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FYI: Workers’ Comp Telemedicine Reimbursed at Facility Rates

May 16, 2018 by Catherine Montgomery

In California and elsewhere, telemedicine isn’t just the future — it’s the present. Of course, this shift to increasingly virtual services means unique new wrinkles in the workers’ comp billing and payment process.

One common point of confusion is “where” telemedicine takes place for billing purposes; i.e. in a facility or non-facility. Fortunately, the Official Medical Fee Schedule (OMFS) provides a simple answer: place of service code 02.

A Medical Services (R)evolution

For those who don’t know, telemedicine is just what the term implies: treatment delivered via communication technology rather than in person. Providers can offer everything from triage to occupational therapy online, through laptops, tablets, and smartphones.

To the extent telemedicine can be delivered effectively, the reduction in costs is massive. The convenience factor for patients and providers is incalculable.

Many workers’ compensation stakeholders see the rise of telemedicine as a boon, eliminating transportation costs and allowing providers to treat injured workers in far-flung and rural locations. As California’s Division of Workers’ Compensation approves the use of telemedicine for more Medical Provider Networks (MPN), many experts expect nothing less than continued rapid growth for this method of delivering care.

Billing for Telemedicine

The Centers for Medicare and Medicaid Services (CMS) responded to the rise of telemedicine in 2016, creating  place of service code 02. In the code’s description under the Place of Service Code Set, the CMS describes the place of service for Telehealth as:

The location where health services and health related services are provided or received, through a telecommunication system.

As to the facility/non-facility conundrum, providers applying place of service code 02 bill at the facility rate. As far as the CMS is concerned, telehealth services are not subject to reimbursement for overhead costs, wherever they’re provided or received. In theory, a provider can just as easily deliver telemedicine from the comfort of their poolside patio as from an office. Therefore, code 02 is calculated at the Facility payment rate.

California’s OMFS soon followed suit, updating the Physician and Non-physician Practitioner Fee Schedule accordingly, effective March 1, 2017.

Telemedicine represents a whole new field of healthcare, full of new opportunities for providers willing to explore the cutting edge. Know the rules and stay compliant, wherever technology takes us next.

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Technology isn’t just changing treatment; it’s improving billing. Ready to see just how easy calculating reimbursement can be? Try our Work Comp Wizard’s OMFS Calculator, which instantly calculates the correct reimbursement for services rendered.

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