COVID-19 and Telehealth

In a Newsline dated 5/12/2020 the California DWC announced a new Order that retroactively changes the reimbursement calculation for telehealth services.

Some of the information on this page may not be correct, depending on the date of service. For the the most up-to-date reimbursement rules, consult the latest Administrative Orders and check back here for updated webinars and blog posts on these changes.

Telehealth rules for both Medicare and CA workers’ comp have changed again, and this time providers really benefit. Expansion of audio-only services and major reimbursement increases are just the beginning. For California workers’ comp, these changes apply retroactively to dates of service on or after 3/1/2020. Providers who have already submitted bills for affected dates could be owed hundreds of additional dollars per bill.

This video comprehensively covers these important changes:

• Place of Service code reporting

• Affected Dates of Service

• Increased reimbursement for audio-only CPT codes

• CMS’ updated list of covered telehealth services

• Telehealth appeal instructions, for those bills submitted for Dates of Service affected by the retroactive aspect of the DWC order

In a Newsline dated October 27, 2020, the California Division of Workers Compensation (DWC) announced the adoption of the updated Medicare List of Telehealth Services, which includes eleven (11) new codes. The DWC’s inclusion of the eleven new telehealth services to the Official Medical Fee Schedule (OMFS) is retroactive for dates of service on and after October 14, 2020.

Effective 10/14/2020, the Centers for Medicare & Medicaid Services (aka “CMS” or “Medicare”) added 11 new services to the List of Telehealth Services that Medicare will reimburse during the COVID-19 emergency.

Per the most recent OMFS regulation update, the California Division of Workers’ Compensation (DWC) has not yet adopted these new services. Once/If the DWC adopts these additional codes, we will update the fee schedules in DaisyWizard and send out an announcement.

Today we focus on the substantial reimbursement increase for the telephone-only CPT codes 99441, 99442, and 99443. These reimbursement changes impact all dates of service on or after 3/1/2020. This is the second of our series on retroactive telehealth rule changes announced by the California Department of Workers’ Compensation (DWC) on 5/12/2020. 

May 14, 2020

On May 12, the California DWC announced retroactive changes to the reimbursement calculation for telehealth services, to the benefit of providers.

In this post we analyze updated reporting requirements for the Place of Service codes, meaning that many providers are now entitled to substantially increased amounts of reimbursement.

May 6, 2020

This is part two of our series analyzing telehealth reimbursement rule changes that were announced last week by the Centers for Medicare & Medicaid Services (aka “CMS'' or “Medicare”). Because many states take their cue from Medicare when establishing workers’ comp reimbursements, we’re closely following and reporting on these updates.

May 5, 2020

Last week the Centers for Medicare & Medicaid Services (aka “CMS” or “Medicare”) significantly changed its telehealth reimbursement rules to adjust to the demands of the COVID-19 crisis. These Medicare telehealth changes impact workers’ comp providers because many states mirror or closely mirror Medicare telehealth reimbursement rules.

In this first of several blog posts about these changes, we cover the expanded list of eligible practitioners as well as newly added telehealth services.

April 29, 2020

California’s Division of Workers Compensation (DWC) ordered further adjustments to the Pathology and Clinical Laboratory Section of the state’s Official Medical Fee Schedule (OMFS) for workers’ compensation. The changes increase reimbursement for “high throughput” COVID-19 testing and apply retroactively.

The latest order by the Administrative Director adds two new billing codes, as well as adjusting fees and clarifying effective dates of service for other, existing codes.

April 27, 2020

Anthem Workers’ Compensation recently sent an email to providers with misleading instructions regarding telehealth video platform compliance. This email misrepresents telehealth privacy and security requirements by incorrectly asserting that various video platforms, such as Skype and Facetime, are disallowed by Medicare and “may result in non-reimbursement” when used to treat injured and ill workers.

April 24, 2020

Many providers reached out to us with questions regarding authorization requirements. For clarification, the California workers’ comp utilization review requirements have not changed. Every medical treatment requires utilization review whether the medical treatment is delivered in person or delivered via telehealth video.

April 20, 2020

As if the logistical challenges of this pivot aren’t daunting enough, keeping up with constantly shifting rules and regulations is yet another drain on provider time and resources.

To help, we’ve created a simple “cheat sheet” for California providers, featuring the most important regulatory must-knows for workers’ compensation, Medicare, and private insurance plans.

April 14, 2020

The recent DWC Newsline and the accompanying Order of the Administrative Director explain three new and important changes to the telehealth regulations. With a single exception, these changes align California workers’ compensation telehealth rules with Medicare telehealth rules.

April 13, 2020

Let’s start off with the unfortunate fact that California workers’ compensation pays providers substantially lower amounts for telehealth services as compared to the reimbursement allowed when the injured worker is treated in a provider’s office location. Compare this to Medicare and California private group health insurers, both of which reimburse providers for telehealth services at a rate equal to the rate for office visits.

April 9, 2020

For California providers, obtaining authorization for workers’ compensation treatment requires substantial administrative resources. As COVID-19 strains those resources, priorities must shift. Claims administrators and state authorities can empower providers to focus their time and effort on patients’ benefit first, by lessening the administrative burdens of the authorization process.

April 8, 2020

Health care providers using (or considering) teleconferencing software Zoom, heed this important warning: serious security, privacy, and data protection issues reportedly plague the product, leading several public and private entities to discontinue use.

April 6, 2020

Many significant changes affecting telehealth have occurred since last week when DaisyBill first presented its California Workers’ Comp Telehealth webinar. Due to all of the changes, we are hosting an updated version of the webinar replete with all of the updates to telehealth issued over the last seven days by Medicare and the California Insurance Commissioner.

April 3, 2020

Today’s blog post is short but extraordinarily important.

Every practice considering furnishing telehealth services should contact their malpractice insurance carrier to confirm that telehealth services are covered by the practice’s policy. Some policies do not cover telemedicine exposure at all or these policies have restrictive vendor requirements, including HIPAA requirements that are in excess of those currently mandated by the DWC and the U.S. Health and Human Services Office for Civil Rights (OCR).

April 2, 2020

While Medicare allows audio-only for some services, the California DWC currently requires a video connection under all circumstances. Audio-only is never considered a telehealth service; audio-only is a telephone call.

April 1, 2020

As COVID-19 redefines the workers’ compensation landscape, providers have many questions. But there is no question as to what persons or which entities have the authority to determine the answers: the California Division of Workers’ Compensation (DWC).

March 30, 2020

California’s Division of Workers Compensation (DWC) ordered adjustments to the Pathology and Clinical Laboratory Section of the state’s Official Medical Fee Schedule (OMFS) for workers’ compensation.

March 26, 2020

While the rest of us come together by staying apart, not all Californians have the option of social distancing. Essential workers accept the high risk of exposure to COVID-19 in order to keep our state functioning at its most basic levels, knowingly subjecting themselves to danger on everyone’s behalf. For their part, California’s Division of Workers’ Compensation (DWC) can help by reducing the burden on logistically strained workers’ comp providers.

March 25, 2020

California workers’ comp providers may continue to treat ill and injured employees remotely during the COVID-19 outbreak. Treatment delivered via telehealth is 100% payable, using the appropriate billing codes and supported by proper documentation. Knowing the current guidelines and regulations is the first step for providers navigating this transition.

March 24, 2020

It’s a new reality for workers’ comp, as stakeholders grapple with drastic changes brought on by COVID-19. DaisyBill is here to help providers navigate this changing landscape, with a series of blog posts, webinars, and other helpful updates aimed at providing the best workers’ comp billing and payment information for those who treat our ill and injured workers.

To begin, we’ll use this post to answer the most frequently asked questions submitted to us by our 5,000+ clients: Who Now Determines the Rules for Workers’ Comp?