Wiki FQHC Coding - Telehealth/Prolonged Services/Chronic Care Management

[Laurenmlomax]

Hello,

I am new to working for an FQHC and my facility would like to start billing for telehealth services starting 2019. However I keep finding conflicting information on the NY Medicaid website and MLN on whether or not we are qualified to bill for distant/originating sites. We are located in Brooklyn, NY. Can anyone please shed some light on the requirements needed to bill for telehealth, specifically telepsychiatry.

https://www.health.ny.gov/health_car...5/mar15_mu.pdf

https://www.cms.gov/Outreach-and-Edu...rvcsfctsht.pdf

https://www.cms.gov/Outreach-and-Edu...cfactsheet.pdf


Also can FQHC's bill for Prolonged Services with direct patient contact? I read the PDF I put above and it is not included, however they define FQHC visits as "A FQHC visit is a medically-necessary medical or mental health visit, or a qualified preventive health visit. The visit must be a face-to-face (one-on-one) encounter between a FQHC patient and a FQHC practitioner during which time one or more FQHC services are furnished. "

Are you all billing for Chronic Care Management? I am trying to get it implemented here but they are saying it will be hard to enforce and hard to track. Do you have any tips?

Thank you,

Lauren

 

[mitchellde]

Located in Brooklyn I doubt that you would qualify as an originating site. The originating site must be located in:
* A county outside of a Metropolitan Statistical Area (MSA)
OR
* A Rural Health Professional Shortage Area (HPSA) located in a rural census tract
The originating site bills with the code Q3014
The patient cannot be located in their home as an originating site.

Your providers may qualify as distant site providers as long as the patient is located in a qualifying site at the time of service and not in their home.

 

[crogers@accelhc.org]

Telehealth services FQHC billing

I work for an FQHC which is in the process of implementing this care to our patients. It is my understanding that we will be contracting specialty providers and we will be compensating them. We will be the originating site and the specialist will come in through telehealth.

On the billing aspect, it is my understanding that since we compensate the specialty providers for their service we will be billing the exam. I’m also assuming we would then not be eligible to bill a facility fee separately?

Would the claim still have only our information listed, or would there need to be the specialty provider listed somewhere?

I appreciate any educational advice you may have.

Thank you

Cheryl Rogers, CPC
Billing Supervisor

 

[mitchellde]

I work for an FQHC which is in the process of implementing this care to our patients. It is my understanding that we will be contracting specialty providers and we will be compensating them. We will be the originating site and the specialist will come in through telehealth.

On the billing aspect, it is my understanding that since we compensate the specialty providers for their service we will be billing the exam. I’m also assuming we would then not be eligible to bill a facility fee separately?

Would the claim still have only our information listed, or would there need to be the specialty provider listed somewhere?

I appreciate any educational advice you may have.

Thank you

Cheryl Rogers, CPC
Billing Supervisor

I am not sure the payers will let you bill it this way. The patient needs to be able to chose their own distant provider and not one that you are paying. The distant provider needs to bill their own service apart from the facility. Since Medicare will pay for telehealth and most commercials do as well the providers should not have any issues with billing their own services. Also did you know that many states have state laws requiring all insurance payers pay for telehealth. But to be safe before you enter into a contract with a provider to do this check with the carrier as well as a good attorney.