Telemedicine Benefits

Kevin Barger, MBA

Virginia Telehealth Summit

Tuesday, April 5, 2011

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What does telemedicine offer you?

•Increased Access to Doctors

•Improved Quality of Care

•Improved Continuity of Care

•Reduction of time lost from work

•Reduction of travel costs

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Who qualifies to provide these services?

•Physician office (including NP, PA)

•Rural health clinic

•Federal qualified health center

•Hospital

•Hospital-based or critical access-based renal dialysis center

•Skilled nursing facility

•Community mental health center

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Examples of Telemedicine Services

•Telehealth Consultation▪ Inpatient▪ Outpatient

•Telehealth Office Visit

•Telehealth Visit▪ Inpatient▪ Outpatient

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What is NOT Telemedicine?

•Audio-only Telephone

•Home Videoconferencing sessions▪ Skype▪ Email functionalities▪ Fax submissions▪ Telephonic monitoring (e.g., pacemakers)

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What about referrals or preauthorizations?

•Under HMO – referrals still required▪ Any service requiring a preauthorization continues to do so

•If provider performing the telemedicine service is out of network, an authorization may be required.

•Member cost share does apply if appropriate

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How does it get billed?

•Q3014▪ Billed by the originating site

•Evaluation and Management Codes▪ Billed by the provider providing the service or consultation▪ Include GT modifier

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Anthem Blue Cross and Blue Shield is the trade name of: In Colorado and Nevada: Rocky Mountain Hospital and Medical Service, Inc. In Connecticut: Anthem Health Plans, Inc. In Indiana: Anthem Insurance Companies, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Maine: Anthem Health Plans of Maine, Inc. In Missouri (excluding 30 counties in the Kansas City area): RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. In New Hampshire: Anthem Health Plans of New Hampshire, Inc. In Ohio: Community Insurance Company. In Virginia (excluding the City of Fairfax, the Town of Vienna and the area east of State Route 123.): Anthem Health Plans of Virginia, Inc. In Wisconsin: Blue Cross Blue Shield of Wisconsin ("BCBSWi"), which underwrites or administers the PPO and indemnity policies; Compcare Health Services Insurance Corporation ("Compcare"), which underwrites or administers the HMO policies; and Compcare and BCBSWi collectively, which underwrite or administer the POS policies. Independent licensees of the Blue Cross and Blue Shield Association. ® ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association.