News

With the COVID-19 pandemic continuing to impact patients, communities, businesses and medical providers, I wanted to share the latest Rapid Response efforts.  We will be launching a new web site for the community, colleagues and civic leaders to share their appreciation for physicians.  We will receive and distribute N95 and KN95 masks and face shields while we continue to provide daily updates for our members via our Physician Playbook, COVID-19 resources on ladocs.org and much more. 
 

Telemedicine Q&A

Many of our members continue to ask telehealth versus telephonic care?  What is covered?  What isn’t?  LACMA now has a partnership with the Center for Connected Health Policy to provide our members, in addition to CMA and CMS updates, timely news.  Below are some of the questions physicians ask:

Which state Medicaid programs cover telemedicine?

Currently, all state Medicaid programs, except for Massachusetts, Iowa, and Rhode Island have some coverage for telemedicine services. Check your state Medicaid program site, program information, or your state policy page at the National Telehealth Policy Center for details.

What types of telemedicine are covered?
 The most covered form of telemedicine is live video telemedicine (think video chat).  Some states additionally cover store-and-forward telemedicine, and remote patient monitoring, or even just phone consultations – but often place restrictions on this coverage (like only covering store-and-forward for certain specialties). Currently, 9 state Medicaid programs pay for store-and-forward telemedicine in some form and 16 programs cover remote patient monitoring.

California Update:
Medi-Cal allows providers to decide what modality, live video or store-and-forward, will be used to deliver eligible services to a Medi-Cal enrollee as long as the service is covered by Medi-Cal and meets all other Medi-Cal guidelines, and policies, can be properly provided via telehealth, and meets the procedural and definition components of the appropriate CPT or HCPCS code.  Specific to telephonic care:  Telephonic services must be reimbursed when provided by specific entities during or immediately following an emergency, subject to the Department obtaining federal approval and matching funds.

How do I bill telemedicine services?
While billing guidelines for telemedicine vary from state to state, we’ve found that many state Medicaid programs follow the example of Medicare. So, you would bill the appropriate CPT/HCPCS code (once you verify it’s covered via telemedicine) and then add on the GT modifier to indicate the service was done via telemedicine. Again, this is the general trend, but make sure you verify billing guidelines with your Medicaid department before submitting a claim.

How much will I get paid?
In general, Medicaid programs seem to be reimbursing for telemedicine services at the same rate as in-person services. So, if you’re billing a standard 99213 E/M code with the GT modifier, it’s likely your Medicaid will just reimburse at your standard rate for 99213.
 
I need help with Medicaid manual terms: hub site, spoke site, originating site, distant site. What does these mean and why are they important to telemedicine?
 
All these terms describe the location of the patient or provider at the time of the telemedicine service. Spoke site or originating site usually describe the location of the patient at the time of the telemedicine visit. The hub or distant site describe the location of the healthcare provider who’s consulting or providing treatment to the patient.
 
It’s important to pay attention to how your Medicaid program defines these terms and what restrictions they place on them. For example, does your program say that only hospitals or provider offices qualify as eligible spoke or originating sites? That means a patient needs to be located at one of those sites to do a telemedicine visit, and cannot do the visit from their home. Right now, 24 states and DC don’t have any specific requirements for the patient location and 25 states specifically recognize the patient’s home as an eligible originating or spoke site. And more states are moving in that direction to expand to eliminate restrictions on where the patient must be at the time of the visit.

Which of my Medicaid patients can do telemedicine?
In most states (82%), as long as the provider and patient are meeting all the other guidelines (doing the visit from an eligible originating site, delivering a covered health service, etc.), any Medicaid beneficiary should be eligible for telemedicine. A few states, however, do make telemedicine coverage dependent on where a patient lives. For instance, Idaho requires Medicaid patients to be in a rural area. Other states may require the patient to live at least X miles away from the provider in order to qualify for telemedicine coverage.

Which providers can practice telemedicine?
While Medicaid will reimburse physicians for telemedicine care in most states, many programs restrict what other healthcare providers are eligible to do telemedicine. Currently, 15 states and DC don’t have any stated restrictions on the type of healthcare provider (check to see if your state is one of the lucky ones!). The rest of the states specifically list out eligible providers. And in 4 states, Medicaid limits telemedicine coverage to physicians only.

Are the Medicaid guidelines for telemedicine likely to change any time soon?
Telemedicine policy is changing rapidly, so there’s a good chance your state’s Medicaid coverage for telemedicine could Change soon. The best way to stay-up-to-date is to keep in touch with your Medicaid rep, have the latest Medicaid manuals on file, and bookmark the resources we’ve provided.

How do I set up my home office for safe and effective telehealth service?
If you are looking for a quick tutorial on how to set up your home virtual telehealth office click here.

We appreciate everyone doing their part during this crisis. Whether it's working the frontline, handling inbound calls or simply social distancing to help save lives.

We invite you to take the time to relax, recharge and reconnect with us!

Join us on Thursday, April 9, 2020, at 6:30 pm to try your hand at games like Heads Up or I Never. It will be a cool and casual ONLINE gathering with friends and colleagues, both old and new.
 

For more details and to RSVP, please email Vitellio.

To RSVP to the Town Hall, please email Lisa Le at lisa@lacmanet.org

This meeting will be held virtually through Zoom. 
Details will be sent upon registration.