

Licensed Behavioral Health Professionals

Registered Dieticians

I/T/U’s with specialty service providers as listed above

Nurse midwife

Clinical Psychologist

Nutrition Professional

Clinical Nurse Specialist

Clinical Social Worker

Authorized distant site specialty Providers

Medicare

Medicaid

Private Payer

Pays for telehealth

Requires a modifier

Patient must be at a rural site*

Providers specified

Primary Care Only for I/T/U

Only reimburses for specific CPT codes

Interactive telecommunication network preapproved

Telemedicine visits counted toward the applicable benefit limits for these services

Store & Forward

Non-covered services: telephone conversation, E-mail, FAX

Patient must be in Oklahoma at time of teleconsult

Reimbursement Comparison

*Medicare defines “Rural “as a non-MSA county . Medicaid defines “rural “as a county with a population of less than 50,000 people.

Medicaid Telehealth/ CodesTelehealth Service CPT/HCPCS Codes

Assessment H0031

Office or other outpatient visits 99201-99215

Behavioral Health Service Plan Development

H0032

Individual Medical Nutrition Therapy

97802-97803

Individual psychotherapy 90832-90834, 90837-90838; H0004

Pharmacologic management Appropriate E/M code

Psychiatric diagnostic interview examination and testing

90791-90792;96101-96103;96118-96120;96110-96111;90887

www.okhca.org “Soonercare Reimbursement Checklist for Telemedicine”

Clinical fee services: same as the current fee schedule amount for services provided without telemedicine. Use appropriate HCPS code with modifier.

Telemedicine/telehealth Modifiers (distant site only): GT for interactive audio and video telecommunications system Does not apply to X-ray, ultrasound or electrocardiogram as they are

not considered telemedicine.

Telehealth Billing: Medicaid/Distant Site

Dual Eligibles If a service is eligible under Medicare

the Medicare payment rate applies and Medicaid would cover some portion of the coinsurance.

If the service isn’t eligible under Medicare Confirm with OHCA it is covered Have the beneficiary sign an Advanced

Beneficiary Notice if a Medicaid copayment is required

Source: Aaron Fischbach , Policy Coordinator, HRSA

Originating Site Fee: Originating site must be Rural. Only the originating site will bill for a facility fee. HCPCS code "Q3014, ($24.24 in 2012)

“telehealth originating site facility fee"; short description "telehealth facility fee.”

The type of service for the telehealth originating site facility fee is "9, other items & services”

Telehealth Billing: Medicaid/Originating Site

Cynthia Scheideman-Miller

Cynthia-scheidemnmiller@ouhsc.edu

Questions?

Telemedicine/Medicaid specific questions:

Adolf Maren

(405)522-7300