Is Independent Health covering and allowing Telehealth and Telemedicine for insured members?
Independent Health covers telehealth and telemedicine for insured members. As of August 1, 2021, telehealth and telemedicine services not related to COVID-19 will once again have a cost share for commercial and Essential Plan 1 members.
We’ve organized important information in the Telehealth Fee Schedule, Coverage Grid, and Policy.
Providers may render services via non-HIPAA compliant technologies such as FaceTime or Skype as permitted by the Department of Health and Human Services Office for Civil Rights.
Additionally, Independent Health is expanding coverage for Primary Care annual well visits. When both audio and visual contact is possible, and in accordance with the guidelines below, annual preventive visits may be performed
via telemedicine during the COVID-19 pandemic for all lines of business. When telephone is the only option (audiovisual is not possible), telephone E/M services can be billed business. Refer to Billing Guidelines for Primary Care Telehealth Preventive Visits for more details.
Important Guidelines for Primary Care Preventive Visits via Telemedicine
- Providers should reference their specialty society professional recommendations for virtual preventive visits.
- Providers should only engage in this care delivery when the patient’s conditions and needs can adequately be met, and the service is safe.
- Billing for the services does not require completion of the physical exam during the state of emergency.
Additional, subsequent preventive visits or well visits should not be billed to Independent Health. In the event a member needs to be brought in later for a specific service, such as immunizations, those services would be
reportable and reimbursed.
- Members will not be required to return to the office for a face-to-face visit to “complete” the preventive service done through telemedicine or telephone contact.
Independent Health is reviewing the use of telehealth and telemedicine regularly and will communicate with providers when any adjustments are necessary
*Coverage for self-funded employer plans (see FAQ below), including Nova, varies by employer group.
Is Independent Health covering telehealth and telemedicine for Self-Funded Members?
Self-funded members are administered through Independent Health Self-Funded Services and Nova Healthcare Administrators. Telehealth and telemedicine coverage updates for these members include the following:
Independent Health Self-Funded Services members
All employer groups who utilize Independent Health Self-Funded Services to administer health coverage for their employees have elected to cover telehealth services for COVID-19 and non-COVID-19 patient visits with no member
Self-funded members are identified on the member ID card. The back of the ID card for these members indicates "administered by Nova" near the top. Self-Funded members should contact customer service at 716-631-2661 or 1-800-257-2753 for more information.
All Western New York clients of Nova, a wholly owned affiliate of Independent Health, have elected to allow telehealth services for all diagnoses under their plans
except New York Business Development
While most Nova clients have chosen to apply a member cost share through a standard office visit copay for telehealth services not related to COVID-19, the following clients have waived the member cost share:
- Jamestown BPU
- Sheet Metal Workers
Nova members are identified by the Nova logo on front of the member ID card. (Lancaster Schools members have an Independent Health Self-Funded Services ID card and the back of the ID card for these members will indicate
"administered by Nova" near the top.) These members can call the customer service number on their ID card or call Nova at 716-773-2122 or toll free 1-800-999-5703. or toll free 1-800-999-5703.
What types of visits are covered for Telehealth/Telemedicine?
Most interactions with a patient can be handled through Telehealth/Telemedicine visit for $0 copay or cost-sharing* for members for these services. Providers should only engage in this care delivery when the patient’s
conditions and needs can adequately be met, and the service is safe. Some Examples are:
- COVID-19 related needs
- Primary Care Annual Well Visits
- New Patient Visits
- Neuropsychological Testing
- Specialist visits
- Lactation Counseling
- Transitional Care Management
- Remote Monitoring (as long as the specified guidelines are satisfied)
Refer to this Coverage Grid for more information.
There are certain services that require in-person interaction (e.g., immunization administration, specimen collection) and therefore are not appropriate for telehealth at this time.
*Medicare Members are responsible for the cost share associated with ancillary services (e.g. dietitians). Coverage for self-funded employer plans varies by employer group.
Who can perform Telehealth/Telemedicine services?
The following provider types can perform Telehealth/Telemedicine services:
- Primary Care Physician (PCP)
- Specialist Physician
- Registered Nurse (if performed solely by the RN, must be performed while working with a supervising physician and under general supervision)
- Non-Physician, independent billing provider (i.e. Audiologist, CSW, Physical Therapist, Psychologist, Dietitian)
The following provider types can NOT perform Telehealth/Telemedicine services:
Urgent care center visits are not covered for telehealth/telemedicine at this time. Independent Health encourages member to reach out to their PCP with urgent needs by phone or through telemedicine. Members without PCP's can call Independent Health Member Servicing for available providers.
- Licensing Practical Nurses (LPNs)
Refer to this Coverage Grid for more information.
What is Teladoc®?
Although Independent Health encourages its members to contact their primary care physician for their medical needs, we realize this isn’t always possible. So, when a member can’t reach their primary care practice, Independent
Health’s telemedicine benefit is provided through Teladoc®. Independent Health is waiving the cost share for Teladoc services during the COVID-19 outbreak.
Teladoc is not available to MediSource, MediSource Connect, Essential Plan and Child Health Plus members. Coverage for self-funded employer plans varies by employer group.
Can Medicare Advantage Member obtain care from out-of-network providers?
Due to the emergency declaration, Medicare Advantage members may obtain care from out-of-network providers at the in-network cost sharing. For more information, see the page called “Getting care during a disaster.”
What is the difference between virtual check-ins and phone visit codes?
Telephone services are provided only via telephone. Virtual check-ins can be performed via telephone or other telecommunication means (e.g., audio, secure text, use of patient portal).
Another virtual service is a “store and forward” remote evaluation where the patient submits a recorded video and/or images and the provider evaluates, interprets and provides follow-up with the patient within 24 hours.
Does Independent Health cover home health, home infusion nursing, and hospital outpatient therapies virtually?
Yes, Independent Health is covering the following services delivered virtually for all lines of business effective immediately and through June 22, 2020:
- Home Health Services
- Home Infusion Nursing
- Hospital Outpatient Therapies
To track and appropriately apply member benefits for these services when delivered virtually, Independent Health is requesting providers append the following modifiers to each applicable claim line based on how the service is provided:
|Synchronous, Two-Way Audio-Visual Technology
||GT or 95
Independent Health is working with providers along with state and federal agencies to determine a possible increase or decrease in the duration of this change, if needed.
Is there any change to current provider reimbursement for home health services, home infusion nursing and hospital outpatient therapies via telephone or two-way audio-visual technology?
No, not at this time.
Should providers continue to submit claims for home health services, home infusion nursing and hospital outpatient therapies?
Yes, beyond the application of the additional modifiers listed above.
Does Independent Health still require concurrent review authorization upon receipt of clinical information for home health services, home infusion nursing and hospital outpatient therapies?
Yes, while notification timeframes are relaxed to ease hospital discharge planning, please continue to notify as close to initiation of care to avoid retrospective denials for medical necessity.