Telehealth and Reimbursement
Telehealth Updates
Cigna Extending End Dates
Cigna’s interim COVID-19 coverage guidelines were set to expire on October 31, 2020. To further help ensure providers can continue to deliver care how and where patients want it, we are again extending our interim coverage guidelines, as follows:
- The cost-share waivers for COVID-19 diagnostic testing and related office visits are extended until January 21, 2021.
- The cost-share waiver for COVID-19 related treatment is extended until December 31, 2020.
- Most other interim accommodations (e.g., administrative relief policies) are extended until December 31, 2020.
Additional key updates
On October 30, 2020, we updated our dedicated COVID-19 provider web page to highlight the extended end dates for our interim coverage accommodations and to provide the latest information on a number of key topics, including our future-state Virtual Care Reimbursement Policy, our coverage and reimbursement of COVID-19 laboratory testing, and our coverage position for specific codes, including Z11.59 and 99072. We encourage you to visit the site to get all the latest information
Aetna Will Not Be Covering CPT 99072
- In Early September, the AMA created CPT code 99072 to compensate you for additional materials, supplies, and clinical staff time spent to follow COVID-19 related guidelines.
- Despite this approval, Aetna has decided that CPT 99072 will not be reimbursed as the company still considers these items and the additional time to be incidental.
KHF will provide additional payment policies concerning 99072 as they come in. Please contact Toni Williams at twilliams@khfirst.com with questions or concerns.
MAGMutual Telemedicine
Telehealth Practices during Coronavirus (COVID-19) Outbreak
- For MAGMutual customers, telemedicine is covered but they must be an established patient, and the provider must also be licensed in the state in which they are providing care.
From The Children’s Care Network: TCCN Telehealth Resources
We have been receiving a lot of inquiries about rapid implementation of telehealth in practices. Click HERE to access a list of some quick resources.
We also have the more in-depth Telemedicine Playbook that was developed last year, which can be found here.
Telehealth Payor Grid—Updated 7/28/20
Click here to download the PDF outlining CPT codes for all major commercial payors!
Telehealth Payor Cheat Sheet—Updated 4/13/20
Click here to download the Word document outlining updates for all major commercial payors!
Kids Health First Telemedicine Informed Consent Form
Click here to download a sample form to use in your practice when performing telemedicine services
Mid-level providers
- Physicians are allowed to monitor their mid-level providers using technology during the pandemic
*This means that the mid-level providers do not have to physically be in the same location as the physician to treat patients.
Reimbursement
As expected, several practices are having issues with their claims. Please reach out is assistance is needed.
- WellCare is working to update their system to pay telemedicine claims without the reduction, however this will take some time. In the interim, WellCare is completing weekly claims reviews and adjusting telemedicine claims to pay the additional amount. As a result providers will receive one payment at the reduced rate and a separate payment with the additional amount. This only applies to telemedicine claims billed with place of Service 02 for DOS after 3/17/2020 that have paid. Any telemedicine claim that has been denied will need to follow the proper dispute/appeals process.
- We are waiting on a response from WellCare on whether or not the provider can initiate the reprocessing of the claims that were underpaid.*
- Patient Responsibility: Please make sure that payors are reimbursing the providers for any patient responsibility that was waived.
Please send any questions to payorconcerns@khfirst.com
FDA Approved List of COVID-19 Testing Manufacturers
Click here to see the full list. Payors have not yet listed any preferred vendors as of 05/11. As updates occur we will notify practices.