Presentation by Kevin Barger, Network Management Director, Anthem Blue Cross Blue Shield

1. Telemedicine Benefits
Kevin Barger, MBA
MATRC 2012 Summit
Thursday, March 15, 2012

2. Why do payors support telemedicine?
•Increased Access to Doctors
•Improved Quality of Care
•Improved Continuity of Care
•Reduction of time lost from work
•Reduction of travel costs
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3. Who qualifies to provide these services?
•Physician office (including NP, PA)
•Rural health clinic
•Federal qualified health center
•Hospital
•Hospital-based or critical access-based renal dialysis
center
•Skilled nursing facility
•Community mental health center
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4. REMINDER: What is NOT Telemedicine
•As specifically stated in the VA Code:
• Audio-only Telephone
• Home Videoconferencing sessions
- Skype
- Email functionalities
- Fax submissions
- Telephonic monitoring (e.g., pacemakers)
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5. What about referrals or preauthorizations?
•Under HMO – referrals still required
▪ Any service requiring a preauthorization continues to do so
•If provider performing the telemedicine service is out of
network, an authorization may be required.
•Member cost share does apply if appropriate
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6. How does it get billed?
•Q3014
▪ Billed by the originating site
•Evaluation and Management Codes
▪ Billed by the provider providing the service or consultation
▪ Include GT modifier
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7. Are our providers using it?
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8. 2011 Preliminary results
•We had professional billings
• 2,554 claims
• Serving 1,184 unique patients
• With 96 providers of these services
• In 31 different entities
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9. 2011 Preliminary results
•Most common diagnoses of patients treated?
• HIV/Other infectious diseases
• Behavioral Health
• Including ADHD
• Cardiology-related
• Including Chest Pain
• Congestive Heart Failure
• Hypertension
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10. Disclaimer
• Anthem Blue Cross and Blue Shield is the trade name of: In Colorado and Nevada: Rocky Mountain Hospital and Medical
Service, Inc. In Connecticut: Anthem Health Plans, Inc. In Indiana: Anthem Insurance Companies, Inc. In Kentucky:
Anthem Health Plans of Kentucky, Inc. In Maine: Anthem Health Plans of Maine, Inc. In Missouri (excluding 30 counties in
the Kansas City area): RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and
HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits
underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans
and do not underwrite benefits. In New Hampshire: Anthem Health Plans of New Hampshire, Inc. In Ohio: Community
Insurance Company. In Virginia (excluding the City of Fairfax, the Town of Vienna and the area east of State Route 123.):
Anthem Health Plans of Virginia, Inc. In Wisconsin: Blue Cross Blue Shield of Wisconsin ("BCBSWi"), which underwrites
or administers the PPO and indemnity policies; Compcare Health Services Insurance Corporation ("Compcare"), which
underwrites or administers the HMO policies; and Compcare and BCBSWi collectively, which underwrite or administer
the POS policies. Independent licensees of the Blue Cross and Blue Shield Association. ® ANTHEM is a registered
trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered
marks of the Blue Cross and Blue Shield Association.
•
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