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Telemedicine Services During the COVID-19 Crisis

NEW TELEHEALTH POLICIES EXPAND COVERAGE FOR HEALTHCARE SERVICES

In order to ensure that all of our members have needed access to care, we are increasing the scope and scale of our use of telehealth services for all products for the duration of the COVID-19 emergency.  These coverage expansions will benefit not only members who have contracted or been exposed to the novel coronavirus, but also those members who need to seek care unrelated to COVID-19 and wish to avoid clinical settings and other public spaces.

Effective immediately, the policies we are implementing include:

  • Continuation of zero member liability (copays, cost sharing, etc.) for care delivered via telehealth*
  • Any services that can be delivered virtually will be eligible for telehealth coverage
  • All prior authorization requirements for telehealth services will be lifted for dates of service from March 17, 2020 through July 25, 2020
  • Telehealth services may be delivered by providers with any connection technology to ensure patient access to care

*Please note: For Health Savings Account (HSA)-Qualified plans, IRS guidance is pending as to deductible application requirements for telehealth/telemedicine related services. 

Providers who have delivered care via telehealth should reflect it on their claim form by following standard telehealth billing protocols in their state. For further billing and coding guidance for telehealth services, we recommend following what is being published by:

We believe that these measures will help our members maintain access to quality, affordable healthcare while maintaining the CDC’s recommended distance from public spaces and groups of people. 

This guidance is in response to the current COVID-19 pandemic and may be retired at a future date.

Updated 5.15.2020

Telehealth Expansion

In order to ensure that all of our members have needed access to care, we are increasing the scope and scale of our use of telehealth services for all products for the duration of the COVID-19 emergency.

These coverage expansions will benefit not only members who have contracted or been exposed to the novel coronavirus, but also those members who need to seek care unrelated to COVID-19 and wish to avoid clinical settings and other public spaces.

We believe that these measures will help our members maintain access to quality, affordable healthcare while maintaining the CDC’s recommended distance from public spaces and groups of people.

  • MEDICARE ADVANTAGE: Effective March 1 and throughout the national public health emergency, Medicare will pay physicians for telehealth services at the same rate as in-office visits for all diagnoses, not just services related to COVID-19.

Effective immediately, the policies we are implementing include:

  • Continuation of zero member liability (copays, cost sharing, etc.) for care delivered via telehealth*
  • Any services that can be delivered virtually will be eligible for telehealth coverage
  • All prior authorization requirements for telehealth services will be lifted for dates of service from March 17, 2020 through June 30, 2020
  • Telehealth services may be delivered by providers with any connection technology to ensure patient access to care

*Please note: For Health Savings Account (HSA)-Qualified plans, IRS guidance is pending as to deductible application requirements for telehealth/telemedicine related services.

No, CMS has approved the use of any telephonic or video channel to deliver virtual care.

However, we are encouraging providers to participate in a formal telehealth platform, as it serves both to protect patient privacy through secure connections, as well as give providers training on best practices related to delivering care remotely.

Qualified providers who have delivered care via telehealth should reflect it on their claim form by following standard telehealth billing protocols in their state.

Medicaid providers must follow state specific guidelines for telehealth billing.

Office-based physicians should use their usual place-of-service (POS) code to be paid at the non-facility rate for telehealth services and add modifier 95 to telehealth claim lines. Telehealth services billed using POS code 02 (telehealth) will be paid at the facility rate.

Any provider claim with a date of service beginning 3/17/20 through 6/30/20 will have $0 member liability.

Any provider claim with a date of service beginning 3/17/20 through 6/30/20 will have $0 member liability applied.

However, any provider claim with the following modifiers regardless of location will also be in scope:

  • Modifier 95
  • Modifier GT
  • Modifier GQ

Office-based physicians should use their usual place-of-service (POS) code to be paid at the non-facility rate for telehealth services and add modifier 95 to telehealth claim lines. Telehealth services billed using POS code 02 (telehealth) will be paid at the facility rate.

No. If you have access to virtual health visits in your practice already, please simply continue to utilize that service.

However, Centene has partnered with two telehealth vendors, Babylon and Teladoc, to deliver virtual care to our members so that they may avoid public spaces without foregoing needed care.

While CMS has approved the use of any telephonic or video channel to deliver virtual care, we are encouraging our providers to contract with one of our vendor partners.

Participation in a formal telehealth platform serves both to protect patient privacy through secure connections, as well as give providers training on best practices related to delivering care remotely.

Please contact Teladoc directly to begin the contracting process:

Teladoc

888-835-2362 (Option 5)

teladoc.com/providers

The timeline to implement virtual visits, which normally takes 4-6 months, could be implemented in 18 to 53 days depending on the regulatory environment, provider network and other state-specific factors.

Any clinician that is permitted to bill Medicare for evaluation and management (E&M) codes can bill for telehealth services. Distant sites (where the clinician is located) can include any health care facility including FQHCs and rural clinics. Home health agencies cannot bill for telehealth. Hospices can only bill for telehealth for their recertifications.

Teladoc Telemedicine/Telehealth Services

Visit Teladoc.com/coronavirus for the most current information regarding telemedicine services.

Yes. Consistent with recommendations from the CDC, if the doctor observes symptoms and risk factors that suggest COVID‐19, s/he now has the ability to add a notation to the “excuse note” advising the patient to self‐quarantine for 14 days. (Clients continue to have the ability to suppress excuse note capabilities at the group level.)

No. Given demand for medical care during this outbreak, we are not able to re‐evaluate healthy patients and issue return‐to‐work notes.

Yes. During the COVID‐19 outbreak, our doctors have the ability to approve 30‐day prescription refills for chronic conditions whenever medically appropriate to do so. Maximum prescription refill duration will be 90 days. Physicians continue to evaluate clinical appropriateness, consider patient safety, and use professional judgement when approving any refill requests.

We are following the evolving guidance for use of ICD‐10 codes. Because Teladoc Health does not test and therefore cannot diagnose COVID‐19, suspected cases are coded using appropriate ICD‐10‐CM codes related to the upper respiratory and related symptoms observed and, as applicable, secondary ICD‐10‐CM codes such as: Z20.828 for “Contact with and (suspected) exposure to other viral communicable diseases,” Z20.89 for “Contact with and exposure to other communicable diseases,” Z20.9 for “Contact with and exposure to unspecified communicable disease.” As patients self‐report to our doctors that they have tested and are confirmed as COVID positive, we will utilize the new ICD‐ 10‐CM codes for respiratory illness with confirmed COVID‐19 diagnosis such as J12.89 for “Pneumonia, confirmed due to COVID‐19,” J20.8 for “Acute bronchitis confirmed as due to COVID‐19, and J22 for “Lower respiratory infection, confirmed as due to COVID‐19”, and J40 for “Bronchitis, not specified as chronic or acute, confirmed as due to COVID‐19.”

Increased demand is taxing the entire healthcare system and virtual care is not immune to that trend. Where public health officials and healthcare organizations have encouraged the use of virtual care and communities have implemented mobility restrictions for citizens, we have seen visit volumes, questions, and registration requests rapidly escalate.

As we serve members at unprecedented scale, our platform and operational functions are performing well. Our technology remains stable; our member service agents offer a first‐line of information and reassurance; and our doctors are taking care to spend more time with patients, answering questions and assessing needs.

We have seen response times exceed our normal standards – moving from minutes to hours in many parts of the country. To address elevated demand and surges in visit requests, we are implementing three key strategies:

  • Optimizing physician capacity: We are grateful for and impressed by the dedication of our doctors who working tirelessly to serve rising demand. To streamline the work for our doctors, we have enhanced our technology to help them efficiently address COVID‐19 cases and supply patients with home care information, automate suspected COVID‐19 case reporting, and approve 30‐day prescription refills and extend 90‐day refills where appropriate. To serve escalating demand, we are rapidly onboarding more high‐quality board‐certified physicians to our network and activating our existing physician network to drive increased consult availability.
  • Temporarily streamlining how people access and receive care: At this time, we are focused on serving on‐demand visits and have paused the scheduled visits option. Video visit requests may be converted to phone visits for faster response. To accelerate customer service, we are encouraging members to make visit requests by mobile App or web rather than by phone for efficient response. For those who choose to call Teladoc, we have implemented technology that enables a callback from a service representative rather than waiting on hold. And after a visit request is initiated, members are encouraged to be available and ready to promptly answer our callbacks, as requests will be considered cancelled after 2 unanswered callback attempts by a doctor.
  • Managing member expectations and experience: We realize that long wait times can be frustrating, especially when you’re not feeling well. By setting realistic expectations with members upfront and throughout their journey, we have helped people understand these challenges and be patient as they await care from the safety of their homes. Our phone, website, and App messaging transparently share that we are experiencing high visit volumes and provide useful information about COVID‐19 while members wait to connect with a doctor. Service communications are being deployed to assure waiting members that they remain in queue and periodic outreach asks members to confirm that they still need to talk to doctor, helping us to efficiently allocate doctors’ time to active, unabandoned visits requests.