Tag: #telehealth

Posted in MVP (NY/VT) Insurance Payer, Training, Updates

MVP (NY/VT): COVID-19 Treatment and Virtual Care, Cost-Share Update

Posted on by KR2Medical Billing

Below policy will apply to MVP plans that are located in New York and Vermont.

New York Virtual Care Cost-Share: Telemedicine

For MVP Medicare Advantage Plans- MVP will continue to apply the cost sharing waver for audio/visual and audio only until the DOS (dates of service) Dec 31,2021.

For MVP Commercial Plans- Starting August 1,2021 and thereafter the patients will have to pay their “in-person visit” cost-share for audio/visual and audio only visits according to their plan details.

Vermont Virtual Care Cost-Share: Telemedicine

For MVP Medicare Advantage Plans- MVP will continue to apply the cost sharing waver for audio/visual and audio only until the DOS (dates of service) Dec 31,2021.

For MVP Commercial Plans- Starting August 1,2021 and thereafter the patients will have to pay their “in-person visit” cost-share for audio/visual and audio only visits according to their plan details.

New York Covid-19 Treatment member Cost-Share:

Effective August 1, 2021, MVP will no longer waive the cost-share for COVID-19 treatment.

***Vermont Covid-19 Treatment member Cost-Share: ***

MVP will continue to cover COVID-19 treatment in full until March 1, 2022 as is required by
Vermont Rules.

COVID-19 Testing Member Cost-Share: NY &VT

MVP will continue to cover COVID-19 testing in full in New York and Vermont

COVID -19 Testing Coding and Billing Corner:

As of January 1, 2021 claims billed with a diagnosis code Z03.818 in conjunction with a COVID19 testing procedure code will be denied

MVP will retain the expanded set of codes eligible for telehealth, consistent with CMS guidance, and will continue to monitor state and federal guidelines and regulations. In addition, MVP supports continued telehealth reimbursement and is currently reviewing coding guidance.

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Posted in HEDIS Measures, Training, Updates

BCBS Empire NY Medicaid: Summary of changes for HEDIS Measures from NCQA (2020/2021)

Posted on by KR2Medical Billing

Source: Empire Health Plus Plan (NY Managed Medicaid Plan)

Revised measures:

  • The former Well-Child Visits in the First 15 Months of Life (W15) measure was revised to Well‑Child Visits in the First 30 Months of Life (W30). It includes two indicators:
    • Well-child visits in the first 15 months — children who turned 15 months during the measurement year with six or more well-child visits
  • Well-child visits for ages 15 to 30 months — children who turn 30 months during the measurement year with two or more well-child visits
  • The former Well-Child Visits in the Third, Fourth, Fifth and Sixth Years of Life (W34) and Adolescent Well-Care Visits (AWC) measures have been combined into Child and Adolescent Well-Care Visits (WCV):
    • The percentage of members 3 to 21 years of age who had at least one comprehensive well-care visit with a PCP or an OB/GYN practitioner during the measurement year

Key measure changes:

  • Controlling High Blood Pressure (CBP and CDC-CBP)
    Telephone visits, e-visits and virtual check-ins are now acceptable settings for blood pressure (BP) readings. Digital BP readings reported by the member are considered numerator compliant.
  • Telehealth updates
    NCQA has updated telehealth guidance in 40 HEDIS® measures for HEDIS measurement years 2020 and 2021. The purpose of these changes is to:
    • Support increased use of telehealth caused by the pandemic.
    • Align with guidance from Centers for Medicare & Medicaid Services and other stakeholders.

Posted in My services, Training, Updates

UHC Updated Telemedicine/Telehealth Policy for 2021

Posted on by KR2Medical Billing

Effective of 01/01/2021– UHC will change its Telehealth/Telemedicine Policy

This policy will apply to Oxford Plans as well

The following is the reimbursement policy for Telehealth/Telemedicine services:

-The only POS (place of service) that will be allowed is 02 (UHC: this is consistent with the Centers for Medicare and Medicaid (CMS) billing and reimbursement guidelines.)

-Modifiers 95, GT or G0 may be appended to telehealth claims reported with POS 2, BUT will not necessary be used to identify the telehealth services instead they are considered informational.

-UHC will consider the home of the member as an originating site for eligible services

 – Various codes will be eligible for consideration under the policy including the code list listed in the current policy, as well as similar types of services rendered using interactive audio and video technology.  (Please see the partial tables below)

-Certain physical, occupational and speech therapy (PT/OT/ST) telehealth services will be considered for reimbursement when performed by a qualified health care professionals and using interactive audio and video technology.

– The policy addresses additional ways of provider-patient communications including E-visits, remote patient monitoring (non-face-to-face, patient initiated communications, like online portals)

– Payment will align with applicable state law.  


Source: (UHC October provider bulletin)      
For full list of covered codes please click here