Lawrence, KS 66044 AHCCCS covers medically necessary, non-experimental, and cost-effective Telehealth services provided by AHCCCS registered providers. Shall not replace provider choice for healthcare delivery modality. All contracts issued, delivered or renewed in this state must provide coverage for health care services that are provided through telehealth if the health care service would be covered were it provided through an in-person encounter between the subscriber and a health care provider and provided to a subscriber receiving the service in this state. (9/01/2020). www.PalmettoGBA.com . 32-2087 & PSYPACT (Accessed Sept. 2021). Telemedicine is “the practice of synchronous (real-time) health care delivery, diagnosis, consultation, and treatment and the transfer of medical data through interactive audio and video communications that occur in the physical presence of the patient.”. 10: Individual Practitioner Services, (10/48), (07/12/2021), IHS/Tribal Provider Billing Manual, (8/49), (7/12/2021). © 2010-2021 Public Health Institute Center for Connected Health Policy, info@cchpca.org (Accessed Sept. 2021), AZ Health Care Cost Containment System, AHCCCS Fee-For-Service Provider Billing Manual, Ch. The Centers for Medicare and Medicaid Services (CMS) uses the Medicare Physician Fee Schedule (MPFS) to reimburse physician services. (Accessed Sept. 2021). Open an office in this state, except as part of a multistate provider group that includes at least one health care provider who is licensed in this state through the applicable health care provider regulatory board or agency. Complies with all existing requirements of Arizona and any other state in which the health care provider is licensed regarding maintaining professional liability insurance, including coverage for telehealth services provided in Arizona. h�b```b`0^�����-��π ��@����� ��������"�1aB!�'����Hi��38���Cp;�4GU��E����M2��}��N�54Jy>EV$gS���i������p�{ں�fy�t^\V�L����&���-�һ�ɣK8�W�T3\H��+�8:�4::��KG�DGCCE^Р���� ��� � �A���2��&��p�1�3��= j`p {�S�����T�wj000�]sHn�#˦�����z ��w1��l�< t������"f��� ���0v1��i�,VP=P�p���)����A&A͡�a��[o���y���^�i�%�6$7\e\��r�3A�����[���jX/�l�q0�;���)�e��T���� H320�z���s!|�@ڍ�}{��U�:�V� ��0[���P��~&�ӭr�Nϋ2L�X��t��X��τ�Y�: Y�S(�d$C>��* �� �03fՔ,�y!�J�mj�T97-�?S�M��s�|�j��lI:���w�´���Ϩ���zڣhH5��F�C� >�� SOURCE: AZ Reg. 4. A doctor of medicine who is licensed to practice in another jurisdiction if the doctor engages in the practice of medicine that is limited to patients with whom the doctor has an already established doctor-patient relationship and who reside outside this jurisdiction when both the doctor and the patient are physically in this state for not more than sixty consecutive days. SOURCE: AZ Health Care Cost Containment System, AHCCCS Fee-For-Service Provider Billing Manual, Ch. 1-2). (Accessed Sept. 2021). %%EOF SOURCE: AZ Statute, Sec. Prescriptions written to prepare a patient for a medical examination. (Accessed Sept. 2021). House Bill 2454 (2021 Session), (Accessed Sept. 2021). Non-emergency transportation (NEMT) is a covered benefit for member transport to and from the Originating Site where applicable. (Accessed Sept. 2021), AZ Health Care Cost Containment System, AHCCCS Fee-For-Service Provider Billing Manual, Ch. 423. The health care provider regulatory board or agency registering the health care provider may use the national practitioner databank to verify the information submitted. Oct. 2019; AZ Health Care Cost Containment System, AHCCCS Fee-For-Service Provider Billing Manual, Ch. 10: Individual Practitioner Services, (10-48), (02/17/2021) & IHS/Tribal Provider Billing Manual, (8/49-50), (02/17/2021). Medicare providers use a modifier on their billing codes when submitting reimbursement claims to indicate that the service was delivered via telehealth. In an emergency situation in which the patient or the patient’s health care decision maker is unable to give informed consent. (Accessed Sept. 2021), AZ Health Care Cost Containment System, AHCCCS Fee-For-Service Provider Billing Manual, Ch. (n.d.) (Accessed Sept. 2021), AZ Health Care Cost Containment System, AHCCCS Medical Policy for AHCCCS Covered Services, Ch. AZ Administrative Code Title 20, Ch. This Provider Manual will serve as a resource for navigating Clover Health’s operations and processes. Look up policy by: ... AZ Health Care Cost Containment System, AHCCCS Fee-For-Service Provider Billing Manual, Ch. A corporation may not require a health care provider to use a telehealth platform that is sponsored or provided by the corporation as a condition of network participation. To provide after-care specifically related to a medical procedure that was delivered in person in another state. This plan is available in the following counties: 940: Quality Management and Performance Improvement Program. Statutes. There are no geographic restrictions for telehealth. (9/01/2020). 32-2053 & Physical Therapy Compact (Accessed Sept. 2021). Pg. 10: Individual Practitioner Services, (10-50), (02/17/2021), IHS/Tribal Provider Billing Manual (8/51), (02/17/2021). AHCCCS covers Teledentistry for Early and Periodic Screening, Diagnostic and Treatment (EPSDT) aged members when provided by an AHCCCS registered dental provider. As an in-network provider, you are expected to be familiar with this manual and Fee-for-Service Provider Manual & IHS/Tribal Provider Billing Manual. There are circumstances that may impact pricing such as: manual pricing, provider-specific certification/pricing, or multiple surgical procedure codes. (Accessed Sept. 2021). A doctor of medicine residing in another jurisdiction who is authorized to practice medicine in that jurisdiction, if the doctor engages in actual single or infrequent consultation with a doctor of medicine licensed in this state and if the consultation regards a specific patient or patients. This information is intended as reference to be used in addition to information from the Centers for Medicare & Medicaid Services (CMS). (Accessed May 2021). 10 Addendum: FQHC/RHC, (10-3), (7/26/2019) (Accessed Sept. 2021). 32-1660 &Nurse Licensure Compact (Accessed Sept. 2021). Before prescribing a controlled substance to a patient, registers with the controlled substances prescription monitoring program. 127 (Accessed May 2021), AZ Admin. This book contains: - The complete text of the Nondiscrimination in Health Programs and Activities (US Department of Health and Human Services Regulation) (HHS) (2018 Edition) - A table of contents with the page number of each section Telepractice includes supervision. 10: Professional and Technical Services, (10-47 & 49), (2/17/2021), IHS/Tribal Provider Billing Manual, (8/48-50), (2/17/2021). 32-1854 as amended by House Bill 2454 (2021 Session) (Accessed Sept. 2021). The health care provider shall use the health care provider’s clinical judgment in considering whether the nature of the services necessitates physical interventions and close observation and the circumstances of the patient, including diagnosis, symptoms, history, age, physical location and access to telehealth. AZ Revised Statute Sec. Except where otherwise indicated, this Provider Manual is effective as of January 1, 2021 for providers currently participating in the Clover Health network. 2021 Humana Healthy Horizons in South Carolina Provider Manual – Effective July 1, 2021, PDF Privacy Policy. In consultation with a health care provider who is licensed in Arizona and who has the ultimate authority over the patient’s diagnosis and treatment. Provider Directory, PDF opens new window. 10: Individual Practitioner Services, (10-50), (02/17/2021) & IHS/Tribal Provider Billing Manual (8/51), (02/17/2021). Network adequacy standards required by federal or state law may not be met by a corporation through the use of contracted health care providers who provide only telehealth services and do not provide in-person health care services in this state or within fifty miles of the border of this state. (Accessed Sept. 2021). (Accessed Sept. 2021), AZ Admin. This text guides patterns of practice; improves quality of care; promotes appropriate use of health care services; and explains physical therapist practice to insurers, policymakers, and other health care professionals. Addressing Patients' Telehealth Concerns FAQ. Easily search by topic across Medicaid, private payer, and COVID-19 state actions. (Accessed Sept. 2021). Except as otherwise provided in this paragraph, a corporation shall reimburse health care providers at the same level of payment for equivalent services as identified by the healthcare common procedure coding system, whether provided through telehealth using an audio-visual format or in-person care. Pricing Action Code (PAC) values are: Blank - Base Medicaid; I - Informational; M - Manual Certain other requirements apply. 10: Individual Practitioner Services, (10-46 & 48), (07/12/2021). Look up policy by: ... AZ Health Care Cost Containment System, AHCCCS Fee-For-Service Provider Billing Manual, Ch. Narconon International (commonly known as Narconon) is a Scientology organization which promotes the theories of founder L. Ron Hubbard regarding substance abuse treatment and addiction.Its parent company is the Association for Better Living and Education (ABLE), which is owned and controlled by the Church of Scientology. Sec. This guide helps people with Medicare understand Medigap (also called Medicare Supplement Insurance) policies. A Medigap policy is a type of private insurance that helps you pay for some of the costs that Original Medicare doesn't cover. Teledentistry does not replace the dental examination by the dentist, limited periodic and comprehensive examinations cannot be billed through the use of Teledentistry alone. When the rate is listed as $0, then the claim is priced manually and requires supporting documentation. (Accessed Sept. 2021). Telehealth and Telemedicine Ch 300, (320-I pg. Medicaid Long-Term Managed Care Program, PDF opens new window. Oct. 2019. 4. 300, (320-I pg. The following requirements apply to coverage of telehealth services: This section does not relieve a corporation from an obligation to provide adequate access to in-person health care services. Written by a licensee through a telehealth program that is covered by the policies and procedures adopted by the administrator of a hospital or outpatient treatment center. SOURCE: AZ Admin. May 26, 2021. 2021 Humana Healthy Horizons in Kentucky Provider Manual – Effective Jan. 1, 2021, PDF. Telehealth Services, (Accessed Sept. 2021). Pg. 10: Individual Practitioner Services, (10/46), (07/12/2021) & IHS/Tribal Provider Billing Manual, (8/48), (02/17/2021). SOURCE: AZ Admin. All services provided via telehealth must be medically necessary, non-experimental and cost-effective services. 1-800-772-1213: Mailing Address: Medicare Contact Center Operations. SOURCE: AZ Administrative Code Title 20, Ch. (Accessed Sept. 2021), AZ Administrative Code Title 20, Ch. (Accessed Sept. 2021), AZ Health Care Cost Containment System, AHCCCS Fee-For- Service Provider Billing Manual, Ch. 435. Material Changes (1) IRM 5.11.6.1(6) - IPU 20U0061 issued 01-08-2020 to update - Clarified the new servicewide policy statement IRM section. At the time of the telehealth encounter, the health care provider shall access clinical information and records, if available, that are appropriate to evaluate the patient’s condition. 132 (Accessed Sept. 2021). (Accessed Sept. 2021). 20-841.09 & 20-1057.13 & 20-1376.05 & 20-1406.05 as amended by House Bill 2454 (2021 Session). As an in-network provider, you are expected to be familiar with this manual and The 1999 edition includes more than 500 code changes. To make coding easy, color-coded keys are used for identifying section and sub-headings, and pre-installed thumb-notch tabs speed searching through codes. p. 2.; IHS/Tribal Provider Billing Manual (8/48 & 50), . “Telepractice” means providing psychological services through interactive audio, video or electronic communication that occurs between the psychologist and the patient or client, including any electronic communication for diagnostic, treatment or consultation purposes in a secure platform, and that meets the requirements of telehealth pursuant to section 36-3602. The Center for Connected Health Policy is a program of the Public Health Institute. 97750 CPT Code Description: Physical performance test or measurement (e.g., musculoskeletal, functional capacity), with written report, each 15 minutes.Physical testing or measurement describes tests and measurements performed by a physician or other qualified health care professional. Telehealth and Telemedicine Ch 300, (320-I pg. Manual Transmittal. 10: Professional and Technical Services, (10-46), (2/17/2021), IHS/Tribal Provider Billing Manual, (8/48-49), (2/17/2021). SOURCE: AZ Health Care Cost Containment System, AHCCCS. This includes psychological and neuropsychological testing and health and behavior (H & B) assessment and intervention codes. Oct. 2019, AZ Health Care Cost Containment System, AHCCCS Fee-For-Service Provider Billing Manual, Ch. (Accessed Sept. 2021). 5, pg. Telepractice, p. 29 (Accessed Sept. 2021). (Accessed Sept. 2021), AZ Health Care Cost Containment System, AHCCCS Fee-For-Service Provider Billing Manual, Ch. Exceptions to this consent requirement include: SOURCE: AZ Health Care Cost Containment System. 1-800-Medicare (1-800-633-4227) Phone number to replace a lost Medicare Card. 36-2907.13. Psychotropic medication adjustment and monitoring. In December 2016, Congress enacted the 21st Century Cures Act which requires states to implement EVV for Medicaid-financed Personal Care Services and Home Health Care Services by January 1, 2020 and January 1, 2023, respectively, to avoid a reduction in federal Medicaid funding. ... June 2020 . Type the word you are looking for into the text box. 07/01/20. 1225 0 obj <> endobj Lawrence, KS 66044 • Any changes in their billing agent or clearinghouse P.O Box 981655 | West Sacramento, CA 95798 600, (670 Pg. Consistent with the best practice guidelines adopted by the telehealth advisory committee on telehealth best practices established by section 36-3607, a health care provider shall make a good faith effort in determining both of the following: Whether a health care service should be provided through telehealth instead of in person. R20-6-1902. Coding Information SOURCE: Arizona Revised Statute Sec. The text provides knowledge about the theory and practical applications for each of the core areas that comprise the field of medical quality management as well as insight and essential briefings on the impact of new healthcare technologies ... Service delivery via telehealth can be done via teledentistry, remote patient monitoring, telemedicine, or asynchronous (store and forward). SOURCE: AZ Administrative Code, R4-24-107, (Accessed Sept. 2021). Telepractice, p. 29 (Accessed Sept. 2021). 320-Q. 300, (320-I pg. The health care provider shall inform the subscriber before the telehealth encounter if there is a charge for the encounter. AHCCCS General and Informed Consent, Ch. Fee-for-Service Provider Manual definitions: Distant site means “the site at which the provider delivering the service is located at the time the service is provided via telehealth (formerly hub site).”, Originating site means “the location of the AHCCCS member at the service is being furnished via telehealth or where the asynchronous service originates (formerly spoke site). Physicians billing for a purchased service, such as the CT scan, should be aware of the anti-markup provisions summarized in the CMS Internet Only-Manual 100-04, Chapter 13, Section 20.3. This plan is available in the following counties: The Board establishes and shall collect a fee to register as an out-of-state health care provider of telehealth services. AZ Administrative Code, R4-26-108, (Accessed Sept. 2021). (Accessed Sept. 2021), AZ Medical Policy for AHCCCS Covered Services. Arizona established a telehealth advisory committee on telehealth best practices in order to adopt telehealth best practice guidelines and recommendations regarding the health care services that may be appropriately provided through an audio-only telehealth format and make updates, when applicable. Telehealth and Telemedicine Ch 300, (320-I pg. 97750 CPT Code Description: Physical performance test or measurement (e.g., musculoskeletal, functional capacity), with written report, each 15 minutes.Physical testing or measurement describes tests and measurements performed by a physician or other qualified health care professional. AHCCCS General and Informed Consent, Ch. Such monitoring may be either synchronous (real-time) or asynchronous (store-and-forward). InternationalPuerto RicoOther US TerritoryAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming. In December 2016, Congress enacted the 21st Century Cures Act which requires states to implement EVV for Medicaid-financed Personal Care Services and Home Health Care Services by January 1, 2020 and January 1, 2023, respectively, to avoid a reduction in federal Medicaid funding. Medicare providers use a modifier on their billing codes when submitting reimbursement claims to indicate that the service was delivered via telehealth. Oct. 2015 (Accessed Sept. 2021) & AZ Health Care Cost Containment System, AHCCCS Fee-For-Service Provider Billing Manual, Ch. 36-2907.13. SOURCE: AZ Rev. (Accessed Sept. 2021), AZ Statute, Sec. Arizona has conditionally repealed and asked to withdraw from the Interstate Medical Licensure Compact. Prescriptions written or prescription medications issued for use by a county or tribal public health department for immunization programs or emergency treatment or in response to an infectious disease investigation, public health emergency, infectious disease outbreak or act of bioterrorism. A corporation may not limit or deny the coverage of health care services provided through telehealth, including ancillary services, and may apply only the same limits or exclusions on a health care service provided through telehealth that are applicable to an in-person encounter for the same health care service, except for procedures or services for which the weight of evidence, based on practice guidelines, peer-reviewed clinical publications or research or recommendations by the telehealth advisory committee on telehealth best practices established by section 36-3607, determines not to be appropriate to be provided through telehealth. 1, 2021, PDF. Sec. (Accessed Sept. 2021). The Hospital Outpatient Prospective Payment System (HOPPS) is used by CMS to reimburse for hospital outpatient services. To submit a claim for an audio-only service, the health care provider must make telehealth services generally available to patients through the interactive use of audio, video or other electronic media. 10: Individual Practitioner Services, (10/46-49), (07/12/2021); IHS/Tribal Provider Billing Manual, Ch. Physical Therapy Compact (Accessed Sept. 2021). 423. The health care provider shall notify the applicable health care provider regulatory board or agency within five days after any restriction is placed on the health care provider’s license or any disciplinary action is initiated or imposed. SOURCE: AZ Health Care Cost Containment System, AHCCCS Fee-For-Service Provider Billing Manual, Ch. Medicaid Long-Term Managed Care Program, PDF opens new window. 3). Oct. 2015 (Accessed Sept. 2021), AZ Health Care Cost Containment System, AHCCCS Fee-For-Service Provider Billing Manual, Ch. (Accessed Sept. 2021). AZ Medical Policy for AHCCCS Covered Services. Telehealth and Telemedicine Ch 300, (320-I pg. Asynchronous (also called “store and forward”) occurs when services are not delivered in real-time, but are uploaded by providers and retrieved, perhaps to an online portal. Beginning October 1, 2021 and on or before the first of each month thereafter, each health care provider regulatory board or agency shall submit to the telehealth advisory committee on telehealth best practices established by section 36-3607 a report identifying the number and type of out-of-state health care providers who have applied for registration pursuant to section 36-3606 and the number and type of out-of-state health care providers whose registration pursuant to section 36-3606 has been approved. Prescriptions written or prescription medications issued for administration of immunizations or vaccines listed in the United States centers for disease control and prevention’s recommended immunization schedule to a household member of a patient. 0 G2012 – Brief communication technology-based service, e.g., virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion. This paragraph does not apply to a telehealth encounter provided through a telehealth platform that is sponsored or provided by the corporation. If the telehealth interaction does not take place in the physical presence of the patient. 2021 Procedural Coding Expert This procedural coding book is designed for a clinical coder's daily work—not the classroom or AAPC's credentialing exams. MyMedicare.gov: Phone number for general questions. Behavioral health providers delivering care via telepractice to Arizona patients must be licensed by the Arizona Board of Behavioral Health Examiners. 360 Comprehensive Assessments and HMRs via Telehealth Updated 5/21/2020. 2), Oct. 2019.; AZ Health Care Cost Containment System, AHCCCS Fee-For-Service Provider Billing Manual, Ch. Birth Settings in America: Outcomes, Quality, Access, and Choice reviews and evaluates maternal and newborn care in the United States, the epidemiology of social and clinical risks in pregnancy and childbirth, birth settings research, and ... 5 & 6. For the purposes of this paragraph, “patient” means a person who is not a resident of this state and who is an athlete or a professional entertainer. SOURCE: Arizona Revised Statute Sec. Tele-presenter services are not billable. SOURCE: AZ Revised Statute Sec. A corporation may establish reasonable requirements and parameters for telehealth services, including documentation, fraud prevention, identity verification and recordkeeping, but such requirements and parameters may not be more restrictive or less favorable to health care providers or subscribers than are required for health care services delivered in person. Acts in full compliance with all applicable laws and rules of this state, including scope of practice, laws and rules governing prescribing, dispensing and administering prescription drugs and devices, telehealth requirements and the best practice guidelines adopted by the telehealth advisory committee on telehealth best practices established by section 36-3607. 5, pg. Organized by major organs and body systems, the text offers comprehensive, abundantly illustrated guidance to enable both the radiologist and clinical oncologist to better appreciate and overcome the challenges of tumor imaging. SOURCE: House Bill 2454 (2021 Session), (Accessed Sept. 2021). AZ Revised Statute Sec. 132 (Accessed Sept. 2021). In Advancing Oral Health in America, the Institute of Medicine (IOM) highlights the vital role that the Department of Health and Human Services (HHS) can play in improving oral health and oral health care in the United States. CMS Internet-Only Manual, Publication 100-04, Medicare Claims Processing Manual, Chapter 4, §230 Billing and Payment for Drugs and Drug Administration and §230.2 Coding and Payment for Drug Administration G2010 – Remote evaluation of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment. 36-3606 & House Bill 2454 (2021 Session), (Accessed Sept. 2021). See manual for example codes. (Accessed Sept. 2021). Services provided through telehealth or resulting from a telehealth encounter are subject to all of this state’s laws and rules that govern prescribing, dispensing and administering prescription pharmaceuticals and devices and shall comply with Arizona licensure requirements and any practice guidelines of the telehealth advisory committee on telehealth best practices established by section 36-3607 or, if not addressed, the practice guidelines of a national association of medical professionals promoting access to medical care for consumers via telecommunications technology or other qualified medical professional societies to ensure quality of care. 20-841.09 & 20-1057.13 & 20-1376.05 & 20-1406.05 as amended by House Bill 2454 (2021 Session). SOURCE: AZ Health Care Cost Containment System, AHCCCS Fee-For-Service Provider Billing Manual, Ch. COVID-19 & Flu Season – How to talk to your Medicare Patients. Please submit notifications using the standardized Pregnancy form located on GAMMIS Georgia Medicaid Management Information System (GAMMIS), For Ambetter information, please visit our Ambetter website. This public domain book is an open and compatible implementation of the Uniform System of Citation. ia asynchronous telehealth can include Naturalistic Observation Diagnostic Assessment (NODA).
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