Updating Health Maintenance Age Templates

Have you ever opened the Health Maintenance Tab on a patient’s chart only to find that the age template that is applied to the patient doesn’t match the patient’s age?

For example, this 40 year old male patient shows that he still has a 19-39 year old male health maintenance template applied to his chart:

This can be manually corrected by removing the incorrect template from the patient’s chart and adding in the correct one for the patient’s age/sex. Note that any data that when removing the old template, any data that was recorded under that template will not be removed from the chart but rather it will be moved to the “Historical” section of Health Maintenance. If the same Health Maintenance item exists on the new template the information will not be found under historical, it will continue to display in the row or that health maintenance item on the main screen.

 To manually update the templates, click on the “Templates” button in the health maintenance screen:

And then, after selecting the tab with the age health maintenance template displayed, hitting “Delete Template” (If you have several templates applied to the patients chart you may need to use the arrows in the upper right corner of the Health Maintenance Templates display window to navigate through all the templates applied to the patient you are viewing.

Once the old template is removed, click the “New Template” button to add the correct age template to the patient’s chart. A window will appear asking for provider or practice ID, to access the universal templates leave these fields blank and hit OK.

The Health Maintenace Template Selection window will appear, to narrow down the available template click on the radio button for “Age/Sex”, highlight the appropriate template for the patient and hit “OK”

The best way to avoid manually updating the charts is to run the Age Health Maintenance utility.

The utility checks whether the correct age/sex template is already applied to the patient. If not, then it removes the incorrect template and applies the correct one. Data associated with the incorrect template is made historical only if the procedure does not exist in another template applied to the patient (for example, if aspirin therapy is part of the incorrect template and not the new template, but it also is part of a protocol template assigned to the patient, the aspirin therapy data will not be made historical). The utility also looks at the patient’s historical data, and makes current any data that is part of the new template but not the incorrect template.

For the utility to work, the patient must have a sex and age entered in the system, and there must be an HM template that matches the sex and age.

To use the Age Health Maintenance Templates utility, go to: Maintenance > Utilities > Health Maintenance Utilities > Age Health Maintenance Templates.

You will be asked if the database is backed up and will need to hit “Yes” to proceed. (If you do not have an automatic remote backup of your database in place please call us at 480.730.3055 to talk to us about our affordable solutions!)

A message will display letting you know the utility is processing.

Once completed you will receive the following notice:

Note: If an individual patient’s health maintenance template has been customized, then the template remains unchanged. A list of these patients is stored in a file called PRHMA.CHG. You can load this file into Windows Notepad or another editor to view and print it. You will need to fix these templates one at a time.

The Age Health Maintenance Templates utility can also be run as a freestanding utility (UpdatePatHmAgeTemplates.exe in the database directory- usually p:\ppart). You can use Windows Scheduler to run this automatically at an interval of your choice.

**We recommend running this utility once per month.

AZCOMP Technologies – the #1 eMDs reseller since 2005.

We are the ultimate source for all things Medisoft & Lytec. Whatever your question or problem or need with Medisoft & Lytec, we can help you. AZCOMP can help with sales, training, coaching, installation, support, EHR, add-on tools such as preferred clearinghouses, or patient statements, patient payments, appointment reminders and more.

For more Medisoft information, visit our website here: http://www.azcomp.com/medisoft/

For more Lytec information, visit our website here: http://www.azcomp.com/lytec/

For more Telehealth information, visit out website here: http://www.azcomp.com/telehealth

Be sure to call us at (877) 959-8292 for all your network and healthcare technology needs.

The Complete Guide to the Merit-Based Incentive Payment System (MIPS)

Whether you are just beginning or have been participating in MIPS for years, this information will be helpful for you!

AZCOMP is dedicated to providing you with useful and relevant information relating to your business, not just amidst the current novel Coronavirus pandemic. We recently hosted a webinar where we discussed everything you need to know about the Merit-Based Incentive Payment Systems (MIPS).

With the pandemic, as well as the changes and challenges the healthcare industry has faced in 2020, many practices are left wondering what to do with MIPS. Many of our clients have expressed concern over the risk of receiving a penalty as high as 9%, and others are looking to take advantage of the increased incentives this year. Therefore, it’s important to take a moment to decide where you stand and if any action needs to be taken to meet your MIPS goals. In this webinar, we discuss the options available for eligible providers, and the flexibility CMS has implemented to help providers.

Maggie Delcamp, RN, AZCOMP’s own EHR Specialist and MIPS Consultant, hosted a webinar including:

  • MIPS in a Minute Overview
  • Potential Financial Impact
  • 2019 Finalized Scores are In
  • Minimum Requirements for 2020
  • Hardship Application
  • MIPS Training & Assistance Available

Check out the video below!

Interested in more information found in this webinar?

The MIPS Webinar slide deck is now available: Check out the PDF by clicking here!

Additionally, we mentioned in the webinar that if you are a provider who would like to appoint staff as a representative, you can download the .ZIP file here and access a series of PDFs to walk you through the steps.

AZCOMP Technologies Disclaimer:

Disclaimer: Although AZCOMP Technologies, Inc. makes every effort to ensure that information regarding MIPS and other government programs are checked and accurate in both our documentation and training, the Medicare/Medicaid programs are constantly changing and individual providers may have unique circumstances that go beyond the typical guidelines laid out in the respective programs they are participating in. Therefore, it is the sole responsibility of each provider to study, interpret and remain abreast of the Medicare/Medicaid program requirements and deadlines, contacting program administrators directly as needed. Any documentation and training provided by AZCOMP Technologies, Inc. is based on our interpretation of the programs and certification rules published by the Department of Human Services and are subject to change. Information and training provided is “as is” and without any express or implied warranties. AZCOMP Technologies, Inc. assumes no responsibility for any inaccuracies, errors, or omissions, expressly disclaiming liability for damages of any kind arising out of the use of, reference to or reliance on any content provided. Using certified electronic health record (EHR) systems and other certified health IT to provide and attest to meaningful use is the sole responsibility of the eligible provider.

The latest MIPS regulations can be found on the CMS web site at https://qpp.cms.gov/

AZCOMP Technologies – the #1 eMDs reseller since 2005.

We are the ultimate source for all things Medisoft & Lytec. Whatever your question or problem or need with Medisoft & Lytec, we can help you. AZCOMP can help with sales, training, coaching, installation, support, EHR, add-on tools such as preferred clearinghouses, or patient statements, patient payments, appointment reminders and more.

For more Medisoft information, visit our website here: http://www.azcomp.com/medisoft/

For more Lytec information, visit our website here: http://www.azcomp.com/lytec/

For more Telehealth information, visit out website here: http://www.azcomp.com/telehealth

Be sure to call us at (877) 959-8292 for all your network and healthcare technology needs.

The Complete Guide to Telehealth

The future arrived faster than any of us could have expected. At the beginning of the year, Telehealth capabilities for your practice was a competitive advantage. Now, it is a survival necessity.

AZCOMP is dedicated to providing you with useful and relevant information relating to your business, not just amidst the current novel Coronavirus pandemic. In response to a large number of calls we have received regarding Telehealth, we hosted a webinar where we discussed everything you need to know about Telehealth during this national emergency.

A group of expert panelists discussed the following:

  • Telehealth Waiver Due to COVID-19
  • Telehealth Options Including a Live Demonstration
  • Documentation Tips
  • Telehealth Billing Guidelines during the COVID-19 National Emergency
  • Collecting from Patients Remotely
  • Best Resources for Information

Check out the video below!

Interested in more information found in this webinar?

The Telehealth slide deck is now available: Check out the PDF by clicking here!

Additionally, we invite you check out our blog post: Telehealth Expansion, Billing, and Testing for COVID-19 for updated information, as we navigate through this time of uncertainty.

AZCOMP Technologies Disclaimer:

Although AZCOMP Technologies makes every effort to ensure that information regarding billing guidelines are checked and accurate in both our documentation and training, it should be understood that our expertise is in the software itself and not in billing practices. Therefore, it is the sole responsibility of the user to study, interpret and remain abreast of billing requirements and deadlines, contacting authoritative sources directly as needed. Any claims documentation and training provided by AZCOMP Technologies is based on our interpretation of the rules published by nucc.org and cms.gov and are subject to change. Information and training provided is “as is” and without any express or implied warranties. AZCOMP Technologies assumes no responsibility for any inaccuracies, errors, or omissions, expressly disclaiming liability for damages of any kind arising out of the use of, reference to or reliance on any content provided.

AZCOMP Technologies – the #1 eMDs reseller since 2005.

We are the ultimate source for all things Medisoft & Lytec. Whatever your question or problem or need with Medisoft & Lytec, we can help you. AZCOMP can help with sales, training, coaching, installation, support, EHR, add-on tools such as preferred clearinghouses, or patient statements, patient payments, appointment reminders and more.

For more Medisoft information, visit our website here: http://www.azcomp.com/medisoft/

For more Lytec information, visit our website here: http://www.azcomp.com/lytec/

For more Telehealth information, visit out website here: http://www.azcomp.com/telehealth

Be sure to call us at (877) 959-8292 for all your network and healthcare technology needs.

The Best Ways to Communicate with Your Patients During COVID-19

Right now, we are experiencing an unprecedented time in healthcare. The COVID-19 pandemic has created a sense of chaos and panic for many people.

We understand the high level of importance for providers to effectively communicate with their patients, to keep them informed, calm and safe. We created a short video for you on the Best Ways to Communicate with Your Patients right now during COVID-19. These best practices will help you in responding to situations where emotions may be running high for everyone.

Patients depend on the healthcare providers they trust, and they want to hear from you. The amount of messages you may be wanting to communicate to your patients will certainly depend on your specialty. However, in this video we will show you a couple methods we believe are the best ways in providing personalized communication to your patients during the COVID-19 pandemic.

Check out the video here!

Interested in Mass Communication with Your Patients through Medisoft?

Download a FREE custom patient list report to start communicating with your patients now. ** PLEASE NOTE: THIS FILE DOES NOT OPEN ON ITS OWN. IN ORDER TO USE THE ATTACHED REPORT, YOU WILL FIRST NEED TO IMPORT IT INTO YOUR MEDISOFT SOFTWARE. **

Check out our YouTube Page to find out how to import reports in Medisoft. This video will be helpful to you if you have had a report designed or customized and need to import the report.

Is AutoRemind Right for You?

If AutoRemind is the answer for your practice, click this link to request more information. A customer service representative will reach out to you, to see how they can be of help to your practice.

If you want to see how AutoRemind integrates with Medisoft, check out the recent webinar below!

AZCOMP Technologies – the #1 eMDs reseller since 2005.

We are the ultimate source for all things Medisoft & Lytec. Whatever your question or problem or need with Medisoft & Lytec, we can help you. AZCOMP can help with sales, training, coaching, installation, support, EHR, add-on tools such as preferred clearinghouses, or patient statements, patient payments, appointment reminders and more.

For more Medisoft information, visit our website here: http://www.azcomp.com/medisoft/

For more Lytec information, visit our website here: http://www.azcomp.com/lytec/

Be sure to call us at (877) 959-8292 for all your network and healthcare technology needs.

CARES Act: Everything You Need To Know

We are keenly aware of the difficult conversations that are happening right now as businesses look down a tunnel of uncertainty, and AZCOMP firmly believes we have a unique opportunity to support each other as small businesses.

If you are worried about operational costs or covering payroll, we want to make sure you are aware of provisions in the Coronavirus Aid, Relief, and Economic Security (CARES) Act, which allots $350 billion in critical aid to small businesses to cover these core expenses.

We think every small business owner should know that there are forgivable loans available to help your business NOW, including a $10,000 advance that will be distributed within 3 days of a successful application. Note: There is a funding cap so businesses are encouraged to apply as soon as possible, emergency loan applications will be accepted starting April 3, 2020.

On Monday, April 6th, we hosted a webinar that showed a clear picture of what the CARES Act Loans can do for you and your business. Joel Friend, accountant and financial advisor, explained a straightforward breakdown of:

  • Which loans provide the largest immediate assistance
  • Clear view of what the loans cover
  • Who can/should apply
  • Stipulations regarding loan forgiveness
  • How to apply

Click here to download a copy of the Excel spreadsheet Joel uses in this video!

Check out the video to learn more about the CARES act!

Ready to get help now?

Our main priority is to get you the information you need to make informed decisions for your business. We pulled in a professional to provide insight into the options available, but we encourage you to check out the following links below to dive into all the details right now:

Emergency Loans Small Business Guide & Checklist

Small Business Guidance & Loan Resources

Coronavirus Small Business Guide

COVID-19 Related Webinars

Need help with Telehealth, Billing, or how to stay secure while working from home? AZCOMP has a host of webinars scheduled to help you as you navigate through this time of uncertainty.

Check out our 2020 webinar calendar on our events page to register! Visit us at: www.azcomp.com/events for more information.

AZCOMP Technologies – the #1 eMDs reseller since 2005.

We are the ultimate source for all things Medisoft & Lytec. Whatever your question or problem or need with Medisoft & Lytec, we can help you. AZCOMP can help with sales, training, coaching, installation, support, EHR, add-on tools such as preferred clearinghouses, or patient statements, patient payments, appointment reminders and more.

For more Medisoft information, visit our website here: http://www.azcomp.com/medisoft/

For more Lytec information, visit our website here: http://www.azcomp.com/lytec/

Be sure to call us at (877) 959-8292 for all your network and healthcare technology needs.

Deadline for Reporting MIPS Postponed

Deadline for Reporting MIPS Postponed

To provide relief to clinicians who are on the front lines of the fight against the 2019 Novel Caronavirus (COVID-19), CMS announced that they will be extending the reporting deadline for MIPS from March 31, 2020 to April 30, 2020. In addition, CMS is evaluating options for providing relief for MIPS participation in 2020.

CMS has also updated the policy for extreme and uncontrollable circumstances ensuring that providers who are unable to report for 2019 at all will not be penalized. In an email sent out by CMS it states the following:

“MIPS eligible clinicians who have not submitted any MIPS data by April 30, 2020 do not need to take any additional action to qualify for the automatic extreme and uncontrollable circumstances policy. These clinicians will be automatically identified and receive a neutral payment adjustment for the 2021 MIPS payment year. All four MIPS performance categories for these clinicians will be weighted at zero percent, resulting in a score equal to the performance threshold, and a neutral MIPS payment adjustment for the 2021 MIPS payment year. However, if a MIPS eligible clinician submits data on two or more MIPS performance categories, they will be scored and receive a 2021 MIPS payment adjustment based on their 2019 MIPS final score.

CMS will continue monitoring the developing COVID-19 situation and assess options to bring additional relief to clinicians and their staff so they can focus on caring for patients.”

The full press release is available at https://cms.gov/newsroom/press-releases/cms-announces-relief-clinicians-providers-hospitals-and-facilities-participating-quality-reporting

For More Information

Please reference the 2019 QPP Data Submission User Guide. CMS also has up to date information about its programs and response to COVID-19 on the Current Emergencies page.

For Quality Payment Program questions you can contact 1-866-288-8292, Monday through Friday, 8:00 AM-8:00 PM ET or by e-mail at: QPP@cms.hhs.gov.

AZCOMP Technologies – the #1 eMDs reseller since 2005.

We are the ultimate source for all things Medisoft & Lytec. Whatever your question or problem or need with Medisoft & Lytec, we can help you. AZCOMP can help with sales, training, coaching, installation, support, EHR, add-on tools such as preferred clearinghouses, or patient statements, patient payments, appointment reminders and more.

For more Medisoft information, visit our website here: http://www.azcomp.com/medisoft/

For more Lytec information, visit our website here: http://www.azcomp.com/lytec/

Be sure to call us at (877) 959-8292 for all your network and healthcare technology needs.

Telehealth Expansion, Billing, and Testing for COVID-19

As the landscape around us is rapidly changing due to the Novel Coronavirus (COVID-19) Pandemic, we have had a slew of calls regarding Telehealth.

Last Updated May 11,2020 Please note that this information was current at time of publication, however rules around Telehealth during the COVID-19 Public Health Emergency are changing daily; we will continue to update this post as information changes but we encourage you to check sources cited frequently for updates. This is not a substitute for legal advice; check with your attorney and other billing advisors. Most of the information reflects the federal government’s stance; you are directed to your private payers and Medicaid plans for their policies about coding and reimbursement, which may vary from the federal government’s.

AZCOMP is prepared to assist you with actual implementation of Telehealth services, however, many of the questions go beyond getting a solution in place. Therefore, we thought it would be beneficial to provide a timeline of what has transpired during the COVID-19 public health emergency as well as a summary of key points to understand regarding different types of telemedicine services, COVID-19 testing, and billing guidelines.

Current Events:

March 5, 2020 – America’s Health Insurance Plans issues a statement regarding action they are taking to address prevention, testing, and treatment of the corona Virus.

March 6, 2020 – Congress passed the Coronavirus Preparedness and Response Supplemental AppropriationsAct (www.congress.gov).  This new legislation will allow physicians and other health care professionals to bill Medicare fee-for-service for patient care delivered by telehealth during the current coronavirus public health emergency.

March 17, 2020 – The Trump Administration announced further expansion of Telehealth coverage for Medicare beneficiaries during the COVID-19 outbreak.

March 17, 2020 – After meeting with the Trump Administration many insurance issuers announced that they are also expanding efforts by waiving copays, waiving prior authorizations, covering the cost of the COVID-19 test, and allowing reimbursement for telehealth. (For details see Health Insurance Providers Respond to COVID-19

March 18, 2020 – CDC Announces new ICD-10-CM code for COVID-19 will be effective April 1, 2020

March 18, 2020 The Families First Coronavirus Response Act becomes law, which among other things includes health provisions that require private health insurance to cover testing for COVID-19 without cost-sharing (deductibles, co-payments or co-insurance), and requires Medicare to cover, without cost-sharing, visits to health care providers that relate to COVID-19 testing during the public emergency.

March 30, 2020 CMS Announces Additional Waivers and New Rules to Address COVID-19 Patient Surge

March 31, 2020 CMS released an interim final rule, “Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency.” This rule further expands telehealth including additional covered services and new/modified billing instructions during the COVID-19 pandemic.

April 30, 2020 Trump Administration Issues Second Round of Sweeping Changes to Support U.S. Healthcare System During COVID-19 Pandemic

To get more details on the most recent announcements we encourage you to review the following:

Physicians and Other Clinicians: CMS Flexibilities to Fight COVID-19 (published 4/29/2020)

CMS Dear Clinician Letter (published April 6, 2020)

Medicare Telemedicine Provider Fact Sheet (published March 17, 2020)

Medicare Telehealth Frequently Asked Questions (published March 17, 2020)

The following instructional video was published by CMS on May 8, 2020 and replaces the previous video:

Types of Telemedicine Visits

It is important to understand the types of telemedicine services as each type of visit will have varying requirements regarding how the service is initiated, administered and billed. All of the services listed below can now be performed for new or established patients during the public health emergency.

  • Telehealth Visits: The provider must use an interactive audio and video telecommunications system that permits real-time communication between the distant site and the patient at home.
    • Effective for services starting March 6, 2020 and for the duration of the COVID-19 Public Health Emergency, Medicare will make payment for Medicare telehealth services furnished to patients in broader circumstances.
    • Limitations have been removed during the emergency allowing telehealth services to be provided in all settings including a patient’s home.
    • Medicare beneficiaries will be able to receive a specific set of services through telehealth including evaluation and management visits (common office visits), mental health counseling and preventive health screenings. *New: The list of covered telehealth services was expanded to include over 80 additional services on March 30, 2020 under the interim rule- for a full list click here.
    • Telehealth services are NOT limited to services related to COVID-19. In order to support social distancing strategies and reduce the risk of COVID-19 transmission the statutory provision broadens telehealth flexibility without regard to the diagnosis of the patient as long as the service billed is reasonable and necessary.
    • Telehealth visits are considered the same as in-person visits and are paid at the same rate as regular, in-person visits.
    • The HHS secretary has been given the authority to waive the originating site requirement (www.cchpca.org) for telehealth services provided by a qualified provider to Medicare beneficiaries (www.cms.gov) in any identified emergency area during emergency periods.
    • Telehealth services may be provided to Medicare beneficiaries by phone, but only if the phone allows for audio-video interaction between the qualified provider and the beneficiary.
    • The Medicare coinsurance and deductible would generally apply to these services. However, the HHS Office of Inspector General (OIG) is providing flexibility for healthcare providers to reduce or waive cost-sharing for telehealth visits paid by federal healthcare programs.
  • Virtual Check-ins: Brief communication service with practitioners via a number of communication technology modalities including synchronous discussion over a telephone or exchange of information through video or image.
    • The patient must verbally consent to receive virtual check-in services.
    • Practitioners may educate beneficiaries on the availability of the service prior to patient agreement. 
    • Virtual check-ins can be conducted with a broader range of communication methods, unlike Medicare telehealth visits, which require audio and visual capabilities for real-time communication.
    • Medicare coinsurance and deductible would generally apply to these services.
  • E-Visits: Patient initiated communication through an online patient portal.
    • Individual services need to be initiated by the patient; however, practitioners may educate beneficiaries on the availability of the service prior to patient initiation. 
    • The patient must consent to receive virtual check-in services.
    • The Medicare coinsurance and deductible would generally apply to these services.
  • Telephone Visits: Audio only visits. *NEW as of March 30, 2020 per the Interim Rule and further expanded on April 30, 2020 under the Second Round of Changes
    • When real-time audio visual equipment is not available to conduct an E/M visit remotely, practitioners may now conduct a visit over the phone for both new and established patients. These services were previously non-covered.
    • Medicare payment for telephone E&M visits is equivalent to the Medicare payment for office/outpatient visits with established patients effective March 1, 2020. (*New as of April 30, 2020 under the Second Round of Changes)
    • CMS is also allowing many behavioral health and education services to be furnished via telehealth using audio-only communications. The full list of telehealth services notes which services are eligible to be furnished via audio-only technology, including the telephone evaluation and management visits can be found here. (*New as of April 30, 2020 under the Second Round of Changes)
  • Remote Patient Monitoring: Allows patients to use mobile medical devices and technology to gather patient-generated health data and send it to healthcare professionals.
    • These services can be provided for both acute and chronic conditions and can now be provided for patients with only one disease. For example, remote patient monitoring can be used to monitor a patient’s oxygen saturation levels using pulse oximetry.
    • For purposes of treating suspected COVID-19 infections, Medicare will allow the service to be reported for shorter periods of time than 16 days (the normal requirement) as long as the other code requirements are met.

Eligible Providers

CMS is allowing all providers that are eligible to bill Medicare for their professional services to bill for Medicare telehealth services, including physical therapists, occupational therapists, speech language pathologists, and others who were previously ineligible, to receive payment for Medicare telehealth services. (*New as of April 30, 2020 under the Second Round of Changes and retroactive to March 1, 2020)

Telehealth BILLING GUIDELINES DURING COVID-19

In this section we will provide information for Medicare Billing guidelines during the Public Health Emergency. Many of the private payers are following suit, but you will need to verify rules with individual payers as they may vary. One of the best guides we have seen for Medicare billing is Special Coding Advice presented by the American Medical Association. (Updated May 4, 2020) We highly recommend reviewing their guide as it includes a variety of scenarios that cover COVID-19 Telehealth billing, COVID-19 Laboratory Billing, Non-COVID-19 Telehealth Billing, and more. A great resource for checking billing guidelines for private payers can be found by clicking here.

CPT Codes

The CPT Code will depend on the type of Telemedicine Service performed. Here is a summary from CMS of the CPT codes that pertain to the type of service:

Summary of Telehealth CPT Codes Covid-19
COVID-19 CPT Billing

Payment for Phone Calls (*NEW as of March 30, 2020 see the Interim Rule)

CMS will now pay for phone calls using codes 99441-99443, and 98966-98968. These are time-based codes.

  • Physicians, nurse practitioners, and physician assistants should use codes 99441—99443
  • Other qualified health care professionals who may bill Medicare for their services, such as registered dieticians, social workers, speech language pathologists and physical and occupational therapists should use codes 98966—98968 with applicable GN, CO, or GP modifiers.

CMS previously announced that Medicare would pay for certain services conducted by audio-only telephone between beneficiaries and their doctors and other clinicians. Now, CMS is broadening that list to include many behavioral health and patient education services. CMS is also increasing payments for these telephone visits to match payments for similar office and outpatient visits. This would increase payments for these services from a range of about $14-$41 to about $46-$110. The payments are retroactive to March 1, 2020. (*New as of April 30, 2020 see Second Round of Changes)

Remote Patient Monitoring

Use CPT Codes 99091, 99457-99458, 99473-99474, 99493-99494

Place of Service (POS) Codes and Modifiers

The following information was updated April 6, 2020 after a correction was released by CMS on April 3, 2020

When billing professional claims to Medicare for all telehealth services with dates of services on or after March 1, 2020, and for the duration of the Public Health Emergency (PHE), bill with:

  • Place of Service (POS) equal to what it would have been had the service been furnished in-person
  • 95 Modifier, indicating that the service rendered was actually performed via telehealth

As a reminder, CMS is not requiring the CR modifier on telehealth services. However, consistent with current rules for telehealth services, there are two scenarios where modifiers are required on Medicare telehealth professional claims:

  • GQ Modifier– Service was furnished as part of a federal telemedicine demonstration project in Alaska and Hawaii using asynchronous (store and forward) technology.
  • GT Modifier– Service was furnished for diagnosis and treatment of an acute stroke.

There are no billing changes for institutional claims; critical access hospital method II claims should continue to bill with modifier GT.

(The following information was added on April 9, 2020 to include information provided by CMS in a Special Edition Newsletter from the Medicare Learning Network dated April 7, 2020)

Providers are to apply Modifier CS on applicable claim lines to identify COVID-19 testing-related services that are not subject to cost sharing under the Families First Coronavirus Response Act. Covered services include medical visits that that result in an order for or administration of a COVID-19 test; are related to furnishing or administering such a test or to the evaluation of an individual for purposes of determining the need for such a test. The effective date for modifier CS is for services performed between March 18, 2020 through the end of the Public Health Emergency.

For professional claims, physicians and practitioners who did not initially submit claims with the CS modifier must notify their Medicare Administrative Contractor (MAC) and request to resubmit applicable claims with dates of service on or after 3/18/2020 with the CS modifier to get 100% payment. 

For institutional claims, providers, including hospitals, CAHs, RHCs, and FQHCs, who did not initially submit claims with the CS modifier must resubmit applicable claims submitted on or after 3/18/2020, with the CS modifier to visit lines to get 100% payment.

Revenue Codes *for institutional claims only

Revenue code 780 is used as the revenue code for telemedicine institutional claims (See Revenue Codes)

Diagnosis Codes (see CDC Official ICD-10 COVID-19 Coding Guidance)

  • Diagnosis of COVID-19: Effective April 1, 2020, for confirmed diagnosis of COVID-19 only, use U07.1 (For visits prior to April 1, 2020, report the code for the patient condition that is related to the COVID-19 (e.g., J12.89, “Other viral pneumonia”) and B97.29, “Other coronavirus as the cause of diseases classified elsewhere.” see New CDC Coronavirus Code Announcement for details)
  • Known Exposure to COVID-19 Without Confirmed Diagnosis of COVID-19: For cases where there is an actual exposure to someone who is confirmed or suspected (not ruled out) to have COVID-19, and the exposed individual either tests negative or the test results are unknown, report Z20.828, “Contact with and (suspected) exposure to other viral communicable diseases.”
  • Possible Exposure to COVID-19 Without Confirmed Diagnosis of COVID-19: For cases where there is a concern about a possible exposure to COVID-19, but this is ruled out after evaluation, assign code Z03.818, “Encounter for observation for suspected exposure to other biological agents ruled out.”
  • Screening for COVID-19: For asymptomatic individuals who are being screened for COVID-19 and have no known exposure to the virus, and the test results are either unknown or negative, assign code Z11.59, Encounter for screening for other viral diseases.
  • Suspected COVID-19: For patients presenting with any signs/symptoms associated with COVID-19 (such as fever, etc.) but a definitive diagnosis has not been established, assign the appropriate code(s) for each of the presenting signs and symptoms such as: R05 Cough, R06.02 Shortness of breath, R50.9 Fever, unspecified
    If a patient with signs/symptoms associated with COVID-19 also has an actual or suspected contact with or exposure to someone who has COVID-19, assign Z20.828, Contact with and (suspected) exposure to other viral communicable diseases, as an additional code. This is an exception to guideline I.C.21.c.1, Contact/Exposure.

We recommend checking with the CDC for ongoing announcements regarding ICD-10 Coding at: https://www.cdc.gov/nchs/icd/icd10cm.htm

Testing (COVID-19 FAQ Sheet)

Medicare Part B will cover a test to determine if beneficiaries have coronavirus for dates of service on or after Feb. 4, 2020. However, providers of the test will have to wait until after April 1, 2020, to submit a claim to Medicare for the test.

Many health plans have publicly announced that COVID-19 diagnostic tests are covered benefits and will be waiving any cost-sharing that would otherwise apply to the test.

CMS will pay hospitals and practitioners to assess beneficiaries and collect laboratory samples for COVID-19 testing, and make separate payment when that is the only service the patient receives. (*New as of April 30, 2020 see Second Round of Changes)

Medicare and Medicaid are covering certain serology (antibody) tests, which may aid in determining whether a person may have developed an immune response and may not be at immediate risk for COVID-19 reinfection. Medicare and Medicaid will cover laboratory processing of certain FDA-authorized tests that beneficiaries self-collect at home. (*New as of April 30, 2020 see Second Round of Changes)

Laboratory Billing

*New: The following information was added after the April 30, 2020 Second Round of Changes

During the COVID-19 Public Health Emergency, CMS is relaxing billing requirements for laboratory tests (PDF) required for a COVID-19 diagnosis. Any health care professional authorized under state law may order tests. Medicare will pay for tests without a written order from the treating physician or other practitioner:

  • If an order is not written, an ordering or referring National Provider Identifier (NPI) is not required on the claim
  • If an order is written, include the NPI of the ordering or referring professional, consistent with current billing guidelines

For a full list of Laboratory Tests that do not require a practitioner order during the Public Health Emergency visit https://www.cms.gov/files/document/covid-ifc-2-flu-rsv-codes.pdf

Additional/Cited Resources:

Although AZCOMP Technologies makes every effort to ensure that information regarding billing guidelines are checked and accurate in both our documentation and training, it should be understood that our expertise is in the software itself and not in billing practices. Therefore, it is the sole responsibility of the user to study, interpret and remain abreast of billing requirements and deadlines, contacting authoritative sources directly as needed. Any claims documentation and training provided by AZCOMP Technologies is based on our interpretation of the rules published by nucc.org and cms.gov and are subject to change. Information and training provided is “as is” and without any express or implied warranties. AZCOMP Technologies assumes no responsibility for any inaccuracies, errors, or omissions, expressly disclaiming liability for damages of any kind arising out of the use of, reference to or reliance on any content provided.

AZCOMP Technologies – the #1 eMDs reseller since 2005.

We are the ultimate source for all things Medisoft & Lytec. Whatever your question or problem or need with Medisoft & Lytec, we can help you. AZCOMP can help with sales, training, coaching, installation, support, EHR, add-on tools such as preferred clearinghouses, or patient statements, patient payments, appointment reminders and more.

For more Medisoft information, visit our website here: http://www.azcomp.com/medisoft/

For more Lytec information, visit our website here: http://www.azcomp.com/lytec/

Be sure to call us at (877) 959-8292 for all your network and healthcare technology needs.