COVID-19 Telehealth Resources

This page contains resources related to Telehealth for Colorado CHCs. We have organized the information by telehealth topic to help you find what you need quickly. We will update our information as the situation changes and we learn more. If you have any suggestions for this page or specific questions please don’t hesitate to reach out to anyone at CCHN.

Counting Visits for Primary Care Fund, CICP, and UDS

(Last Reviewed: February 24, 2021)

Primary Care Fund Visits

HCPF clarified on 3/26/20 that telehealth visits via “all allowable means” will be accepted for the FY 2021-22 Primary Care Fund application. This includes telephone, live chats, etc. CHCs are asked to document this service as they normally would do. 


Colorado Indigent Care Program (CICP) Visits

  • Both telephone and telemedicine visits are allowable under CICP.  Read more about applications (need not be filled out in person) and more in the March 2020 CICP update.
  • HCPF posted FAQs related to CICP and telehealth during the COVID-19 crisis on their website. The FAQs answer application, co-pay, backdating/end dating, documentation, and income calculation questions. Visit the FAQs page.

UDS Visits

CHCs should use the definition of virtual visit in the  2020 UDS manual: Report documented virtual (telemedicine) contact between a patient and a licensed or credentialed provider who exercises their
independent, professional judgment in the provision of services to the patient as a visit in Column B2. Report virtual visits that occurred during the reporting year rendered by salaried, contracted, or volunteer staff. Most visits reported in Column B2 will be provided by staff identified in Column A. Virtual visits purchased from contracted providers on a fee-for-service basis will also be reported. 


Dental

(Last Reviewed: March 4, 2021)

ADA COVID-19 Coding and Billing Interim Guidance (updated March 24, 2020)
Provides coding guidelines for the use of telecommunication technology to triage patients and determine urgency/emergency of cases, and additional required codes to distinguish synchronous vs. asynchronous consultations. Also describes HIPAA considerations, appropriate platforms, and a practice considerations checklist.


Colorado Department of Health Care Policy and Financing (HCPF): Teledentistry Guidance
Statement from HCPF regarding expansion of telemedicine to include dental consultations. Includes basic teledentistry requirements and billing guidance.


Emergency Teledental Screening Tool (Denver Health): Scripting for triage of dental patients, including consent, clinical questions, and recommended documentation.


Teledentistry Visit Standard Work (Denver Health): A step-by-step guide for dentists to use during a teledentistry visit, including visit types based on established vs. non-established patients, scripting, consent, documentation, and emergency procedure guidance from the ADA and CDA.


Guidance Document for Patient Assessment via Synchronous Teledentistry: A guide to coaching patients through a teledentistry visit to obtain optimal images for assessment via video or photo. Created by Scott Howell, DMD, MPH, this link also includes one of his recorded webinars on the topic.

HIPAA

(Last Reviewed: February 24, 2021)

Office for Civil Rights Announcements Related to COVID-19: This page includes all the announcements that have been released for HIPAA during the COVID-19 Public Health Emergency


HRSA

(Last Reviewed: February 24, 2021)

Telehealth Program Assistance Letter (PAL 2020-01)Within the context of the Health Center Program scope of project, “telehealth” is not a service or a service delivery method requiring specific HRSA approval; rather, telehealth is a mechanism or means for delivering a health service(s) to CHC patients using telecommunications technology or equipment. As such, CHCs are not required to seek prior approval from HRSA for a change in scope to use telehealth, nor separately record the use of telehealth as the means, to deliver a service that is already in scope on Form 5A: Services Provided or to explicitly indicate the use of telehealth on Form 5A.  


Medicaid Billing

(Last Reviewed: April 8, 3:00 PM)

During the COVID-19 state of emergency, Medicaid will reimburse CHCs for telehealth services for all normally billable providers at each CHC’s applicable encounter rate.

Read more about the authorizationThis link includes the following:

  • Specificity that providers can still only bill codes they are eligible to bill
  • Consent to receive telemedicine services
  • Maintenance of prior authorization rules
  • HIPAA information, noting that the Office for Civil Rights has relaxed enforcement of some HIPAA standard
  • UB-04 billing guidance

Modalities to be reimbursed are:

  • Interactive audiovisual visits
  • Telephone visits
  • Live-chat

Telemedicine does not include: fax consultations, text, email or instant messaging.  Costs associated with these modalities can be included in cost reporting.


Behavioral Health

In an effort to remove administrative and regulatory barriers to delivering remote services during the COVID-19 state of emergency, all RAEs are currently allowing outpatient treatment services listed in the Uniform Services Coding Standards Manual (USCSM) to be delivered via audiovisual, telephone, or live chat modalities, when it is clinically viable and appropriate. The Department and the RAEs have NOT changed USCSM requirements, prior authorization policies, or payment rules. Providers must follow each individual RAE’s billing policies.

Specific guidance and frequently asked questions are available from each RAE through the following websites:

The Department will continue to post updates on policies, codes, and other information important to providers on their website as it becomes available. HCPF will continue to send out communications via bulletins and newsletters too and will post those on their COVID-19 Resource Center.


Medicare

(Last Reviewed: February 24, 2021)

Coronavirus Aid, Relief, and Economic Security (CARES) Act was signed into law on March 27, 2020. This bill authorizes Medicare reimbursement for health centers and rural health clinics as distant sites for the duration of the emergency, not reimbursed at PPS rate but instead “such payment methods shall be based on payment rates that are similar to the national average payment rates for comparable telehealth services under the physician fee schedule under section 1848.” On April 17, CMS issued guidance about how FQHCs can bill Medicare as telehealth providers.  See the guidance here.


New & Expanded Flexibilities for RHCs & FQHCs during the COVID-19 PHE


Other Payers

(Last Reviewed: March 30, 1:30 PM)

CHPA provided an email update about how different payers are handling telehealth visits on March 27. See below for these updates.

  • Anthem: Anthem has expanded services to include telehealth and telephonic visits, prescription coverage, and some member cost-shares.  
  • Bright HealthBright Health has made updates to expand telehealth services, allow early medication refills and provide non-emergency transportation.  
  • CignaCigna has expanded and updated its medical billing guidelines for telehealth back to March 2nd, and can start billing on April 6th.  Please see this Cigna COVID-19 Billing Update.
  • HumanaHumana has expanded telehealth service scope and reimbursement rules.  
  • Oscar Health:  Oscar Health is waiving all early refill limits and encouraging members to stock up on 30 day supplies.  However, since telehealth is a benefit in Colorado you should be able to bill and receive contract rates for services provided.
  • United Health CareUnited Healthcare has expanded services to include telehealth and telephonic visits, prescription coverage and some member cost-shares.  

State Resources
Workflows, Processes, and Protocols

(Last Reviewed: February 24, 2021)

CHC Telehealth Examples: CHC examples of policies, procedures, and workflows related to telehealth are available in the links below. For documents that are password protected please use the password for CCHN’s members-only website. CCHN is seeking sample telehealth/telephone visit workflows, policies, and procedures from Colorado CHCs. If you have a sample to share, please send it to holly@cchn.org.


Telehealth Examples from Community Health Centers

Please note with the rapid developments for telehealth these documents may have been updated since the date they were shared with CCHN.


Other Telehealth Examples and Resources: