Telehealth/Telemedicine Online Visit

Transcription

1 Telehealth/Telemedicine Online Visit Blue Cross Blue Shield and Blue Care Network 1 Telemedicine Medical Policies The Blue Cross Blue Shield of Michigan and Blue Care Network Medical Policies are attached below and can be easily accessed using web-denis. BCBSM Medical Policy MEDICA L POLICY - BCBSM ONLY - TELE BCN Medical Policy MEDICAL POLICY - BCN ONLY - TELEME BCN e Visit Policy MEDICAL POLICY - BCN ONLY - evisits Term Definitions: Telehealth Telemedicine On line visit (also referred to as evisit ) An umbrella term for remote health care that may include health care education and administration as well as real time clinical services A subset of telehealth, this describes realtime clinical health care services provided through electronic technology when distance separates the patient and health care provider A real time (synchronous) two way to communication that is initiated by the patient to virtually connect a physician or other health care provider for a low complexity health care services 3 information. 1

2 Example of the Differences between an online visit and a telemedicine visit: Example of an Online Visit is a patient initiated clinical interactive, low complexity visit using the appropriate HIPAA approved, secure equipment for issues such as: URI Symptoms, Colds, Sore Throat, Runny Nose, Sinus Congestion, Gastrointestinal, Headaches, etc.. Example of a Telemedicine Visit is the substitution of a face-to-face visit, hands on encounter between a patient and provider for a virtual visit, connecting the patient and provider via a secure network. The visit can be more than a low complexity visit and is within the provider scope of practice and makes sense. The visit can include a highly complex medical conditions and follow-up to ongoing chronic conditions In addition to the low complexity examples listed above. This list of examples is not all inclusive. 4 Difference between an online visit and a telemedicine visit: Online Visit/e Visit Telemedicine Real Time (synchronous) Patient Initiated Required Not Always; can be initiated by the patient or physician Audio Visual Required Not Required includes telephone Audio /Telephone 99441, 99442, 99443, 98966, 98967, 98968, Low Complexity Encounter High Complexity Encounter Chronic Care/ Ongoing Care Management 5 Con t.difference between an online visit and a telemedicine visit: Online Visit/e Visit Telemedicine GT Modifier Requirement CPT Codes and Multiple procedure codes; consistent with the providers scope of practice Who can provide the service? American Well (Am Well) Network provider Licensed providers billing within their scope of practice using HIPAA approved technology (procedure code only) Yes HIPAA Compliant etc technology Licensed providers billing within their scope of practice using HIPAA approved technology Yes HIPAA Compliant etc technology Originating Site Requirement Yes for BCN Not required for BCBSM 6 information. 2

3 Telemedicine: Originating Site- An authorized place where the patient is located at the time of the telemedicine service. Originating Site Requirements BCN Yes BCBSM Not Required GT Modifier - via interactive audio and video telecommunication systems Required to identify telemedicine services. Not required for the defined telephone and online procedure codes. Note Blue Cross has been reimbursing for telemedicine services since Effective 2016, the policy was broadened to include online and telephone procedure codes and no longer require the originating site. 7 On-line Visits: On-Line Visits - No Originating Site Required No GT Modifier Required The following procedure codes are payable for Online Visits: - BCN: BCBSM and Telephone Telephone Evaluation & Management and Assessment & Management No Originating Site Required No GT Modifier Required Not Payable for Blue Care Network The following telephone codes are payable for Blue Cross Blue Shield: 99441, 99442, 99443, 98966, 98967, information. 3

4 Inclusions: The provider must be licensed, registered, or otherwise authorized to perform services in their health care profession in the State where the patient is located The provider is not required to be located in the State of Michigan Providers are required to perform services that fall within their scope of practice 10 Exclusions: The following services are excluded from the Telehealth/Telemedicine Policy Store and Forward Telemonitoring only communication Facsimile transmission Text only communication Request for medication refills Reporting of normal test results Provision of educational materials Scheduling of appointments and other health care related issues Registration or updating billing information Reminders for health care related issues Referrals to other providers 11 Exclusions Cont. Any on-line visit resulting in an office visit, urgent care or emergency care encounter on the same day for the same condition Any on-line visit for the same condition originating from an office visit, urgent care or emergency care encounter within the previous seven days Any on-line visit occurring during the post-operative period (Please refer the specific BCN or BCBSM Medical Policy for additional information) 12 information. 4

5 Coverage Reference for BCBSM & BCN BCBSM BCN Online Visits and Audio /Telephone 99441, 99442, 99443, 98966, 98967, 98968, only Telemedicine Telemedicine GT Modifier Telemedicine Originating Site Required 13 Frequently Asked Questions: Q: If I want to perform on-line or telemedicine services, do I need to register? A: Registration is not required, but it is highly encouraged so that we reflect these services in the provider directory. (HOW?) Q: Are there restrictions regarding the devise used? For example, can the patient use an iphone, ipad? A: Devices such as iphones and ipads are acceptable for on-line visits, but not for BCN telemedicine due to requirement of origination site. See American Telemedicine Association guidelines for further information. Consider using a vendor. Q: Can the patient use programs or apps such as Skype or Facetime? A: It is up to the provider to determine. See American Telemedicine Association guidelines. Generally these applications may not meet HIPAA privacy standard that is required. 14 Frequently Asked Questions Cont: Q: Does the patient have to give informed consent to participate in the on-line visit? A: Yes Q: Are telephone visits reimbursable? A: For Blue Cross- yes, BCN- no Q: Are there provider eligibility exclusions? A: If a provider is practicing within the scope of practice and legally able to submit a claim with an applicable procedure code, they are eligible 15 information. 5

6 Frequently Asked Questions Cont Q: Will a member have a co-pay? A. A co-pay may be required depending on the service provided and the group benefit. Some groups have specific co-pays for office visits that may differ from the online visit co-pay. Group benefits vary; however telemedicine services (GT Modifier) will not change group specific copays. Q: How do we determine if a member has a benefit for online visits: A: The benefit will show on WebDenis under the Office visit/er copay button and under the benefit description. Online visits are subject to the same referral requirements (when applicable) as office visits. 16 Frequently Asked Questions Cont Q: Are behavioral health services payable as online and/or telemedicine? A: BCBSM allows any service that is payable under the provider s license to be payable as an online and/or telemedicine service. BCN will pay telepsychiatry E&M services with GT modifier to psychiatrists and certified nurse practitioners. Q: When is the originating site required? A: Originating site is not required for online visits. For telemedicine services, BCN requires the originating site; BCBSM no longer requires an originating site. 17 information. 6