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© 2020 Experian Information Solutions, Inc. All rights reserved. Experian Confidential. FAQs - COVID-19 & Telehealth/Telemedicine Contact/Information Dashboard: http://www.experianhealthproductdashboard.com/ Community Portal: https://experianhealth.force.com/portal/s/ E-mail: [email protected] Phone: 1 866 854 6796, Option 1 Table of Contents Telehealth/Telemedicine Claims ClaimsScrubber ClaimSource - Includes information on HRSA (billing uninsured patients) Connectivity IP Restrictions Financial Services PaySafe Patient Estimates Patient Estimates - RQA MyResponse Telehealth Widget Eligibility Examples of Telehealth Messages Definitions

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Page 1: FAQs - COVID-19 & Telehealth/Telemedicine€¦ · Telehealth/Telemedicine Claims ClaimsScrubber . ClaimSource - Includes information on HRSA (billing uninsured patients) Connectivity

© 2020 Experian Information Solutions, Inc. All rights reserved. Experian Confidential.

FAQs - COVID-19 & Telehealth/Telemedicine

Contact/Information

Dashboard: http://www.experianhealthproductdashboard.com/

Community Portal: https://experianhealth.force.com/portal/s/

E-mail: [email protected]

Phone: 1 866 854 6796, Option 1

Table of Contents

Telehealth/Telemedicine Claims

ClaimsScrubber

ClaimSource

- Includes information on HRSA (billing uninsured patients)

Connectivity IP Restrictions

Financial Services PaySafe

Patient Estimates

Patient Estimates - RQA

MyResponse Telehealth Widget

Eligibility • Examples of Telehealth Messages

Definitions

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© 2020 Experian Information Solutions, Inc. All rights reserved. Experian Confidential.

Telehealth/Telemedicine

Q. Do health plans pay for telemedicine services?

• Pre-COVID-19 o Many plans are covering a wide variety of healthcare services via telemedicine. o Almost every state Medicaid plan covers some telehealth services. o Private insurance coverage requires same coverage as in person service in 31 states and the

District of Columbia. • During COVD-19

o Payers are rapidly changing policies to help react to this crisis. A list of payer updates, as they are received can be found on our dashboard here: https://www.experianhealthproductdashboard.com/category/announcements/covid-19/ Medicaid FAQ was issued stating state Medicaid programs have broad authority to utilize

telehealth within their Medicaid programs including using telehealth or telephonic consultations in place of typical face-to-face requirements when certain conditions are met.

Medicare – allowing multiple telehealth services with expansion to 1135 waiver. Private insurance – several payers have announced they will make telehealth more widely

available, but details are still developing. o Experian Health is offering free access a COVID-19 specific Payer Alerts link that will allow clients

to subscribe to payer alerts to help stay informed of changes. https://www.experian.com/lp/healthcare/covid-19-payer-alerts

Q. Where can I find information on Reimbursement?

• Medicare o CMS has lifted a number of Telehealth policy restrictions. You can see information using the

Payer Alerts and the CMS website https://www.cms.gov/Medicare/Medicare-General-Information/Telehealth

• Commercial o Most have been forgiving reimbursement for Telehealth. o Consult the commercial payer/policy for details

• Medicaid o Will vary state by state. o You can use the Center for Connected Health Policy to review.

https://www.cchpca.org/

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© 2020 Experian Information Solutions, Inc. All rights reserved. Experian Confidential.

Connectivity

Q. We want to connect to Experian Health products while working remotely and are unable?

• Please have your I.T. or Self-Service Portal Administrator contact the Experian Health support desk to address any remote connectivity issues.

• Example:

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© 2020 Experian Information Solutions, Inc. All rights reserved. Experian Confidential.

Patient Estimates – RQA Q. We have created a temporary clinic for COVID-19 patients. How can we prevent RQA alerts from firing on this temporary department?

• Please open a support case to create an Alert Bypass for this department/location. Please include the department code and/or assigned location code and a patient example. The RQA support team will use this information to create an RQA Alert Bypass for this department.

Q. How can I add COVID-19 tests to Patient Estimates?

• Please add the COVID-19 test to your chargemaster and submit using the same method used for previous chargemaster updates. PE will upload the latest chargemaster into PE production.

Q. How can I add COVID-19 tests to Self Service Patient Estimates?

• If this procedure is already part of your Patient Estimates chargemaster, please open a support case requesting that this procedure also be added to Self Service Patient Estimates. Please include the chargemaster code, the category you would like this procedure to appear under, and the patient friendly procedure description. The team will map this procedure to your chargemaster for pricing.

• If this procedure will not be part of your Patient Estimates chargemaster and will only appear in Self Service, a support case should be opened. Please include the category you would like this procedure to appear under, the patient friendly procedure description, CPT code, revenue code, and price. The team will build this procedure directly into SSPE.

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© 2020 Experian Information Solutions, Inc. All rights reserved. Experian Confidential.

Claims Q. Are the Covid-19 and telehealth codes valid in the system?

• Yes o ICD10 Codes o HCPC/CPT Codes o Modifier Codes

Q. How do we bill uninsured patient claims?

• The following three resources define how to handle uninsured patient claims 1. HRSA Program summary Webpage 2. HRSA Companion Guide (for transmitting claims) 3. HRSA Webinar FAQ’s

1. Please review the “Health Resources & Services Administration, HRSA: COVID-19 Claims Reimbursement

to Health Care Providers and Facilities for Testing and Treatment of the Uninsured” Website o https://www.hrsa.gov/CovidUninsuredClaim

Summary of information on the program.

2. HRSA COMPANION GUIDE a. https://coviduninsuredclaim.linkhealth.com/static/HRSA%20COVID-

19%20Uninsured%20Claim_Companion%20Guide.pdf i. Payer Id to use: 95964

ii. For 837P & 837I iii. LOOP 2010BA NM1 SEGMENT NM103 Name Last or Organization Name R 1/60 AN

(BLANK) iv. LOOP 2000B PAT SEGMENT PAT05 CLAIM FILING INDICATOR O 2/3 ID Required if

patient is known to be deceased v. LOOP 2000B PAT SEGMENT PAT06 DATE TIME PERIOD QUALIFIER S 1/35 AN Required if

patient is known to be deceased vi. LOOP 2010BB NM103 SEGMENT Name Last or Organization Name R 1/60 AN “COVID19

HRSA Uninsured Testing and Treatment Fund”

3. HRSA WEBCAST FAQ’S

a. https://coviduninsuredclaim.linkhealth.com/static/HRSA%20COVID-19%20Uninsured%20Program%20Webcast%20Top%20FAQs.pdf

A. Are diagnostic testing and testing-related visits eligible for reimbursement if the result of the

COVID-19 test is negative? i. ANSWER: For the HRSA COVID-19 Uninsured Program, claims for diagnostic testing will

be eligible for reimbursement if one of the following diagnoses codes is included in any position on the claim: • Z03.818 • Z11.59 • Z20.828.Claims for diagnostic testing-related

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visits will be eligible for reimbursement if the place of service is an office visit, telehealth visit, urgent care or emergency room AND one of the following diagnoses codes is included in any position on the claim: Z03.818 • Z11.59 • Z20.828. While U0001, U0002, U0003, U0004, G2023, G2024 and 87635 are COVID-19 specific procedure codes, one of the Z codes above will need to be included on the claim to be eligible for reimbursement for testing as part of the HRSA COVID-19 Uninsured Program.

B. The Terms and Conditions for the Uninsured Treatment pool of funding indicate that

providers can request claims for reimbursement for care or treatment related to positive diagnoses of COVID-19. To qualify as a positive diagnosis of COVID-19, does the primary diagnosis on a claim for treatment need to be B97.29 or U07.1? ii. ANSWER: For the HRSA COVID-19 Uninsured Program, eligible treatment claims are

determined as follows: 1. Treatment for services or discharges prior to April 1, 2020, will be eligible for

reimbursement if the primary diagnosis is B97.29 OR if the primary diagnosis is pregnancy O98.5- and the secondary diagnosis is B97.29.

2. Treatment for services or discharges on or after April 1, 2020, will be eligible for reimbursement if the primary diagnosis is U07.1 OR if the primary diagnosis is pregnancy O98.5- and the secondary diagnosis is U07.1.

C. The Terms and Conditions for the Uninsured Treatment pool of funding indicate that providers can request claims for reimbursement for care or treatment related to positive diagnoses of COVID-19. To qualify as a positive diagnosis of COVID-19, does the primary diagnosis on a claim for treatment need to be B97.29 or U07.1? iii. ANSWER: For the HRSA COVID-19 Uninsured Program, eligible treatment claims are

determined as follows: 1. Treatment for services or discharges prior to April 1, 2020, will be eligible for

reimbursement if the primary diagnosis is B97.29 OR if the primary diagnosis is pregnancy O98.5- and the secondary diagnosis is B97.29.

2. Treatment for services or discharges on or after April 1, 2020, will be eligible for reimbursement if the primary diagnosis is U07.1 OR if the primary diagnosis is pregnancy O98.5- and the secondary diagnosis is U07.1.

D. If a patient is treated for sepsis and also tests positive for COVID-19, is the sepsis treatment

eligible for reimbursement? iv. ANSWER: The ICD-10-CM Official Coding Guidelines – Supplement for Coding encounters

related to COVID-19 Coronavirus Outbreak do not apply to the HRSA Uninsured COVID 19 program. For the HRSA COVID-19 Uninsured Program, eligible treatment claims are determined as follows:

1. Treatment for services or discharges prior to April 1, 2020, will be eligible for reimbursement if the primary diagnosis is B97.29 OR if the primary diagnosis is pregnancy O98.5- and the secondary diagnosis is B97.29.

2. Treatment for services or discharges on or after April 1, 2020, will be eligible for reimbursement if the primary diagnosis is U07.1 OR if the primary diagnosis is

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pregnancy O98.5- and the secondary diagnosis is U07.1. HRSA is not providing coding guidance to providers. The program guidance is intended to define what services are eligible for reimbursement under the program.

E. Prior to the April 1, 2020, effective date for U07.1 COVID-19 diagnosis, the program guidelines

indicate that treatment would be eligible for reimbursement if B97.29 is the primary diagnosis. Can B97.29 be used for a primary diagnosis? v. ANSWER: For the HRSA COVID-19 Uninsured Program, the criteria for treatment to be

eligible for reimbursement is as follows: 1. Treatment for services or discharges prior to April 1, 2020, will be eligible for

reimbursement if the primary diagnosis is B97.29 OR if the primary diagnosis is pregnancy O98.5- and the secondary diagnosis is B97.29.

2. Treatment for services or discharges on or after April 1, 2020, will be eligible for reimbursement if the primary diagnosis is U07.1 OR if the primary diagnosis is pregnancy O98.5- and the secondary diagnosis is U07.1.

3. To address the usage of B97.29 as a primary diagnosis, we refer providers to recent guidance released by CMS: (see CR 11764 at: cms.gov/files/document/mm11764.pdf). This guidance explicitly allows for B97.29 to be included in any position on the claim.

4. The goal of the program is to provide consistent eligibility for reimbursement of COVID-19 treatment before and after April 1, 2020, when the U07.1 diagnosis code became effective. Prior to the effective date of the U07.1 code we are relying on the B97.29 code to identify claims where COVID-19 is the primary reason for treatment. HRSA is not providing coding guidance to providers. The program guidance is intended to define what services are eligible for reimbursement under the program.

5. HRSA is not providing coding guidance to providers. The program guidance is intended to define what services are eligible for reimbursement under the program.

F. Are ambulance providers and other emergency medical service providers eligible for

reimbursement for treatment services? Will claims for presumptive diagnoses be eligible for reimbursement under this program? vi. ANSWER: For the HRSA COVID-19 Uninsured Program, eligible treatment claims are

determined as follows: 1. Treatment for services or discharges prior to April 1, 2020, will be eligible for

reimbursement if the primary diagnosis is B97.29 OR if the primary diagnosis is pregnancy O98.5- and the secondary diagnosis is B97.29.

2. Treatment for services or discharges on or after April 1, 2020, will be eligible for reimbursement if the primary diagnosis is U07.1 OR if the primary diagnosis is pregnancy O98.5- and the secondary diagnosis is U07.1.

G. If a temporary member ID is valid for 30 days, can providers still submit a claim after the 30-day period is over?

vii. ANSWER: For professional and institutional outpatient – Temporary member ID will be valid for 30 days from date of service. Eligible claims can be submitted using the

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temporary member ID with date of service within the validity period. For example, if Patient A had a date of service of February 4, 2020, then the temporary ID assigned to her will be valid from February 4, 2020, through March 4, 2020.

1. For institutional inpatient – Temporary member ID will be valid from date of admission and expire 30 days from date of discharge. Eligible claims can be submitted using the temporary member ID with date of admission and date of discharge within the validity period. For example, if Patient B had a date of admission of February 4, 2020, and date of discharge of February 20, 2020, then the temporary member ID assigned to him will be valid from February 4, 2020, through March 20, 2020.

2. NOTE: If an uninsured individual was treated in the ER before being admitted as an inpatient, use the date of admittance to the ER as the inpatient admittance date.

3. Claims can still be submitted after the date of validity, but the temporary member ID must be eligible for the date of service or admittance.

Q. Does the Claims processing system have rules for Covid-19?

• Edits done relative to COVID-19 and/or Telehealth:

• CA Medicaid 837I/837P Payer ID CAMC1/SKCA0 (excludes Medicare crossovers and SOFP/PACT/FQHC/RHC) SOURCE: Medi-cal manual.

o HCPCS U0001, U0002, 87635, 86328 and 86769 maximum units allowed is 2. o HCPCS U0001, U0002 and 87635 may not be billed concurrently on the same claim. o CPT 86328 and 86769 may not be billed concurrently on the same claim. o HCPCS U0003 and U0004 may not be billed concurrently on the same claim with each

other AND may not be billed with CPT/HCPC 87635, U0001 and U0002. o HCPCS U0003 and U0004 – if modifier is present, only modifiers allowed are 33, 59,

90 and 99.

• CO Medicaid 837P Payer ID 77016 – When the place of service is 02, the corresponding CPT/HCPCS must be listed on the attachment. SOURCE: https://www.colorado.gov/hcpf/provider-telemedicine

• All Payers, 837I – If condition code DR is present, at least one of the following diagnosis codes is required - B97.29; U07.1; Z03.818; Z20.828. SOURCE: https://www.nubc.org/nubc-announcement-covid-19-claims

• UHC and Affiliates 837P – Claim must contain a covered Telehealth CPT/HCPCS code when modifier GT, GQ or 95 is present. SOURCE: https://www.uhcprovider.com/content/dam/provider/docs/public/policies/index/oxford/telemedicine-ohp.pdf AND https://www.uhcprovider.com/content/dam/provider/docs/public/policies/comm-reimbursement/COMM-Telehealth-and-Telemedicine-Policy.pdf

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Financial Services Q. In response to covid 19 we would like to investigate the use of department configuration vs workstation configuration as outlined in EPIC Electronic Payments Setup and Support Guide.

• Experian/PaymentSafe supports both department and workstation configuration. Clients using Epic have successfully been able to work with their network and epic teams to offer their staff the ability to work from including the use of the Ingenico credit card devices.

Q. Can our hospitals and offices take the credit card devices home to use in response to covid 19?

• Experian and AxiaMed payment solution powers home-based business office employees to securely accept patient payments through Payment Fusion payment terminals (Ingenico devices). If your organization already utilizes PaymentSafe and has the Ingenico devices employees with remote access to your patient accounting system will be able to utilize these devices from their homes.  We have already been in contact with several of our clients to enable their home-based employees to handle secure patient payments and have assisted these clients in their increased efforts to enable home-based collections.

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MyResponse In an effort to assist our clients through the Covid-19 pandemic, we have added a Telehealth widget to our responses. This will help you quickly and easily determine any patient cost shares associated with telehealth services. The widget will appear on the lower right side of the My View tab and has been added to all standard My Responses.

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Eligibility Q. Can Experian Health access telemedicine/telehealth data in the Eligibility Verification response?

• Yes, if the payer returns that data currently.

Q. How can I see the telehealth benefits in my Eligibility Verification response?

• [Epic users] We have normalized several payers for our P271 response moving from the 98 STC benefit to 9 Other Medical to make it easier for Epic clients to pull benefit information to the top of the response.

• For eCare NEXT and OneSource users, Telehealth is a widget that can be added to MyResponse. • We continue to normalize payer responses in order to pull this information out more concisely.

Q. Is there an official service code for telehealth or telemedicine? • No, there is currently not a telehealth/telemedicine STC in the current X12 version, though including a

specific code is planned for future versions. • Epic: For Epic client currently Experian Health can normalize responses to return this as STC 9, other

medical, in message segments and/or under STCs 96 and/or 98 where possible.

Q. What is the best way a provider can ask for telehealth benefits in an Eligibility Verification Request?

• Utilizing a STC of 30 (General/Health Benefit Plan) or 98 (Professional Physician- Visit – Office) with an appropriate NPI is the most efficient method.

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Examples of Telehealth messages

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M

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Definitions Q. What is telemedicine/telehealth?

• The remote delivery of health care services and clinical information using telecommunications technology, including internet, wireless, satellite and telephone media.

Q. What is telehealth? • A collection of means or methods for enhancing health care, public health, and health education delivery

and support using telecommunications technologies. • Telehealth encompasses a broad variety of technologies and tactics to deliver virtual medical, health, and

education services. • The purpose of telehealth is to increase cost efficiency, to reduce transportation expenses, to improve

patient access to specialists and mental health providers, and to improve quality of care and communication among providers.

Q. What are the differences between telehealth and telemedicine? • Telemedicine is the use of technology to electronically exchange medical information and provide medical

services to patients from a distance. • Telehealth encompasses a broader definition of remote health care that doesn’t always involve clinical

services, but can also be preventative, educational and health related administrative activities.

Q. Why are Telemedicine and Telehealth important? • Pre-COVID-19 Telehealth was already emerging as a critical component of the healthcare crisis solution as

it increases access to healthcare and allows remote patients to more easily obtain clinical services. • With the COVID-19 crisis, providers are utilizing telehealth/telemedicine services in order to maintain

social distancing guidelines and still provide necessary services to patients.