Telemedicine - Welcome | Magellan Of Virginia · Telemedicine: Getting Credentialed Not a Magellan provider •Join the Network at . When prompted for pre-approval, enter “TELEHEALTH”

Telemedicine

November 2018

Training Objectives

Define Telemedicine

Understand the benefits of Telemedicine

Learn what services provided by Telemedicine are reimbursed by Medicaid

Understand what equipment is required to provide Telemedicine

Learn what is needed to become credentialed to provide Telemedicine

Understand how to bill for services provided via Telemedicine

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Telemedicine Basics

Telemedicine: Definition

The real-time or near real-time exchange of information for diagnosing and treatment of medical conditions

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Interactive telecommunications when the member and the behavioral health provider are not in the same physical location

Utilizes both audio and video connections linking practitioners in one locality with members in another locality

Telemedicine: Benefits

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Real-time, two-way communication via

secure online virtual session

Treat members at a place and time that fits best into your schedule

– and theirs

Convenient

Simple

Secure and private

Improves access to care for more members,

such as rural residents or members with

mobility issues

Telemedicine: Originating Site

Originating Site: The DMAS enrolled site where the member is located during the telemedicine appointment

A provider or designee must attend the encounter with the member unless there is a documented reason for staff not to be present, such as:

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member reporting injuries due to abuse

psychiatric care where member may feel uncomfortable

Telemedicine: Originating Site

Originating Site Location Options

Telemedicine service

provider outpatient

offices

Federally Qualified

Health Centers

HospitalsNursing Facilities

Health Department

Clinics

Community Services Boards

Psychiatric Residential Treatment Facilities

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Telemedicine: Covered Services

Telemedicine: Covered Behavioral Health Services

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Psychiatric diagnostic interview exam

Evaluation and management office visits or other outpatient visits

Initial and subsequent hospital care

Individual, family, and group therapy

Crisis Intervention

IACCT Assessments


In-state telemedicine may be provided by licensed providers operating within the scope of their practice

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Only enrolled Physicians can provide out-of-state telemedicine services

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TXLA

MS

TN

KY

GA

SC

NC

WV

KS

OK ARNM

AZ

NV

ORID

ME

PA

MD

WA

MT ND

SD

NE

MO

MN

WI

IA

IL INOH

MI

WY

UTCO

CA

AL

FL


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Individual medical records at all sites are to document the telemedicine encounter consistent with the service documentation described in Chapter II of the DMAS provider manuals

The documentation is to specifically reference telemedicine as the means for conducting the medical service

Telemedicine: Equipment Requirements


Equipment and transmission speed must be technically sufficient to support the services billed to DMAS

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• Broadband internet connection

• Computer with microphone and web camera

• Telehealth software/platform

• Training for staff in the competent use of telemedicine equipment


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Security

• All telemedicine activities are to comply with the requirements of the Health Insurance Portability and Accountability Act of 1996 (HIPAA)

• Skype and FaceTime do not meet HIPAA confidentiality requirements


Is your telehealth software/platform HIPAA compliant?

Your software/platform vendor is required to have a Business Associate Agreement (BAA). To remain HIPAA compliant and protect a member’s PHI, this BAA must outline methods used by the vendor to ensure the protection of the data and provisions for regular auditing of the data’s security.

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Approved Secure Technology for Telemedicine Services include:

If your preferred program is not listed, contact the Magellan of Virginia network department to confirm that the technology is approved for HIPAA information

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American Well Securevideo.com

Carepaths Theralink

DoxyMe Vidyo

E-Clinical Works Virtual Therapy Connect

E-Psychiatry Vsee

Life Size WECounsel

Polycom Zoo

Secure Telehealth.com

Credentialing Process

Telemedicine: Getting Credentialed

Not a Magellan provider

• Join the Network at www.MagellanProvider.com. When prompted for pre-approval, enter “TELEHEALTH” to indicate your interest in servicing members via telehealth

• Documents can be obtained by calling 1-800-424-4536 or using the Contact Us link on www.magellanofvirginia.com

• Each service location that would like to receive reimbursement will need to be credentialed and contracted with Magellan

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http://www.magellanprovider.com/

http://www.magellanofvirginia.com/

Telemedicine: Getting Credentialed

Already a Magellan provider

• Complete the following:−Sites and Service Form

−Telehealth Services Provider Attestation

−Copy of the License to render Behavioral Health services

• Approximate turnaround time 2-3 weeks for sites already in network with Magellan

• Documents can be obtained by calling 1-800-424-4536 or using the Contact Us link on www.magellanofvirginia.com

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http://www.magellanofvirginia.com/

Billing Basics

Telemedicine: Billing

All providers utilizing telemedicine and billing for

behavioral health services must be enrolled with DMAS/Magellan

All coverage requirements described in the DMAS provider manuals apply when the service

is delivered via telemedicine

The use of telemedicine must be noted in the service

documentation of the member record

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Telephone calls, e-mail, fax and similar electronic measures are not

considered telemedicine

When billing for services, either the “GT” (via interactive audio and video) or “95” modifier must be entered on

the claim

Provider groups whose offices or other locations may serve as the originating site for telemedicine are found in the Virginia Medicaid Memo dated May 13, 2014 – Updates to Telemedicine

Coverage

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• As a Magellan provider, you will continue to verify benefit and eligibility, as well as submit claims, exactly as you do for other services

• Telemedicine must be a covered benefit under the member’s benefit plan to be reimbursed

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Resources

Telemedicine: Resources

For more information:

• Chapter V of the DMAS Physician Provider Manual

• Virginia Medicaid Memo dated September 30, 2009 – Expanded DMAS Telemedicine Coverage – Effective November 1, 2009

• Virginia Medicaid Memo dated May 13, 2014 – Updates to Telemedicine Coverage

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Telemedicine: Resources

For more information:

• Magellan’s telehealth page: http://wwwmagellanprovider.com/education/telehealth.aspx

• American Telemedicine Association: State Policy Resource Center http://www.americantelemed.org

• Center for Connected health Policy: The national Telehealth Policy Resource Center: http://cchpca.org

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http://wwwmagellanprovider.com/education/telehealth.aspx

http://www.americantelemed.org/

http://cchpca.org/

Thank You

Confidentiality statement for providers

The information presented in this presentation is confidential and expected to be used solely in support of the delivery of services to Magellan members. By receipt of this presentation, each recipient agrees that the information contained herein will be kept confidential and that the information will not be photocopied, reproduced, or distributed to or disclosed to others at any time without the prior written consent of Magellan Health, Inc.

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