Telemedicine now allows providers to virtually interact with patients in a way that improves the quality and delivery of care, especially for those patients who are unable to come to the office. The convenience and instant feedback patients receive are among the driving factors behind this rapidly growing branch of medicine. It’s a win-win situation for both medical practices and their patients, but you must know the criteria to ensure Medicare reimbursement.
Location, Location, Location
Medicare will reimburse Part B providers for telehealth services only if the patient presents from a qualifying — and rural — location.
Here’s a list of qualifying originating sites with their POS codes:
The service must be on the list of Medicare telehealth services and meet all of the following:
The Health Resources and Services Administration (HRSA) determines whether the originating site qualifies as rural and reevaluates these sites every year, so be sure to verify your address. Many sites that qualified in December 2017 lost their qualifying rural status on Jan. 1, 2018.
“The patient has to present from a rural location; the doctor can be anywhere. There is no requirement for the doctors’ location,” O’Leary said.
For example: Medicare Part B will reimburse a physician located in Boston if she has a telemedicine appointment with a Part B recipient who uses a video system to call in from a qualifying, rural site of origin, like a rural skilled nursing facility, as long as the other conditions are met and the documentation has the necessary information.
Remember: The patient’s home is not an approved originating site. Even if the patient is homebound, a telemedicine encounter qualifies for Part B reimbursement only if the patient presents at an originating site in a rural location.
Caution: A patient’s condition has no bearing on telemedicine coverage requirements.
Use the Right Equipment
Though the technology in your office (or even your pocket) make connecting over a video call possible, you need to use equipment that is advanced enough that there won’t be any lag time.
You must use interactive audio and video telecommunications system that permits real-time communication between the doctor and the beneficiary. Asynchronous ‘store and forward’ technology is not permitted except in federal telemedicine demonstration programs in Alaska and Hawaii.
Submit This Documentation
The claim for reimbursement should be the same as with any patient encounter, except you need to add the following information:
Get to Know the Telehealth Services Medicare Covers
Medicare pays for the following services for an approved provider to a patient located at an approved originating site. Note that telehealth services can be included as a HCPCS or CPT® code, and the code descriptor may not specific “telehealth” or “telemedicine.”
General Outpatient Care:
Health and Condition Management:
Originating Site Reimbursement
Originating sites are paid an originating site facility fee for telehealth services as described by HCPCS code Q3014 (Telehealth originating site facility fee). You should bill the MAC for the originating site facility fee, which is a separately billable Part B payment.
Remember: The originating site refers to the location of the patient at the time of telehealth services. Medicare reimburses telehealth services only if the patient is present at the site that is either a rural health professional shortage area or any place outside a metropolitan area.
Key: Originating sites are specified as the office of a provider; a hospital; a critical access hospital, or CAH; a rural health clinic, or RHC; a federally qualified health center, or FQHC; a hospital based or CAH based renal dialysis center; a skilled nursing facility, or SNF; or a community mental health center, or CMHC.
Important: As of 2018, the originating site payment has increased from $25.40 to $25.76.
Note: When a CMHC serves as an originating site, the originating site facility fee does not count toward the number of services used to determine payment for partial hospitalization services.
Strategy: When billing the facility fee for the originating site, you will not have to report the particular CPT® code that the distant site will be reporting for the service they provide through telehealth. Instead, you will only bill one code claiming the facility fee for the originating site for any service that you provide through telehealth. There is only one code for the originating site and it is Q3014 (Telehealth originating site facility fee).
Important: Deductible and coinsurance rules apply to Q3014.
Example: Your psychiatrist performs an initial psychiatric evaluation of a patient who is suffering from symptoms of depressed mood. The patient is receiving the services from the outpatient department of a hospital that is within a rural HPSA. Both your provider and the patient communicate with each other using interactive video and audio telecommunication systems. You report 90792 (Psychiatric diagnostic evaluation with medical services) for the evaluation your provider performs. To let the payer know that the service is a telehealth service, report 90792 with the modifier 95 appended. The outpatient department of the hospital will bill the facility fee for their part of the service using Q3014.
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