Billing codes update; IHCP seeks Provider Seminar input
By Carol Hoppe, CPC, CCS-P, CPC-I
MedLucid Solutions

Two noteworthy changes occurred this week. They are reflected in the updated telemedicine billing decision trees for Indiana and for Indiana FQHC/RHCs.

CPT times may be used if billing is based on total time during the PHE
The latest CMS interim rule, released on April 30, now allows for the use of CPT times if billing an office/outpatient E/M based on total time during the PHE. Here is the background from CMS:   
        Time Used for Level Selection for Office/Outpatient Evaluation and Management Services Furnished Via Medicare Telehealth
In the March 31st COVID-19 IFC (85 FR 19268 through 19269), for the duration of the PHE for the COVID-19 pandemic, we revised our policy to specify that the office/outpatient E/M level selection for office/outpatient E/M services when furnished via telehealth can be based on MDM or time, with time defined as all of the time associated with the E/M on the day of the encounter. We stated that currently there are typical times associated with the office/outpatient E/M visits, and that those times are what should be met for purposes of level selection. We stated that typical times associated with the office/outpatient E/M visits were available as a public use file here.

Members of the physician community have brought to our attention that the policy announced in the March 31st COVID-19 IFC relies on typical times listed in our public use file even when those times do not align with the typical times included in the office/outpatient E/M code descriptors. We agree that discrepancies between times can be confusing. We believe that, because the times are being used for the purpose of choosing which level of office/outpatient E/M CPT code to bill, the times listed in the codes themselves would be most appropriate for the purpose. Therefore, we are finalizing on an interim basis, for the duration of the PHE for the COVID-19 pandemic, that the typical times for the purposes of level selection for an office/outpatient E/M are the times listed in the CPT code descriptor. 

UHC updates telehealth audio-visual requirements
Starting May 11, 2020, telehealth visits for UnitedHealthcare (UHC) Medicare Advantage members, including DSNP members, must be an interactive audio-video visit (such as Zoom, FaceTime, Skype, Google Duo or dedicated telehealth solutions) to qualify for reimbursement, except for certain audio-only visits classified by CMS on May 1, 2020. Medicare fee schedule rates for audio-only evaluation and management codes (99441-99443) have been adjusted retroactively for dates of service March 1, 2020, or later, such that reimbursement aligns with in-office fee schedule rates for comparable codes.

Cost share for both covered interactive audio-video telehealth visits and audio-only telehealth visits will continue to be waived.

Waiving Cost Share for UHC Medicare Advantage Members
UHC is waiving cost share (copays, coinsurance and deductibles) for UnitedHealthcare Medicare Advantage plan members for all covered office-based professional services performed by both primary care physicians and specialists with dates of service starting May 11, 2020, until at least Sept. 30, 2020. Waiving cost share for primary care and specialty care can make it easier for members to get the care they need, however they choose to access it. 

This applies to all UHC Medicare Advantage members, including Group and all Special Needs Plan (SNP) members. More information about the Medicare Advantage cost share can be found here.

HCP seeks input for 2020 Provider Webinar 
The Indiana Health Coverage Programs (IHCP), the division of Indiana Health and Human Services Administration that oversees Indiana’s Medicaid plans, is seeking presentation topic suggestions for its 2020 Provider Seminar. 

Anyone interested in providing feedback should plan to attend an IHCP webinar this Wednesday, May 20, at 1 p.m. EDT. The webinar’s objective is to collaborate with providers about ideas for new topics and how to best present them.

Wednesday’s webinar will include a review of feedback on the 2019 IHCP Annual Provider Seminar and allow time for additional critiques. The rest of the webinar will discuss recommendations for the 2020 IHCP Annual Provider Seminar. All suggestions are welcome.

To participate in Wednesday’s webinar, go here to sign in. Ensure that Guest is selected, type your name, and click Enter Room.

Please note:
  • The audio will be voice-over-internet, so participants will need to use speakers or headphones to hear the presentation.
  • Prior to the webinar, participants can go here to test the connection. The test will prompt the user for any updates or add-ins needed to participate in the webinar.
  • Do not log in to the webinar using Citrix or a virtual private network (VPN) because these services will not be able to play back audio.
  • Download the Adobe Connect Mobile app if you wish to log in using your mobile device.

For those who cannot attend on May 20, a recording of the webinar will be posted later on the IHCP Live web page.