telemedicine and first quarter policy updates€¦ · quarter policy updates april 25, 2019 yvette...
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Telemedicine and First Quarter Policy Updates
April 25, 2019
Yvette Christopher, Director of Billing and Reimbursement
Ashley Ciardelli, Professional Provider Fee Schedule Lead1
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Objectives
o To review and highlight BWC’s payment for telemedicine
o Highlight first quarter policy updates to the Billing and Reimbursement Manual (BRM)
• Hospital services
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Telehealth Telemedicine
Remote
monitoring
Communication
technology-
based services
Store and
forward
eHealth
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Telemedicine
o Subset of telehealth
o Requires the use of synchronous or live audio/visual conferencing
o Does not include:
• Audio-only telephone.
• Email or fax.
• Store and forward.
• Communication technology-based services. 4
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Telemedicine Providers
o Ohio specific requirements
• Ohio license
• Telemedicine certificate
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Telemedicine Providers
o Check state-licensure requirements
• Reciprocity
• May require a license in the state
o Reimbursement is contingent upon meeting licensure requirements.
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BWC Telemedicine Policy
o Parameters
• Synchronous telemedicine only as defined
• Location of care (originating and distant sites)
• Billing
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Telemedicine Location Limitso Distant site: The location of the physician or
health-care provider that’s providing medical services.
o Originating site: The location where the patient is physically located at the time when services are being performed.
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BWC Telemedicine Policy
o Eligible originating sites
• Provider office/clinic
• Hospital
• Nursing home
• Private location at the employer’s site
o Not eligible: Home
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Telemedicine Billing Requirementso Place of Service Code 02 – telemedicine
• Distant-site use only
• Originating site bills actual place of service for the location.
o Modifier-95: Synchronous telemedicine service
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Telemedicine
o BRM-09 Telemedicine policy
o Originating facility fee
o 41 services on the professional provider fee schedule
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Updates to the BRM
o Quarterly updates
• Published on the last business day of each quarter
o Goal: To reformat policies into the technical format and provide ease of provider navigation
o Policies can be new, revised, reformatted or republished.
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o New/Revised/Updated Policies
Locating BRM Policies
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First Quarter Policy Updates
o Hospital Services Policy
o Timed-code Service Policy
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Accessing Past Webinars
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Hospital Policy
o Updated to technical-policy format
o Key changes
• Notification of emergency inpatient hospitalizations
• Accepted bill types
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Notification
o Required data elements • Injured worker’s full name
• Injured worker’s claim number, if available
• Date of emergency admission
• Date of notification
• Hospital name
• Hospital contact name and title
• Hospital contact phone number
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Notification
o Acceptable forms of notification
• Fax
• Person-to-person phone conversation
o Voice message does not satisfy the requirement.
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Hospital Policy
o Electronic submission of facility bills (111 or 131)
o Bill types – hard-copy submission only
• Late charges (01X5)
• Replacement of prior bill (01X7)
• Void (01X8)
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Upcoming Events
Date Title
April 26 -27 BWC’s Medical and Health Symposium
May 28 Best clinical practices for opioid use
June 26 Understanding workers’ compensation International
Classification of Diseases coding for the provider’s office
July 2 Navigating the Billing and Reimbursement Manual Quarterly
update - Second Quarter
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Questions
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BWC Contacts
Contact information following today’s webinar
• 1-800-477-2292
• Via chat from our website, www.bwc.ohio.gov
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Looking for reminders, updates, tips and
breaking news on workers’ compensation?
Follow us on Twitter!twitter.com/ohiobwc
@OhioBWC
facebook.com/ohioBWCFraud ohiobwcfraud.wordpress.com
Our special investigations department also uses social media in its
efforts to detect and deter workers’ compensation fraud