Patients and providers alike embraced telehealth during the COVID-19 public health emergency (PHE) when the Centers for Medicare and Medicaid Services (CMS) broadened access to telemedicine services to provide beneficiaries continuing access to a wider range of services without having to travel to a healthcare facility. Since the PHE ended in 2023, many flexibilities have continued to remain in place for those participating in Medicare or Medicaid, especially in rural service areas. Even as these remaining flexibilities were set to expire for government payers in 2024, they were extended again through March 31, 2025 when Congress passed the bipartisan American Relief Act. The AMA added a new series of CPT®/E/M codes for telemedicine services for 2025, but CMS confirmed in the Physician Fee Schedule (PFS) final rule that it will only pay for one of them.
The healthcare system remains in flux where telehealth is concerned. One thing is certain - it is imperative to know the individual payer's policies and guidelines to ensure proper submission of claims and accurate reimbursement. Participate in this program to better comprehend these nuances. Be informed about the telehealth flexibilities that have been made permanent and identify which services are only temporarily still in place. Know which telehealth services will continue to be covered by private payers, and by which carriers. Review examples of carrier specific rules and learn how to locate payer-specific telehealth service requirements to keep you informed of future changes.
Highlights:
- Key telehealth terminology
- Telecommunications methods and approved modalities
- State vs Federal requirements
- Understand relevant HIPAA Privacy and Security guidelines
- Approved providers and telehealth services
- Current approved telehealth service codes and modifiers
- Audio visual vs. audio only visits
- Place of service and distant / originating site requirements
- Avoiding fraud and abuse
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Jan Hailey
MHL, CMC, CMCO, CMIS, CMOM, CMCA E/M
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Jan Hailey has more than 30 years of experience in healthcare. She is proficient in administration, coding, and billing roles, and teaches medical office professionals around the country how to excel in their careers. Jan has also been instrumental in the development of PMI's Workforce Initiatives program.
Jan's affinity for teaching has helped countless healthcare providers and medical office professionals over the years. During her expansive career, she has served as Director of Quality for Saint Joseph Physician Network located in Mishawaka, IN, and Director of Care Management with Select Health Network, an entity of Saint Joseph Health System. As Care Management Director, Jan led the physician network and comprehensive interdisciplinary team across the health system working closely with providers, management, staff, community, and payers to develop strategies for process improvement, gap closures, and patient experience. She developed a documentation improvement program and a Hierarchical Condition Category (HCC) coding education program to predict future healthcare utilization by accurately reporting patient complexity.
Prior to joining Saint Joseph, Jan was the Director of Quality, Coding, and Compliance for one of the largest health systems in Northern Indiana. She has a Master of Health Leadership and four professional certifications in office management, coding, insurance processing, and compliance. She is a member of WPS Government Health Administrators (Medicare) Provider Outreach and Advisory Group.
Medical coders, billers, auditors, clinicians, and practice managers will benefit from this program. This session will help ensure your providers receive accurate reimbursement for telehealth services and avoid penalties associated with fraudulent telehealth billing.
No prerequisites required. However, this intermediate-level course assumes base knowledge of provider coding and reimbursement.
Self-paced online program includes unlimited review of previously recorded instruction and the downloadable digital course materials for 6 months.
Comments from past participants:
"Very informative. It was well-presented and the handout is great."
"Good timely information. Thank you!"
"Excellent. Presentation included clarification on modifiers that will help us in future billings."
Prod ID: 509