By Carol Hoppe, CPC, CCS-P, CPC-I
MedLucid Solutions
Last week, the Centers for Medicare and Medicaid Services took some actions applicable to federally qualified health centers (FQHCs) and rural health centers (RHCs). My
Telehealth Decision Tree for ISMA has been updated to reflect the following changes:
For telehealth distant site services furnished
between Jan. 27, 2020, and June 30, 2020, continue to bill with regular codes as you normally would
with modifier “95” (Synchronous Telemedicine Service Rendered via Real-Time Interactive Audio and Video Telecommunications System) on the claim.
- RHCs will be paid at their all-inclusive rate (AIR), and FQHCs will be paid based on the FQHC Prospective Payment System (PPS) rate.
- Payment to RHCs and FQHCs for distant site telehealth services is set at $92.
- These claims will be automatically reprocessed in July when the Medicare claims processing system is updated with the new payment rate. RHCs and FQHCs do not need to resubmit these claims for the payment adjustment
For telehealth distant site services furnished
between July 1, 2020, and the end of the COVID-19 PHE, RHCs and FQHCs will use an RHC/FQHC specific G code,
G2025, to identify services that were furnished via telehealth. RHC and FQHC claims with
the new G code will be paid at the $92 rate.
Like other health care providers, during the COVID-19 PHE, CMS will pay all of the reasonable costs for any service related to COVID-19 testing, including applicable telehealth services, for services furnished beginning on March 1, 2020. For services related to COVID-19 testing, including telehealth,
RHCs and FQHCs must waive the collection of co-insurance from beneficiaries. For services in which the coinsurance is waived,
RHCs and FQHCs must put the “CS” modifier on the service line. RHC and FQHC claims with the “CS” modifier will be paid with the coinsurance applied, and
the Medicare Administrative Contractor (MAC) will automatically reprocess these claims beginning on July 1. Coinsurance should not be collected from beneficiaries if the coinsurance is waived.
IHCP addresses telemedicine, coding for COVID-19
Also, Indiana Health Coverage Programs (IHCP) released two bulletins this week that are important for physician practices who care for Indiana Medicaid patients:
BT202049 – IHCP COVID-19 Response: Telemedicine FAQs as of April 21
BT202048 – IHCP COVID-19 Response: IHCP Provides Coding Guidance for COVID-19