Indiana Medicaid Telehealth Reimbursement

 Medicaid Reimbursement / Posted 6 months ago by Telehealthist

Indiana Medicaid reimburses for live video telemedicine for certain services and providers. Indiana Medicaid does not reimburse for store-and-forward although store-and-forward can still be used to facilitate other reimbursable services. Indiana Medicaid defines telehealth as including remote patient monitoring (RPM) services and reimburses home health agencies for RPM for patients with diabetes, congestive heart failure and COPD.

Definitions
Telemedicine services are defined as “the use of videoconferencing equipment to allow a medical provider to render an exam or other service to a patient at a distant location.”

Live Video

Indiana Code requires reimbursement for video conferencing for FQHCs, Rural Health Clinics, Community Mental Health Centers, Critical Access Hospitals and a provider determined by the office to be eligible, providing a covered telemedicine service.

Eligibility

All services that are available for reimbursement when delivered as telemedicine are subject to the same limitations and restrictions as they would be if not delivered by telemedicine.

Eligible Providers
The distant site physician or practitioner must determine if it is medically necessary for a medical professional to be at the originating site.

Eligible Sites
Services may be rendered in an inpatient, outpatient or office setting.

Geographic Limits
No reference found.

Facility/Transmission Fee
Healthcare Common Procedure Coding System (HCPCS) code Q3014 – Telehealth originating site facility fee, billed with modifier 95, is reimbursable for providers that render services via telemedicine at the originating site.

Store-and-Forward
Policy
The IHCP allows store-and-forward technology (the electronic transmission of medical information for subsequent review by another healthcare provider) to facilitate other reimbursable services; however, separate reimbursement of the originating-site payment is not provided for store-and-forward technology because of restrictions in 405 IAC 5-38-2(4). Only live video is separately reimbursed by the IHCP.

Eligible Services/Specialties
No reference found.

Geographic Limits
No reference found.

Transmission Fee
No reference found.

Remote Patient Monitoring
Policy
Indiana Code requires Medicaid to reimburse providers who are licensed as a home health agency for telehealth services.

Conditions
Click for a list of eligible conditions.

Provider Limitations
Reimbursement for home health agencies under certain conditions.

Other Restrictions
Treating physician must certify the need for home health services and document that there was a face-to-face encounter with the individual.

Email/Phone/Fax
Click for a list of exceptions to telehealth technology.

Consent
Providers should always give the member the choice between a traditional clinical encounter versus a telemedicine visit. Appropriate consent from the member must be obtained by the originating site and documentation maintained at both the distant and originating sites.

Out of State Providers
Out-of-state providers can perform telemedicine services without fulfilling the out-of-state prior authorization requirement if they have the subtype “telemedicine” attached to their enrollment.

Miscellaneous
For patients receiving ongoing telemedicine services, a physician should perform a traditional clinical evaluation at least once a year, unless otherwise stated in policy. The distant site physician should coordinate with the patient’s primary care physician.