Understanding Policy Regulations and Reimbursement Practices Impacting Telehealth Programs

1. Understanding Policy Regulations and Reimbursement Practices Impacting Telehealth Programs Rena Brewer, RN, MA CEO, Global Partnership for Telehealth Lloyd Sirmons Director, SE Telehealth Resource www.setrc.us

4. Telehealth The use of telecommunications technology to support and deliver healthcare from a distance.

6. An Overview of Medicare Telehealth Reimbursement • https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/telehealthsrvcsfctsht.pdf • Medicare pays for a limited number of Part B services that are furnished by a physician or practitioner to an eligible beneficiary via a telecommunications system. • For eligible telehealth services, the use of a telecommunications system substitutes for an in-person encounter.

7. Eligible Providers • Only the following health professionals may claim reimbursement for remote telehealth services: • Physician; • Nurse practitioner; • Physician assistant; • Nurse midwife; • Clinical nurse specialist; • Clinical psychologist,* • Clinical social worker;* • Registered dietitian or nutrition professional. * Clinical psychologists and clinical social workers cannot bill for psychotherapy services that include medical evaluation and management services under Medicare. These practitioners may not bill or receive payment for the following CPT codes: 90805, 90807, and 90809.

8. The Originating Site • An originating site is the location of an eligible Medicare beneficiary at the time the service being furnished via a telecommunications system. Medicare beneficiaries are eligible for telehealth services only if they are presented from an originating site located in: • A rural Health Professional Shortage Area, either located outside of a Metropolitan Statistical Area (MSA) or in a rural census tract, as determined by the Office of Rural Health Policy within the Health Resources and Services Administration (HRSA); • Or a county outside of a MSA. You can access HRSA’s website tool to determine a potential originating site’s eligibility for Medicare telehealth payment at http://datawarehouse.hrsa.gov/telehealthAdvisor/telehealthEligibility.aspx

9. Eligible Originating Sites • The offices of physicians or practitioners; • Hospitals; • Critical access hospitals (CAH); • Rural health clinics (RHC); • Federally qualified health centers (FQHC); • Hospital-based or CAH-based renal dialysis centers (including satellites); • Skilled nursing facilities (SNF); • Community mental health centers (CMHC) Note: Independent Renal Dialysis Facilities are not eligible originating sites.

10. Billing and Payment for Professional Services Furnished Via Telehealth • Originating sites are paid an originating site facility fee for telehealth services as described by HCPCS code Q3014. • You should bill the Medicare Contractor for the originating site facility fee, which is a separately billable Part B payment.

11. Billing and Payment for Professional Services Furnished Via Telehealth • Reimbursement to the health professional delivering the medical service is the same as the current fee schedule amount for the service provided. • Submit the appropriate CPT procedure code for covered professional telehealth services along with the "GT" modifier ("via interactive audio and video telecommunications system"). • By coding and billing the "GT" modifier with a covered telehealth procedure code, the distant site physician/practitioner certifies that the beneficiary was present at an eligible originating site when the telehealth service was furnished.

12. Transitional Care • CMS added the following services to the list of Medicare telehealth services for CY 2014: • CPT code 99495: Transitional care management services with the following required elements: communication (direct contact, telephone, electronic) with the patient and/or caregiver within 2 business days of discharge; medical decision making of at least moderate complexity during the service period; face-to-face visit within 14 calendar days of discharge. • CPT Code 99496: Transitional care management services with the following required elements: communication (direct contact, telephone, electronic) with the patient and/or caregiver within 2 business days of discharge; medical decision making of high complexity during the service; period face-to-face visit within 7 calendar days of discharge. • This policy will allow the required face-to-face visit component of both services to be furnished through telehealth.

13. FL Medicaid – Telemedicine Services Florida Medicaid and Telemedicine Services November 20, 2014 Justin M. Senior Florida Medicaid Director Agency for Health Care Administration Presented at the Telehealth Cornerstone Conference Telemedicine services are available to recipients in both the Managed Medical Assistance (MMA) and fee-for-service programs for the following services: • –Behavioral health • –Dental • –Physician • –Interpretation of diagnostic testing results by Florida licensed physicians. • Plans participating in the MMA program are allowed to offer telemedicine for most covered services with Agency approval.

14. Florida Medicaid Resources • http://cchpca.org/fl-medicaid-program-live-video-reimbursement • http://portal.flmmis.com/FLPublic/Portals/0/StaticContent/Public/HANDBOOKS/Practitioner%20Services%20Handbook_Adoption.pdf • http://portal.flmmis.com/FLPublic/Portals/0/StaticContent/Public/HANDBOOKS/Community_Behavioral_Health_Services_Coverage_and_Limitations_Handbook_Adoption.pdf • http://www.floridahealth.gov/AlternateSites/CMS-Kids/providers/documents/handbook_physician.pdf

15. Thank you www.telehealthresourcecenter.org www.setrc.org Lloyd.sirmons@setrc.us Rena.brewer@gatelehealth.org