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Telemedicine
November 2018
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Training Objectives
Define Telemedicine
Understand the benefits of Telemedicine
Learn what services provided by Telemedicine are reimbursed by Medicaid
Understand what equipment is required to provide Telemedicine
Learn what is needed to become credentialed to provide Telemedicine
Understand how to bill for services provided via Telemedicine
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Telemedicine Basics
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Telemedicine: Definition
The real-time or near real-time exchange of information for diagnosing and treatment of medical conditions
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Interactive telecommunications when the member and the behavioral health provider are not in the same physical location
Utilizes both audio and video connections linking practitioners in one locality with members in another locality
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Telemedicine: Benefits
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Real-time, two-way communication via
secure online virtual session
Treat members at a place and time that fits best into your schedule
– and theirs
Convenient
Simple
Secure and private
Improves access to care for more members,
such as rural residents or members with
mobility issues
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Telemedicine: Originating Site
Originating Site: The DMAS enrolled site where the member is located during the telemedicine appointment
A provider or designee must attend the encounter with the member unless there is a documented reason for staff not to be present, such as:
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member reporting injuries due to abuse
psychiatric care where member may feel uncomfortable
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Telemedicine: Originating Site
Originating Site Location Options
Telemedicine service
provider outpatient
offices
Federally Qualified
Health Centers
HospitalsNursing Facilities
Health Department
Clinics
Community Services Boards
Psychiatric Residential Treatment Facilities
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Telemedicine: Covered Services
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Telemedicine: Covered Behavioral Health Services
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Psychiatric diagnostic interview exam
Evaluation and management office visits or other outpatient visits
Initial and subsequent hospital care
Individual, family, and group therapy
Crisis Intervention
IACCT Assessments
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Telemedicine: Covered Behavioral Health Services
In-state telemedicine may be provided by licensed providers operating within the scope of their practice
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Telemedicine: Covered Behavioral Health Services
Only enrolled Physicians can provide out-of-state telemedicine services
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TXLA
MS
TN
KY
GA
SC
NC
WV
KS
OK ARNM
AZ
NV
ORID
ME
PA
MD
WA
MT ND
SD
NE
MO
MN
WI
IA
IL INOH
MI
WY
UTCO
CA
AL
FL
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Telemedicine: Covered Behavioral Health Services
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Individual medical records at all sites are to document the telemedicine encounter consistent with the service documentation described in Chapter II of the DMAS provider manuals
The documentation is to specifically reference telemedicine as the means for conducting the medical service
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Telemedicine: Equipment Requirements
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Telemedicine: Equipment Requirements
Equipment and transmission speed must be technically sufficient to support the services billed to DMAS
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• Broadband internet connection
• Computer with microphone and web camera
• Telehealth software/platform
• Training for staff in the competent use of telemedicine equipment
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Telemedicine: Equipment Requirements
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Security
• All telemedicine activities are to comply with the requirements of the Health Insurance Portability and Accountability Act of 1996 (HIPAA)
• Skype and FaceTime do not meet HIPAA confidentiality requirements
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Telemedicine: Equipment Requirements
Is your telehealth software/platform HIPAA compliant?
Your software/platform vendor is required to have a Business Associate Agreement (BAA). To remain HIPAA compliant and protect a member’s PHI, this BAA must outline methods used by the vendor to ensure the protection of the data and provisions for regular auditing of the data’s security.
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Telemedicine: Equipment Requirements
Approved Secure Technology for Telemedicine Services include:
If your preferred program is not listed, contact the Magellan of Virginia network department to confirm that the technology is approved for HIPAA information
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American Well Securevideo.com
Carepaths Theralink
DoxyMe Vidyo
E-Clinical Works Virtual Therapy Connect
E-Psychiatry Vsee
Life Size WECounsel
Polycom Zoo
Secure Telehealth.com
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Credentialing Process
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Telemedicine: Getting Credentialed
Not a Magellan provider
• Join the Network at www.MagellanProvider.com. When prompted for pre-approval, enter “TELEHEALTH” to indicate your interest in servicing members via telehealth
• Documents can be obtained by calling 1-800-424-4536 or using the Contact Us link on www.magellanofvirginia.com
• Each service location that would like to receive reimbursement will need to be credentialed and contracted with Magellan
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Telemedicine: Getting Credentialed
Already a Magellan provider
• Complete the following:−Sites and Service Form
−Telehealth Services Provider Attestation
−Copy of the License to render Behavioral Health services
• Approximate turnaround time 2-3 weeks for sites already in network with Magellan
• Documents can be obtained by calling 1-800-424-4536 or using the Contact Us link on www.magellanofvirginia.com
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Billing Basics
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Telemedicine: Billing
All providers utilizing telemedicine and billing for
behavioral health services must be enrolled with DMAS/Magellan
All coverage requirements described in the DMAS provider manuals apply when the service
is delivered via telemedicine
The use of telemedicine must be noted in the service
documentation of the member record
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Telemedicine: Billing
Telephone calls, e-mail, fax and similar electronic measures are not
considered telemedicine
When billing for services, either the “GT” (via interactive audio and video) or “95” modifier must be entered on
the claim
Provider groups whose offices or other locations may serve as the originating site for telemedicine are found in the Virginia Medicaid Memo dated May 13, 2014 – Updates to Telemedicine
Coverage
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Telemedicine: Billing
• As a Magellan provider, you will continue to verify benefit and eligibility, as well as submit claims, exactly as you do for other services
• Telemedicine must be a covered benefit under the member’s benefit plan to be reimbursed
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Resources
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Telemedicine: Resources
For more information:
• Chapter V of the DMAS Physician Provider Manual
• Virginia Medicaid Memo dated September 30, 2009 – Expanded DMAS Telemedicine Coverage – Effective November 1, 2009
• Virginia Medicaid Memo dated May 13, 2014 – Updates to Telemedicine Coverage
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Telemedicine: Resources
For more information:
• Magellan’s telehealth page: http://wwwmagellanprovider.com/education/telehealth.aspx
• American Telemedicine Association: State Policy Resource Center http://www.americantelemed.org
• Center for Connected health Policy: The national Telehealth Policy Resource Center: http://cchpca.org
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Thank You
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Confidentiality statement for providers
The information presented in this presentation is confidential and expected to be used solely in support of the delivery of services to Magellan members. By receipt of this presentation, each recipient agrees that the information contained herein will be kept confidential and that the information will not be photocopied, reproduced, or distributed to or disclosed to others at any time without the prior written consent of Magellan Health, Inc.
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