State of Emergency: Coronavirus Waivers and Flexibilities Sam Ross, - - PowerPoint PPT Presentation

THE CHICAGO HIT REGIONAL EXTENSION CENTER Bringing Chicago together through health IT

State of Emergency: Coronavirus Waivers and Flexibilities

Sam Ross, Project Manager 4/15/2020

This webinar was developed with support from the Office of National Coordinator for Health Information Technology (ONC), the Centers for Medicare & Medicaid Services (CMS), and the Illinois Department of Healthcare and Family Services (HFS). The contents do not necessarily reflect the opinions of the ONC, CMS or HFS.

Policy changes within the COVID-19 environment are rapidly

• developing. We are unable to cover complete details of waivers and

flexibilities during the public health emergency, nor address all potential scenarios for each provider and practice type. This presentation is intended to provide a high-level overview of available information at time of publication. The contents of this presentation are not legal advice. Webinar registrants, attendees, viewers and readers are encouraged to work with individual counsel and insurance companies to ensure compliance with relevant regulations, policies and procedures.

Agenda

• Federal Waivers and Flexibilities
• State Waivers and Flexibilities
• Telehealth Expansion – Medicare
• Telehealth Expansion – Medicaid
• Telehealth Coding and Reimbursement
• COVID-19 Coding

Federal Waivers and Fle lexibilities

Section 1135 Waivers

• Health and Human Services (HHS) can temporarily modify or waive certain Medicare,

Medicaid, CHIP or HIPAA requirements using section 1135 of the Social Security Act (SSA)

• When there's an emergency, sections 1135 or 1812(f) of the SSA allow blanket waivers and

flexibilities to help beneficiaries access care

• Blanket waivers are in effect with a retroactive date of March 1, 2020 through the end of

the emergency declaration

• Blanket waivers do not require CMS providers to apply for individual waivers or seek

additional approvals

https://www.cms.gov/about-cms/emergency-preparedness-response-operations/current- emergencies/coronavirus-waivers

Fle lexibilities Overview

• Equip the American healthcare system with maximum flexibility to respond to COVID-19
• Relax regulatory requirements to help system create and staff non-traditional care sites

https://www.cms.gov/files/document/covid-flexibilities-overview-graphic.pdf

Telehealth/care by phone Rapidly expand workforce Test patients where they are Make use of community resources COVID-only care centers Expand hospital capacity Patients over paperwork

Examples – Physicians and Other Clinicians

• Allowing physician supervision to be provided virtually using real-time audio/video
• Establishing hotlines to enroll and receive temporary Medicare billing privileges:
• Waiving certain screening requirements
• Postponing revalidation actions
• Same-day screening and approval for physicians and non-physician practitioners
• Waiving requirement that a physician or non-physician practitioner must be licensed in the

state in which s/he is practicing (when meeting certain conditions and subject to state requirements)

• Waiving “Stark Law” requirements in order to permit renting equipment or services, making

loans, providing benefits to staff, or furnishing medically necessary services in the home

https://www.cms.gov/files/document/covid-19-physicians-and-practitioners.pdf

Examples – Hospitals

• Conducting screenings or providing services in non-hospital buildings/other facilities or

setting up temporary expansion sites in places such as hotels or community facilities

• Waiving requirements for Critical Access Hospitals to limit beds and length of stay
• Allowing flexibilities for verbal orders, discharge planning, and utilization review
• Waiving requirements for emergency preparedness policies and procedures
• Waiving requirements for sterile compounding and respiratory services
• Allowing physicians whose privileges will expire to continue practicing or new physicians to

practice before full staff review

https://www.cms.gov/files/document/covid-hospitals.pdf

Payment

• Suspending most Fee-For-Service pre- and post-payment medical review
• Expanding the current Accelerated and Advance Payment Program
• Authorizes payments during period of emergency to providers that submit a request

and meet requirements

• Medicare Administrative Contractors will work to review requests and and issue

payments within seven calendar days

• Extending repayment to begin from 90 days to 120 days after issuance
• Appeals in Fee for Service, Medicare Advantage (MA) and Part D
• Allowing extensions to file an appeal
• Allowing waiver of requirements for timeliness for requests for additional information

to adjudicate appeals

• Allowing process of appeal with incomplete information

https://www.cms.gov/files/document/covid-hospitals.pdf https://www.cms.gov/files/document/covid-19-physicians-and-practitioners.pdf

HIP IPAA, Civil Rights, and COVID ID-19 19

• During the COVID-19 public health emergency, the HHS Office for Civil Rights (OCR) has

provided guidance on enforcement discretion under the HIPAA Privacy Rule

• OCR has identified key areas for enforcement discretion:
• Not imposing penalties for noncompliance with good faith participation in the
• peration of Community-Based Testing Sites
• Not imposing penalties for good faith rendering of telehealth services
• Permitting covered entities to disclose protected health information of an individual

who has been infected with, or exposed to, COVID-19 with law enforcement, paramedics/first responders, and public health authorities without the individual’s authorization

https://www.hhs.gov/hipaa/for-professionals/special-topics/hipaa-covid19/index.html

Dis iscretion for Tele lehealth Communications

• Some telehealth technologies, and the manner in which they are used, may not fully

comply with the requirements of the HIPAA Rules

• OCR will not impose penalties for noncompliance with HIPAA in connection with the good

faith provision of telehealth during the COVID-19 nationwide public health emergency

• Providers are encouraged to notify patients of privacy risks, and should enable all available

encryption and privacy modes when using such applications

• May use popular applications that allow for video chats, including Apple FaceTime,

Facebook Messenger video chat, Google Hangouts video, Zoom, or Skype

• Facebook Live, Twitch, TikTok, and similar public facing communications should not be used

https://www.hhs.gov/hipaa/for-professionals/special-topics/emergency-preparedness/notification-enforcement- discretion-telehealth/index.html

State Waivers and Fle lexibilities

Section 1135 Waivers

• In additional to blanket federal waivers, Illinois has requested additional waivers to provide

flexibility to state Medicare, Medicaid and CHIP programs during the COVID-19 pandemic

• Partial approvals were received on March 23rd, providing for:
• Temporary suspension of (and extension of existing) prior authorization requirements
• Provisionally, temporarily enroll providers who are enrolled with another state

Medicaid agency or Medicare for the duration of the public health emergency

• Waive screening requirements (application fee, background check, site visits, in-state

licensure requirements) for providers not already enrolled with another state Medicaid agency or Medicare

• Reimburse otherwise payable claims from out-of-state providers approved by another

state Medicaid or Medicare with a valid out-of-state license

• Additional requests were submitted and more may be made as needs are identified

https://www.illinois.gov/hfs/MedicalProviders/notices/Pages/prn200320c.aspx https://www.illinois.gov/hfs/SiteCollectionDocuments/1135WaiverRequestFactSheetFINAL.pdf https://www.illinois.gov/hfs/SiteCollectionDocuments/PartialApprovalIllinoisSection1135Waiver.pdf

Additional Fle lexibilities

• Pharmacy billing policies:
• Allow a 90 day supply of insulin (reviewing other medications)
• Adjusting preferred drug list
• Temporary coverage of OTC coverage for acetaminophen and cough suppressants
• Transportation providers
• Physician Certification Statement (PCS) form not required for prior approvals
• Transportation to/from alternative destinations (tent triage, convention center

converted to medical center) is appropriate

• FQHC/RHC advance payments to address revenue shortfall during transition to a per-

member, per-month (PMPM) methodology

• For a full list of updates, visit https://www.illinois.gov/hfs/Pages/coronavirus.aspx

https://www.illinois.gov/hfs/MedicalProviders/notices/Pages/prn200330a.aspx https://www.illinois.gov/hfs/MedicalProviders/notices/Pages/prn200408b.aspx https://www.illinois.gov/hfs/MedicalProviders/notices/Pages/prn200408d.aspx

Section 1115 Demonstration Application

• Submitted to CMS as part of a larger package of waivers and State Plan amendments to

maximize flexibility during the public health emergency

• Application is designed to 1) mitigate the impact and community spread of COVID-19, 2)

streamline Medicaid application processing to provide access to services, and 3) preserve access to Medicaid coverage

• Examples:
• Provide no-cost coverage to the uninsured and no out-of-pocket cost to insured

through secondary coverage

• Provide temporary housing to the homeless and home-delivered meals to

beneficiaries

• Allow state to determine aged, blind and disabled adult applicants presumptively
• Allow non-state staff to process Medicaid applications
• Extend coverage renewal dates for 12 months

https://www.illinois.gov/hfs/SiteCollectionDocuments/032620201115WaiverRequestFactSheet.pdf https://www.illinois.gov/hfs/SiteCollectionDocuments/03262020IllinoisCOVID19Section1115DemonstrationPropo salFinal.pdf

Tele lehealth Expansion - Medicare

Summary

• CMS is expanding telehealth benefits on a temporary and emergency basis
• Medicare can pay for office, hospital, and other visits furnished via telehealth across the

country, including in patient’s places of residence

• HHS Office of Inspector General (OIG) is providing flexibility for healthcare providers to

reduce or waive cost-sharing for telehealth visits paid by federal healthcare programs

• To the extent the waiver requires that the patient have a prior established relationship, HHS

will not conduct audits to ensure it existed for claims submitted during this public health emergency

https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet

Tele lehealth Services

• Available services have been expanded to include evaluation and management visits,

mental health counseling, preventive health screenings, emergency department visits, home visits, therapy services, and more, without regard to patient diagnosis

• Telehealth services require an interactive audio and video telecommunications system
• Considered the same as in-person visits and are paid at the same rate as in-person visits
• Requires same selection of E/M level based on medical decision making or time, with

waived documentation requirements for history and/or physical exam

https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet

Vir irtual Check-Ins

• Already available prior to waiver; technically not considered “telehealth services”
• Expected to be initiated by the patient; however, practitioners may need to educate

beneficiaries on the availability of the service prior to patient initiation

• Patient must verbally consent to receive virtual check-in services
• Practitioner may respond to the patient’s concern by telephone, audio/video, secure text

messaging, email, or use of a patient portal

• Must meet the following criteria:
• Is not related to a medical visit within the previous 7 days; and
• Does not lead to a medical visit within the next 24 hours (or soonest available)

https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet

e-Vis isits

• Already available prior to waiver; technically not considered “telehealth services”
• Need to be initiated by the patient; however, practitioners may educate beneficiaries on the

availability of the service prior to patient initiation

• Patient must verbally consent to receive e-visit services
• Include communications through online patient portals over up to a 7-day period
• Separate visit types for:
• Practitioners who may independently bill for evaluation and management visits; and
• Clinicians who may not independently bill for evaluation and management visits

https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet

Tele lephone Evaluation and Management Services

• Finalized March 30th ; technically not considered “telehealth services”
• Provided to new and established patients (or parent or guardian)
• Must meet the following criteria:
• Not related to a medical visit within the previous 7 days; and
• Does not lead to a medical visit within the next 24 hours (or soonest available

appointment)

• Separate visit types for:
• Practitioners who may independently bill for evaluation and management visits; and
• Clinicians who may not independently bill for evaluation and management visits

https://www.cms.gov/files/document/covid-19-physicians-and-practitioners.pdf

FQHC and RHC

• Coronavirus Aid, Relief and Economic Security (CARES) Act provides additional flexibility for

virtual care provided by FQHC and RHC to act as distant site provider

• On 4/17/20, CMS issued the following guidance:
• Payment to RHCs and FQHCs for distant site telehealth services is set at $92, which is

the average amount for all comparable PFS telehealth services, weighted by volume

• For telehealth distant site services furnished between January 27, 2020, and June 30,

2020, RHCs and FQHCs must use modifier 95 on the claim

• For telehealth distant site services furnished between July 1, 2020, and the end of the

COVID-19 public health emergency, RHCs and FQHCs will use G2025 to identify services that were furnished via telehealth

• Virtual care services may be billed under HCPCS code G0071, which may include 5 minutes
• r more virtual (non-face-to-face) communication, 5 minutes or more remote evaluation of

recorded video and/or images in lieu of an office visit, or online digital evaluation and management for up to 7 days

https://www.cms.gov/files/document/se20016.pdf

Tele lehealth Expansion - Medicaid

General In Information

• Changes to telehealth policy during the current public health emergency related to COVID-

19, applying under fee-for-service as well as HealthChoice Illinois managed care plans

• Telehealth services are medically necessary and clinically appropriate services covered

under the Medical Assistance Program as set forth in 89 Ill. Adm. Code section 140.3 (the same set of services covered for face-to-face visits) when delivered using:

• an “interactive telecommunication system” or “telecommunication system”;
• a communication system where information exchanged between the physician or
• ther qualified health care practitioner and the patient during the course of the

synchronous telehealth service is of an amount and nature that would be sufficient to meet the key components and requirements of the same service when rendered via face-to-face interaction

• Telehealth services are reimbursed at the same rate paid for face-to-face services provided
• n-site; separate rates are established for virtual check-ins, e-visits and teledentistry

https://www.illinois.gov/hfs/MedicalProviders/notices/Pages/prn200320b.aspx https://www.illinois.gov/hfs/MedicalProviders/notices/Pages/prn200330d.aspx

Originating Sit ite

• Waiver allows any location that allows the patient to use technology as defined to be an
• riginating site, including a patient’s place of residence
• Originating sites eligible for a facility fee include, but are not limited to:
• Hospitals (already eligible prior to emergency)
• Licensed substance abuse centers
• Supportive Living Program providers;
• Hospice providers;
• Community Integrated Living Arrangement (CILA) providers;
• Providers who receive reimbursement for a patient's room and board, including

nursing facilities and Intermediate Care Facilities for the Developmentally Disabled:

• Family Support Program residential providers
• Medically Complex Facilities or Persons with Developmental Disabilities
• Specialized Mental Health Rehabilitation Facilities

https://www.illinois.gov/hfs/MedicalProviders/notices/Pages/prn200320b.aspx https://www.illinois.gov/hfs/MedicalProviders/notices/Pages/prn200330d.aspx

Dis istant Sit ite

• Waiver expands locations of the provider giving services to a patient at the originating site
• Distant sites may be enrolled provider, operating within their scope of practice, and with

the appropriate license or certification, including but not limited to:

• Practitioner (including Dentist)
• Hospital
• Federally Qualified Health Center
• Rural Health Clinic or Encounter Rate Clinic
• Licensed Clinical Psychologist (LCP) or Licensed Clinical Social Worker (LCSW)
• Advanced Practice Registered Nurse certified in psychiatric and mental health nursing
• Local Education Agency (LEA) or School Based Health Center
• Physical, Speech, or Occupational therapist
• Local Health Department
• Community Health Agency, Community Mental Health Center or Behavioral Health

Clinic

https://www.illinois.gov/hfs/MedicalProviders/notices/Pages/prn200320b.aspx https://www.illinois.gov/hfs/MedicalProviders/notices/Pages/prn200330d.aspx

FQHC and RHC

• May act as distant site during emergency period
• Will be reimbursed at the same rate paid for face-to-face services provided on-site (FQHC

fee schedule), including behavioral health

• Will be reimbursed for virtual check-ins and e-visits at the rate established on the HFS

Practitioner Fee Schedule

https://www.illinois.gov/hfs/MedicalProviders/notices/Pages/prn200320b.aspx https://www.illinois.gov/hfs/MedicalProviders/notices/Pages/prn200330d.aspx

Tele lehealth Coding and Reimbursement

Dis isclaimer

• The following information is a reference point for Medicare and Medicaid services
• Reimbursement rates are based on publicly available fee schedule data; Medicare rates

identified are based on non-facility prices for the Chicago MAC locality

• Reimbursement for services covered outside of Medicare and Medicaid fee schedules may

be unavailable or subject to individual insurance carrier and plan requirements

• Reimbursements are dependent upon following proper coding and billing guidelines
• As a best practice, please contact each patient’s insurance company for information on pre-

authorizations, coding, billing and reimbursement

Tele lehealth Service

• Continue using normal encounter codes (e.g. evaluation and management 99201-99205 for

new patients or 99211-99215 for established patients)

• For a complete list of services payable under the Medicare Fee Schedule when furnished

via telehealth, visit https://www.cms.gov/Medicare/Medicare-General- Information/Telehealth/Telehealth-Codes

• For a complete list of Medicaid reimbursements, visit

https://www.illinois.gov/hfs/MedicalProviders/MedicaidReimbursement/Pages/default.aspx

Tele lehealth - In Inpatient/ED Consultation

Procedure Code Description IL Medicaid FFS Max1 Medicare PFS Max2 G0406 Limited (typically 15 minutes communication with patient via telehealth) $39.17 $41.97 G0407 Intermediate (typically 25 minutes) $72.13 $77.09 G0408 Complex (typically 35 minutes) $103.70 $110.74

Follow-up inpatient consultation:

Procedure Code Description IL Medicaid FFS Max1 Medicare PFS Max2 G0425 Typically 30 minutes communication with patient via telehealth $100.35 $107.69 G0426 Typically 50 minutes $136.14 $145.75 G0427 Typically 70 minutes or more $201.99 $216.55

Emergency department or initial inpatient consultation:

• 1. https://www.illinois.gov/hfs/SiteCollectionDocuments/COVID19FfeeScheduleFINALRev04012020.pdf
• 2. https://www.cms.gov/apps/physician-fee-schedule/search/search-criteria.aspx

• 1. https://www.illinois.gov/hfs/SiteCollectionDocuments/COVID19FfeeScheduleFINALRev04012020.pdf
• 2. https://www.cms.gov/apps/physician-fee-schedule/search/search-criteria.aspx

Vir irtual Check-In In

Virtual check-ins (may include telephone-only): Must meet both the following criteria:

• Not originating from a related evaluation and management service provided within the previous 7

days

• Not leading to an evaluation and management service provided within the next 24 hours or

soonest available appointment

Procedure Code Description IL Medicaid FFS Max1 Medicare PFS Max2 G2010 Remote evaluation of recorded video and/or images submitted by established patient, including interpretation with follow-up time with patient within 24 hours $12.10 $12.86 G2012 Brief communication technology-based service by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient; 5-10 minutes of medical discussion $21.37 $15.72

e-Vis isit

Procedure Code Description IL Medicaid FFS Max1 Medicare PFS Max2 G2061 Cumulative time during 7 days: 5-10 minutes $12.10 $12.79 G2062 11-20 minutes $21.37 $22.64 G2063 21 or more minutes $33.14 $35.43

Qualified non-physician professional online assessment, established patient, up to 7 days:

Procedure Code Description IL Medicaid FFS Max1 Medicare PFS Max2 99421 Cumulative time during 7 days: 5-10 minutes $13.19 $16.47 99422 11-20 minutes $27.14 $33.26 99423 21 or more minutes $43.23 $53.73

Online digital evaluation and management service, established patient, up to 7 days:

• 1. https://www.illinois.gov/hfs/SiteCollectionDocuments/COVID19FfeeScheduleFINALRev04012020.pdf
• 2. https://www.cms.gov/apps/physician-fee-schedule/search/search-criteria.aspx

Tele lephonic Vis isit (Medicare)

Procedure Code Description Medicare PFS Max1 98966 Assessment and management service; 5-10 minutes of medical discussion N/A 98967 Assessment and management service; 11-20 minutes of medical discussion N/A 98968 Assessment and management service; 21-30 minutes of medical discussion N/A

Telephonic visits, non-physician Qualified Health Professional:

• 1. https://www.cms.gov/apps/physician-fee-schedule/search/search-criteria.aspx

Must meet both the following criteria:

• Not originating from a related E/M service provided within the previous 7 days
• Not leading to an E/M service provided within the next 24 hours or soonest available appointment

Procedure Code Description Medicare PFS Max1 99441 Evaluation and management service; 5-10 minutes of medical discussion N/A 99442 Evaluation and management service; 11-20 minutes of medical discussion N/A 99443 Evaluation and management service; 21-30 minutes of medical discussion N/A

Telephonic visits, physician or Advanced Practice Provider:

Tele ledentistry (Medicaid)

Procedure Code Description IL Medicaid Max1 D9995 Synchronous; real-time encounter $13.19 D9996 Asynchronous; information stored and forwarded for subsequent review $9.24

Teledentistry:

• 1. https://www.illinois.gov/hfs/SiteCollectionDocuments/COVID19FfeeScheduleFINALRev04012020.pdf
• Does not require existing relationship
• Claims should be billed in conjunction with D0140 – Limited Oral Evaluation

Pla lace of Service and Modifiers

• Medicare:
• As a general rule, apply the usual place of service code (e.g. POS 11 for private office);

services reported using POS 02 will be paid at the facility rate

• For telehealth services and inpatient/ED consultation, use modifier 95
• For e-visits, virtual check-ins and telephone visits, no modifier is needed as these are

technology-based codes

• For services furnished for diagnosis and treatment of an acute stroke, use modifier G0
• Critical Access Hospital method II claims should continue to bill with modifier GT
• Medicaid:
• As a general rule (exceptions exist), distant site providers billing for telehealth

services, e-visits, virtual check-ins, inpatient/ED consultations and teledentistry must use place of service 02 on their claims and GT modifier

• For medical encounters, use the GT modifier on all detail code service lines.
• For behavioral health encounters, use the GT modifier on all service lines; the

behavioral health modifier must be the first appended to the encounter “T” code

https://www.illinois.gov/hfs/MedicalProviders/notices/Pages/prn200330d.aspx https://www.cms.gov/outreach-and-educationoutreachffsprovpartprogprovider-partnership-email-archive/2020-04-03-mlnc-se

Tele lehealth Resources

• General Telehealth:
• Center for Connected Health Policy
• National Consortium of Telehealth Resource Centers
• Upper Midwest Telehealth Resource Center
• Telehealth during COVID-19
• American Academy of Family Physicians
• American College of Physicians
• American Medical Association
• Many more; check with your preferred academy, college, association, medical society,

billing company, payer or other resource

COVID ID-19 Coding

CDC Guidance: IC ICD-10 Codes

https://www.cdc.gov/nchs/data/icd/COVID-19-guidelines-final.pdf Condition Guidance Asymptomatic individuals being screened for COVID-19, results unknown or negative Z11.59 (encounter for screening or other viral diseases) Possible exposure to COVID-19, ruled out after evaluation Z03.818 (encounter for observation for suspected exposure to

• ther biological agents ruled out)

Actual exposure to COVID-19 Z20.828 (contact with and (suspected) exposure to other viral communicable diseases) Confirmed COVID-19, documented by provider, documented test result, or presumptive positive test result U07.1 (COVID-19) – use first in sequence with any additional associated Dx below Confirmed COVID-19 with pneumonia U07.1 and J12.89 (other viral pneumonia) Confirmed COVID-19 with acute bronchitis U07.1 and J20.8 (acute bronchitis due to other specified

• rganisms) or J40 (bronchitis, not specified as acute or chronic)

Confirmed COVID-19 with lower respiratory infection U07.1 and J22 (unspecified acute lower respiratory infection) or J98.8 (other specified respiratory disorders) Confirmed COVID-19 with acute respiratory distress syndrome (ARDS) U07.1 and J80 (acute respiratory distress syndrome) Signs and symptoms, no definitive COVID-19 Dx R05 (cough), R06.02 (shortness of breath), R50.9 (fever, unspecified), etc.

Note: Diagnosis code B34.2 (coronavirus infection, unspecified) is generally not appropriate because cases have been universally respiratory in nature

Lab Services

Procedure Code Description IL Medicaid Max1 Medicare PFS Max2 87635 Infectious agent detection by nucleic acid (DNA or RNA); severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]), amplified probe technique $51.31 N/A U0001 CDC 2019-Novel Coronavirus Real-Time RT-PCR Diagnostic Panel $35.91 N/A U0002 Coronavirus (COVID-19) SARS-COV-2/2019-NCOV, Non- CDC Lab Test $51.31 N/A

COVID-19 lab codes: Note: No pricing information available on Medicare PFS lookup; check with your MAC

• 1. https://www.illinois.gov/hfs/SiteCollectionDocuments/COVID19FfeeScheduleFINALRev04012020.pdf
• 2. https://www.cms.gov/apps/physician-fee-schedule/search/search-criteria.aspx

Cost-Sharing Waiver

• The Families First Coronavirus Response Act waives cost-sharing for Medicare Part B

patients for:

• Diagnostic testing and administration of tests for the detection of COVID-19
• Items and services furnished during office visits, urgent care center visits and

emergency room visits that result in the order or administration of COVID-19 testing, to the extent they relate to the evaluation determining the need for such testing

• Physicians should use the CS modifier on applicable claim lines to identify services subject

to cost-sharing waiver (testing or services resulting in the order/administration of a test)

• Cost-sharing waiver is effective for dates of service between 3/28/20 and end of

emergency; physicians should contact Medicare Administrative Contractor (MAC) to resubmit applicable claims submitted without the modifier

• Beneficiaries should not be charged for any coinsurance or deductible; MAC will pay 100%
• f the allowable claim

https://www.aafp.org/patient-care/emergency/2019-coronavirus/telehealth.html https://www.cms.gov/files/document/FFCRA-Part-42-FAQs.pdf

Q & A

Q & A

Q: If the Doctor is not allowed to go to the nursing home but a patient needs to be seen, he is doing a video conference with the help of nursing home staff. What happens if the patient cannot give consent because the patient can't communicate (for example: pt. has dementia). Should the doctor mention that verbal consent could not be given by the patient because of their diagnosis? A: In In the a absence of f formal l le legal l guid idance or r a dir irect reference fr from CMS or r Ill Illin inois is HFS, a potentia ial l reference poin int is is t the r response provid ided on page two

• f

f the Americ ican Academy of f Neurolo logy Tele lemedic icin ine and COVID-19 FAQ at https:/ ://www.a .aan.com/sit iteassets/home-page/tools ls-and- resources/practic icin ing-neurologis ist--

• -admin

inis istrators/tele lemedicin ine-and-remote- care/20-tele lemedic icin ine-and-covid id19-webinar-faq-v204.pdf

Q & A

Q: Can prescribers still bill Medicaid when the client is not able to use the video portion for the session or refuse to use video? A: Ill Illin inois is HFS guid ideli lines state that t tele lehealt lth servic ices are eli ligib ible le for reimbursement when delivered using “a communication system where in informatio ion exchanged between the p physic icia ian or r other r quali lifi fied healt lth care practit itio ioner and the patie ient duri ring the course of f the synchronous tele lehealt lth servic ice is is o

• f

f an amount and nature that would ld be suffi ficie ient to meet the k key components and requir irements of f the same servic ice when rendered via ia face- to to-face interaction.” This option does not require the use of video.

Q & A

Q: What are the codes to bill for FQHC as distant site for Medicare telehealth? A: [NOTE: This answer has been updated, and differs from the presenter’s response during the live webinar.] On 4/1 /17/20, , CMS published guidance on FQHC billing as a distant sit ite for Medicare tele lehealth services during the public health emergency. . For tele lehealth distant sit ite services fu furnished between January 27, , 2020, , and June 30, , 2020, , RHCs and FQHCs must use modifier 95 on the cla laim. . For tele lehealth distant sit ite services fu furnished between July 1, , 2020, , and the end of f the COVID ID-19 public health emergency, , RHCs and FQHCs wil ill use G2025 to id identify fy services that were fu furnished via ia telehealth. . Payment to RHCs and FQHCs for distant sit ite tele lehealth services is is set at $92, , which is is the average amount for all ll corresponding PFS tele lehealth services weig ighted by volume. Ple lease see https://www.cms.gov/fi files/document/se20016.pdf for more in information.

Q & A

Q: Does paid at same rate mean encounter rate for FQHC's? A: Illinois HFS guidance states that “reimbursement for telehealth services wil ill c l contin inue to be made at the s same rate paid id for r face-to to-face servic ices provid ided on-site.” FQHCs acting as a distant site to provide telehealth servic ices and bil illi ling f for typic ical l face-to to-face vis isit it codes wit ith P Pla lace Of f Service 02 and modif ifie ier GT w wil ill b l be paid id at medic ical/ l/dental/ l/behavio ioral l encounter rates appli licable le to their ir FQHC.

Q & A

Q: How do you cover new pt codes without PE? New pt E/M codes require meeting 3 out of 3 key components. A: CMS regulatory revisions state: “On an interim basis, we are revising our poli licy to specify ify that the o

• ffi

fice/outpatie ient E/M le level l sele lectio ion for these servic ices when fu furn rnis ished via ia tele lehealt lth can be based on MDM or r tim ime, , wit ith tim ime defi fined as all ll of f the t tim ime associa iated wit ith t the E E/M on the day of f the encounter; and to remove any requir irements regardin ing documentatio ion of f history and/or physical exam in the medical record.”

Q & A

Q: Could Sam clarify the types of visits based on which are synchronous (live) vs asynchronous (send and receive communication not in real time)...are e-visits via portal the only asynchronous type of visit? A: Asynchronous procedures may in inclu lude onli line evalu luatio ion/e-vis isit its (G (G2061- G2063 and 99421-99423), remote evalu luatio ion of f recorded vid ideo and/or im images (G (G2010), and in informatio ion stored and forw rwarded to dentis ist f for subsequent revie iew (M (Medic icaid id-only ly, D9996).

Q & A

Q: Will Medicaid of Illinois pay for the same codes as CMS - Medicare? Example: Hospital video conference 99233, POS: 21, Mod: 95 A: Duri ring the p publi lic healt lth emergency, Ill Illin inois is Medic icaid id tele lehealt lth servic ices for medic icall lly necessary ry and cli linic icall lly appropriate servic ices usin ing p procedure code 99233 are eli ligib ible le for reim imbursement at the s same rate as when provid ided in in p

• person. When bil

illi ling this is p procedure as a tele lehealt lth servic ice to Ill Illin inois is Medic icaid id, use P POS 02 and modif ifie ier GT.

Q & A

Q: Which CPT codes does Medicaid of IL allow for Video Conference? Will they allow Hospital and nursing home visits like Medicare? A: Duri ring the p publi lic healt lth emergency, Ill Illin inois is Medic icaid id tele lehealt lth servic ices are “medically necessary and clinically appropriate services covered under the M Medic ical l Assis istance Program that a are deli livered usin ing a a communicatio ion or r technolo logy system to a p patie ient at an ori rigin inatin ing sit ite by a provid ider at a distant site.” This definition includes hospital and nursing home visits deli livered usin ing v vid ideo conference.

Q & A

Q: For telehealth, is the POS for a nursing home facility still the same with modifier 95? A: For Medic icare tele lehealt lth servic ices, use t the same POS as when provid ided in in person wit ith m modif ifie ier 95. . Wit ith li limit ited exceptio ions, Ill Illin inois is Medic icaid id tele lehealt lth servic ices should ld use P POS 02 wit ith m modif ifie ier GT.

Q & A

Q: Clarification for Medicaid use POS 11 modifier GT with the standard E&M codes? A: For Ill Illin inois is Medic icaid id, use POS 02 w wit ith m modif ifie ier GT f for standard E&M codes provid ided as t tele lehealt lth servic ices.

Q & A

Q: A little off topic - If anyone has requested an attestation letter from PMP and has not received it - please email jennifer.erickson@illinois.gov. The new normal for working remotely has gotten easier, but I [Jen] don't want anything to get missed. A: Thank you, Jen, , for your contin inued support rt wit ith u usin ing t the Il Illi linois Prescrip iptio ion Monit itorin ing Program for publi lic healt lth reportin ing obje jectiv ives under r the Promotin ing In Interoperabil ilit ity Programs (M (Medic icaid id Stage 3, , Medic icare MIP IPS), whic ich contin inue duri ring the publi lic healt lth emergency. For r program year 2019, , Ill Illin inois is Medic icaid id has ext xtended the a attestatio ion deadli line to May 30. . Medic icare has ext xtended the M MIP IPS submis issio ion deadli line to Apri ril l 30.

Q & A

Q: Can audio-only be billed as telehealth example 99213, when a patient does not have access to video and when the provider was NOT offering telehealth prior to COVID? A: CMS guidance on telehealth visits states, “The provider must use an in interactiv ive audio io and vid ideo tele lecommunic icatio ions system that p perm rmit its real- time communication between the distant site and the patient at home.” This poli licy would ld not all llow bil illi ling for 99213 wit ithout a access to vid

• ideo. Provid

iders may in instead bil ill a l as a vir irtual l check-in in (G (G2012) or r tele lephonic ic vis isit it (9 (99441- 99443, , 98966-98968). [NOTE: A webinar attendee reported contacting Medicare regarding Part B payment for telehealth services using procedure code 99213 and being told video was not required. While this policy has been implemented by other payers, it is contrary to CMS published guidance. You may wish to reach out for clarification.]

Q & A

Q: What if the telehealth visit, was patient concerned they may have corona virus, but have not been tested, should we be using the CS modifier? A: [NOTE: This answer has been updated, and differs from the presenter’s response during the live webinar.] The CS modifie ier is is u used t to waiv ive cost-sharin ing for: COVID-19 dia iagnostic ic testin ing; ; it items and servic ices rela lated to admin inis istratio ion of f the t test; ; it items and servic ices rela lated to evalu luatio ion that determ rmin ined the n need for the admin inis istratio ion of f a COVID-19 test. . If If no order or r admin inis istratio ion of f a COVID- 19 test o

• ccurs as a r

result lt of f the tele lehealt lth vis isit it, , the C CS modifie ier should ld not be used. . Ple lease see https:/ ://www.c .cms.gov/fil iles/document/FFCRA-Part-42 42-FAQs.pdf for more in informatio ion.

Q & A

Q: What about inpatient visits with confirmed COVID diagnosis? Should all visits have the CS modifier? A: [NOTE: This answer has been updated, and differs from the presenter’s response during the live webinar.] The CS modifie ier is is u used t to waiv ive cost-sharin ing for: COVID-19 dia iagnostic ic testin ing; ; it items and servic ices rela lated to admin inis istratio ion of f the t test; ; it items and servic ices rela lated to evalu luatio ion that determ rmin ined the n need for the admin inis istratio ion of f a COVID-19 test. . Whil ile this is m may apply ly to in inpatie ient vis isit its, , the C CS modifie ier should ld only ly be used if if the v vis isit it result lts in in a a COVID-19 test bein ing ordered or r admin inis

• istered. Therefore it

it w would ld not apply ly to vis isit its wit ith patie ients that have been previo iously tested and confi firmed to have a COVID-19 19 dia iagnosis is as the r result lt of f an earl rlie ier vis isit it. . Ple lease see https:/ ://www.c .cms.gov/fil iles/document/FFCRA-Part-42 42-FAQs.pdf for more in informatio ion.