Medicaid Managed Care Telehealth Expansion Medicaid Managed General

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Medicaid Managed Care Telehealth Expansion Medicaid Managed General Billing during. Care COVID-19

Medicaid Managed Care Telehealth Expansion Medicaid Managed General Billing during. Care COVID-19

Illinois Association of Medicaid Health Plans 7 MCO Members (2020): County. Care – Health.

Illinois Association of Medicaid Health Plans 7 MCO Members (2020): County. Care – Health. Choice Illinois, Cook County Only Next. Level Health – Health. Choice Illinois, Cook County Only BCBSIL – Health. Choice Illinois, MMAI Molina Healthcare – Health. Choice Illinois, MMAI Meridian Health a Centene Company – Health. Choice Illinois, MMAI Illini. Care an Aetna CVS Company – Health. Choice Illinois, MMAI Humana – MMAI

Telehealth Basics

Telehealth Basics

IAMHP has created a telehealth billing guide that can be found here: https: //iamhp.

IAMHP has created a telehealth billing guide that can be found here: https: //iamhp. net/providers IAMHP’s Telehealth Basics All services billed and provided via telehealth must be clinically appropriate to provide via telehealth. Telehealth services may generate 2 claims: 1 for the originating site (where the member is located) and 1 for the Distant site (where the clinician is located. ) Distant sites providers will use the GT modifier and the 02 place of service.

Visual and audio is preferred via Skype, Face. Time, Zoom, etc. Equipment you need

Visual and audio is preferred via Skype, Face. Time, Zoom, etc. Equipment you need to provide telehealth Telephone only is accepted when appropriate. Full telehealth equipment or coordination between the originating site and distant site may provide a more comprehensive appointment.

You no longer need to have an existing relationship with a member to provide

You no longer need to have an existing relationship with a member to provide telehealth services. PT, OT, ST, Dentists, and BH providers are now able to provide telehealth services. Medicaid now covers virtual check-ins, portal/ E-visits, and remote evaluations. Members can now receive telehealth services while they are located at home Changes to Medicaid Telehealth Coverage

Originating Site Billing

Originating Site Billing

The originating site is WHERE THE PATIENT IS LOCATED Hospice Providers use Revenue

The originating site is WHERE THE PATIENT IS LOCATED Hospice Providers use Revenue Code 0657 in conjunction with HCPCS code Q 3014. Basic Claim Requirements Hospitals billing requirements for telehealth have not changed with regards to the originating site. Practitioners’ offices use HCPCS code Q 3014. The Place of Service should be where the member is i. e. a mobile unit, FQHC, or nursing home. More guidance regarding other facilities (e. g. nursing homes, SLFs, residential treatment, etc) and the revenue codes that should be utilized are forthcoming. If the originating site is the patient’s home, no originating site claim will be submitted

Encounter Rate Clinic Guidance When ERCs are serving as the originating site they should

Encounter Rate Clinic Guidance When ERCs are serving as the originating site they should bill the T 1015 and HCPCS Q 3014. Unlike other originating sites, an ERC will be paid their encounter rate. The ERC is responsible for reimbursing the distant site.

Distant Site Billing

Distant Site Billing

The Distant Site is where the clinician is located Providers should follow standard billing

The Distant Site is where the clinician is located Providers should follow standard billing practices including billing with IMPACT registered providers and only billing for HCPCS/CPT codes that are covered by IL Medicaid. Providers should bill using place of service 02 when serving as a distant site regardless of where the member is located. Providers should use the GT modifier on all service codes. Basic Telehealth Claim Requirements

Encounter Rate Clinic Guidance For physical health services the ERC should bill using the

Encounter Rate Clinic Guidance For physical health services the ERC should bill using the T 1015 code, modifier GT, and Place of Service 02. For Mental health services the ERC should use the T 1015 code, the appropriate behavioral health modifier first, and the GT modifier second. Place of service should be 02.

Dental Telehealth Services Bill the appropriate D 9995 or D 9996 in conjunction with

Dental Telehealth Services Bill the appropriate D 9995 or D 9996 in conjunction with D 0140. Place of service should be 02.

The following services and corresponding activity codes are billable to Medicaid for telehealth

The following services and corresponding activity codes are billable to Medicaid for telehealth services: SUPR Guidance 01 - Individual 04 - Continued Stay Review and Discharge Planning 05 - Treatment Planning 11 - Psychiatric Evaluation 12 - Medication Monitoring 70 - Admission Assessment 71 - Discharge Assessment For billing Health Plans, SUPR providers ARE required to bill with Place of Service 02 and the GT modifier, this is to ensure the originating site claims pays appropriately. This guidance differs from how providers bill HFS.

All Group A, B and C services are eligible for telehealth EXCEPT: - Group

All Group A, B and C services are eligible for telehealth EXCEPT: - Group psychotherapy - Mobile Crisis Response - Crisis Stabilization For Health Plans, CMHCs, BHCs and SUPR providers ARE required to bill with Place of Service 02 and the GT modifier, this is to ensure the originating site claims pays appropriately. This guidance differs from how providers bill HFS CMHC & MH Guidance

New Codes & When to Use Them

New Codes & When to Use Them

Virtual Check-Ins & Remote Evaluations (established patients only)

Virtual Check-Ins & Remote Evaluations (established patients only)

Portal /E-Visits: (established patients only)

Portal /E-Visits: (established patients only)

Remote Inpatient & ED Evaluations

Remote Inpatient & ED Evaluations

Modifiers & Place of Service New Codes should still utilize the GT modifier. The

Modifiers & Place of Service New Codes should still utilize the GT modifier. The place of service for the new codes should be 02.

Additional Resources

Additional Resources

IAMHP Key Contacts

IAMHP Key Contacts

Subscribe and Learn More

Subscribe and Learn More

IAMHP Webinars

IAMHP Webinars

Samantha Olds Frey, CEO IAMHP Contact Information • samantha@iamhpteam. org Alaina Kennedy, COO •

Samantha Olds Frey, CEO IAMHP Contact Information • samantha@iamhpteam. org Alaina Kennedy, COO • alaina@iamhpteam. org

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