Medicaid (Apple Health)
New and updated CMS coding guidance (June 2020)
The Washington State Health Care Authority has released guidance, including CPT codes, to help address your questions on billing Apple Health (Medicaid) fee-for-service programs and managed care organizations for services including telehealth: Apple Health (Medicaid) clinical policy and billing for COVID-19. (Updated May 1, 2020)
Note: The FAQ specifies that telemedicine needs to be delivered via HIPAA-compliant communications; however, the federal government announced that it has relaxed HIPAA rules for health care providers using telehealth in response to COVID-19. See COVID-19 Temporary Legal Changes.
Additional Medicaid telehealth reimbursement guidance and resources:
On April 30, 2020, CMS issued an interim final rule that builds on the previous regulatory waivers and flexibilities issued on March 17, 2020 and March 30, 2020. These temporary waivers and flexibilities remove barriers so health care systems and physicians can better respond to the COVID-19 pandemic.
The Provider Page (of the HHS Telehealth Toolkit for Providers and Your Patients) contains comprehensive information on the telehealth waivers and other flexibilities, including HIPAA, cost sharing, and more. It also provides information on billing and reimbursement, legal considerations, planning your telehealth workflow, and how to prepare your patients for telehealth.
Of note: The HHS Office of Inspector General notified physicians and other practitioners that they will not be subject to sanctions for reducing or waiving any cost-sharing obligations that beneficiaries may owe for telehealth services (March 17, 2020).
Additional Medicare telehealth reimbursement guidance and resources:
The Washington State Office of the Insurance Commissioner issued an emergency order on March 5, 2020, indicating that a carrier cannot deny telehealth reimbursement for use of a non-traditionally HIPAA-compliant platform.
America's Health Insurance Plans has compiled this list of individual insurance carriers' response to the COVID-19 outbreak. While not all carriers operate in Washington state, the list details which are offering reimbursement and waivers for COVID-19-related treatment, including telehealth. (Updated regularly)
The Washington State Department of Labor and Industries has announced a temporary telehealth policy. This policy will allow physicians and health care providers to treat injured workers from their homes with the goal of supporting the containment of COVID-19. Read the policy in full. (March 10, 2020)
The U.S. Department of Health and Human Services, through the Health Resources and Services Administration, launched a new COVID-19 Uninsured Program Portal, allowing physicians and providers who have conducted COVID-19 testing or provided treatment for uninsured COVID-19 individuals on or after Feb. 4, 2020 to submit claims for reimbursement. Access the portal at COVIDUninsuredClaim.HRSA.gov. The reimbursement was established as part of the federal Coronavirus Aid, Relief, and Economic Security (CARES) Act.