BUILDING TELEHEALTH CAPACITY for BEHAVIORAL HEALTH ... ... > Review Medicaid billing and reimbursement

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    Telehealth Billing & Reimbursement

    April 29, 2020

  • Northwest Mental Health Technology Transfer Center

    Our Role:

    Provide training and technical assistance (TA) in evidence-based practices (EBP) to behavioral health

    and primary care providers, and school and social service staff whose work has the potential to improve

    behavioral health outcomes for individuals with or at risk of developing serious mental illness in

    SAMHSA’s Region 10 (Alaska, Idaho, Oregon, and Washington).

    Our Goals:

    • Ensure availability and delivery of free, publicly-available training and TA to Region 10 providers.

    • Heighten awareness, knowledge, and skills of the workforce addressing the needs of individuals with mental illness.

    • Accelerate adoption and implementation of mental health-related EBPs across Region 10.

    • Foster alliances among culturally diverse mental health providers, policy makers, family members, and


  • The MHTTC uses affirming language to promote the

    promises of recovery by advancing evidence-based and

    culturally informed practices.

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    CHAT Box > We’ll share info about logistics

    > Let us know if you are having tech issues

    > To you: from our training team

    > From you: only visible to hosts/panelists

    > NOT for content-related questions (see next slide)

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    1. Type question into Q&A Window

    Questions – 2 options (participants are muted):

    Click Raise Hand in the Webinar Controls.

    The host will be notified that you've raised your hand.

    Click Lower Hand to lower it if needed.

    2. Raise hand (will be called on/unmuted in order)

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    > Will be shared in the chat box near the end & also emailed out

    > Helps the presenters plan future sessions

     There will NOT be certificates or CEUs for this series.

     Slides & resources WILL be posted after the session

    After today’s session Please complete the evaluation survey (LINK):

  • Today’s Presenters

    • Gail Kreiger, BSN

    Section Manager

    Medicaid Compliance Review and Analytics

    Medicaid Program Operations and Integrity

    • Catherine Britain

    Executive Director, Telehealth Alliance of Oregon

    Founding Board Member, Northwest Regional

    Telehealth Resource Center

  • Today’s Panelists

    • Brad Felker, MD VA Puget Sound Health Care System Professor, University of Washington Dept of Psychiatry & Behavioral Sciences

    • Marc Avery, MD Principal Consultant, Health Management Associates Clinical Professor of Psychiatry, University of Washington

    • Melody McKee, MS, SUDP Program Director, Behavioral Health Training, Workforce and Policy Innovation Center, Behavioral Health Institute

    • Cara Towle MSN RN MA Associate Director, Telepsychiatry University of Washington

  • Behavioral Health Institute (BHI)

    Training, Workforce and Policy Innovation Center

    The Behavioral Health Institute (BHI) Is a Center of Excellence where

    innovation, research and clinical practice come together to improve

    mental health and addiction treatment. The BHI established initial

    priority programs which include:

    • Improving care for youth and young adults with early psychosis

    • Behavioral Health Urgent Care Walk in Clinic

    • Expanded Digital and Telehealth Services

    • Behavioral Health Training, Workforce and Policy Innovation






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    > Review Medicaid billing and reimbursement for telehealth during the Covid19 public health emergency

    > Review Medicare billing and reimbursement for telehealth during the Covid19 public health emergency

    > Review private payer billing and reimbursement for telehealth during the Covid19 public health emergency

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    > Any information provided in today’s talk is not to be regarded as legal advice. Today’s talk is purely for informational purposes.

    > Always consult with legal counsel.

    > Presentation is based on information available as of 4/25/2020.

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    In the healthcare community the words telehealth and telemedicine are often used interchangeably.

    • For WA Medicaid:

    • Telemedicine per state law is defined as: the delivery of health care services through the use of HIPAA compliant interactive audio and video technology, permitting real-time communication between the patient at the originating site and the provider, for the purpose of diagnosis, consultation, or treatment.

    • Telehealth considered: an umbrella term that includes Telemedicine as well as other temporary policies, including technologies that may not be HIPAA compliant and may not be conducted through interactive audio- video exchange. Telehealth policies were implemented to expand the type of telecommunications that can be used to provide assessment, diagnosis, intervention, consultation, supervision and information in lieu of an in- person visit.

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    •Adhering to it’s current telemedicine policies, but added new telehealth policies that will be effective through the pandemic

    •Instructing providers to bill using the CPT or HCPC code that would be billed if the visit was in-person

    •Paying the same amount for a “tele” visit as it would for an in-person visit

    •Offering additional codes to be used, as required:

    •for telephone calls with new or established patients: 99441 - 99443

    •for on-line digital exchange vis patient portal: 99421 - 99423

    •for a brief virtual check-in telephone call, or texting, with an established patient: G2012

    •for “tele” contacts made outside of M-F 8-5; and on weekends: 99050 & 99051

    Refer to the BHFAQ for specifics on the policy, how to bill and who may bill.

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    • Read the entire BHFAQ some parts are general information ( PARTs V-VI) applicable to every provider/biller

    • Just like if you are billing for a BH in-person visit, know which benefit you are using and what you are billing for: o Is it a SERI encounter service that is reported/billed to an MCO, BHSO or ASO?

    Then bill according to PART l of the BHFAQ o Is it a service being billed to ProviderOne, you are an approved AI/AN provider and

    billing according to Part II of the FFS Mental Health Billing Guide? Then bill according to PART ll of the BHFAQ

    o Is it a service being billed to ProviderOne or a MCO and defined in Part I of the FFS MH Billing Guide?

    Then bill according to PART lll of the BHFAQ

    • Any service provided that meets the definition of telemedicine is billed using POS “02”. The use of a modifier is addressed in each specific PART of the BHFAQ

    • Any service being rendered using another telehealth technology use the POS specific to where the client is.... not the provider, and bill using the CR modifier if your EHR will support it

    • Although the MCOs and ASOs are to follow these “tele” policies, they may have different billing requirements so please follow any instructions they may provide

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    HCA has dedicated a section of its COVID-19 website covid-19 to behavior health providers.

    On this page you will find telehealth/ telemedicine Q&As and Webinars, including specifically: A telemedicine/ telehealth brief providers/telehealth-brief-for-COVID-03-2020.pdf

    Behavior health FAQ and-providers/behavioral-health-policy-and-billing-COVID- 19.pdf &

    OTP FAQ treatment-program-faq.pdf