Amendments to payor rules for providing telemedicine services

The best recommendation to meet HIPAA compliance for software platforms is to utilize your EHR/practice management telemedicine options or a third party HIPAA compliant telemedicine system. 

CMS guidelines

• The originating site has been removed and services can be provided to patients who are at home.
• Telehealth can be provided by two way video as well as “audio and video capabilities that are used for two-way, real-time interactive communication”, a smartphone.
  • From the Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020.
  • Resource: https://docs.house.gov/billsthisweek/20200302/BILLS-116hr6074-SUS.pdf

 

United Health Care

• United Health Care, effective immediately has removed the CMS originating site restriction, which allows for patients to be seen for telehealth services at home. This will remain in effect until April 30^th, 2020.
  • Resource: https://www.uhcprovider.com/en/resource-library/news/provider-telehealth-policies.html

BCBS of IL

• BCBS of IL, in addition to the telemedicine approved codes, effective immediately has also approved CPT codes 99441, 99442, 9443, 99421, 99422 and 99423 for eligible BCBSIL PPO and Blue Choice members.
  • Resource: https://www.bcbsil.com/provider/education/2020/2020_03_11.html

Humana

• Humana will remove costs for urgent care needs for the next 90 days
  • Resource: https://humananews.com/news-details/2020/humana-takes-steps-to-care-for-members-in-response-to-coronavirus/default.aspx#gsc.tab=0

Co-Payment

Certain payors have elected to waive co-pays for telehealth services for the next 90 days. Below is a detail of payors plan for co-pays as of 3.16.20

Payor	Plan for co-payment
Aetna	Waiving next 90 days
BCBS	Depends on plan if co-pay will be waived
Humana	Waiving for urgent care needs
HMO	Depends on plan if co-pay will be waived
UHC	Not waiving co-pay as of 3.16.20
Cigna	Not waiving co-pay as of 3.16.20