Turning Problems into Profits

Medicare Telehealth Options to Address COVID-19 Emergency

As many optometrists are aware, the CDC and AOA have both recommended all routine eye exams be rescheduled because of the coronavirus outbreak.  Medicare has also issued three new coding options to help address the challenges COVID-19 is presenting to optometrists.

First, optometrists are now allowed a VIRTUAL CHECK-IN with patients for follow-up visits.  If the physician has not seen the patient within the last seven days and will not see the patient again for 24 hours, they can use this option.  Virtual check-ins are 5-10 minute visits over the phone or using captured video or images that are billed with G codes.  Physicians can’t bill this option if they decide to have the patient come in within 24 hours.  G2012 is used for telephone follow-up visits and G2010 is for captured video or images. The reimbursements for these G codes are generally low, around $15.

The second option, called ON-LINE DIGITAL EVALUATION, is communication with patients through the physician’s online portal. If the patient initiates the portal contact, the physician can bill for the cumulative time they spend communicating with the patient over a seven day period, provided they don’t see the patient for a medical visit within 24 hours. Previous HIPAA requirements or the capabilities to store these patient communications have been waived during the COVID-19 emergency. The billing codes are based upon total time spent answering the patient through the portal: 99421 is for 5-10 minutes and reimburses around $15.52; 99422 for 11-20 minutes, $31.04; and 99423 for 21 or more minutes, $50.16.

Finally, Medicare’s new COVID-19 guidelines allow for TELEHEALTH SERVICES. These are office visits conducted over video applications such as Facetime or Skype and are billed with the 99-series evaluation and management codes, such as 99212 or 99213.  The 92-series eye exam codes do not apply.  Unlike previous telehealth guidelines, this option is no longer restricted to remote or rural areas, the patient can be at home, and providers do not have to use a HIPAA compliant software, only any real-time audio and video for live, interactive telecommunication between the provider and patient.  Billing for telehealth exams requires some software setup for required modifiers and place of service, so if any of OBS doctors decide to utilize this option, please notify your coordinator or Branda so that we can ensure the claims have the proper coding.

So far these three billing options have only been approved by Medicare, but because Medicare sets the gold standard in billing, other commercial payers often follow. Some commercial carriers may already have other remote billing options in place for telephone evaluations. We can only advise providers to check with their local commercial insurance carriers to see what options they may have to continue to provide medical eye care to patients throughout this emergency.

Here are links to the AOA webinar held on March 17 that covers Medicare’s changes in more detail:   AOA Recorded Webinar     Link to PowerPoint

IMPORTANT INFORMATION FOR SPECTERA PROVIDERS

Spectera is currently issuing new contracts which require all clinics to use an Essilor lab for glasses, including Vision Source providers who have always had the autonomy to choose their own lab. If you are a Spectera provider, this means you will no longer have the option to operate as your own lab UNLESS you live in a state that has passed legislation allowing optometrists and patients the freedom of choice in lab selection. Doctors who practice in a “Lab of Choice” state (such as Alabama, Arkansas, Florida, Georgia, Kansas, Maine, Missouri, New Jersey, Oregon, Texas, Vermont, Virginia, and West Virginia) cannot be forced to use a designated lab IF THEY DO NOT SIGN THE NEW LAB CONTRACT and negotiate a new agreement. So if you live in one of the above states, please do not sign the new Spectera contract until you talk to Branda. If you are a Vision Source provider, you also need to talk to Branda. Even if your practice is in a state without legislative protection and you’re forced to use a designated lab, there are still things that need to change in the way your opticians operate and how we bill for you. And finally, if you are uncertain what the new Spectera contract means for your practice or you just have questions, please feel free to call 877-727-3695. Ask our receptionist Misty to schedule an appointment time so you and Branda can discuss your options.