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Facility Fees & Telehealth Reimbursement

by | Feb 2, 2019 | 10 comments

facility feesProperly identifying facilities that rely upon reimbursable services can also point the way for additional fees that are exclusive to telehealth. For example, “facility fees” are often reimbursable. They are the U.S. government’s way of supporting the technology infrastructure costs often related to setting up and maintaining a range of telehealth technologies. Rates are generally $22 to $70 per session, depending on the insurer’s desire to obtain specialty services (Medicaid vs private insurer such as Blue Cross/Blue Shield). For example, in New Mexico, where there is a high demand for psychiatrists, Blue Cross/Blue Shield (BCBS) pays $70 per session as a facility fee.

A useful revenue estimation tool to help calculate fees for Medicare/Medicaid by the state is found here at the 1DocWay website. (We strongly encourage you to work with this tool for a few minutes to see its power. It will almost certainly be a very useful tool for you to decide which states to consider serving and to make financial projections.) When added to Medicare or Medicaid fees, this additional telehealth fee is the single largest factor that allows telehealth programs to be financially sustainable and profitable.

To collect the facility fee, the following specifications must be met, however:

  • Use this CPT code: Q3014
  • In the CMS document, entitled, “Program Memorandum Intermediaries/Carriers,” published by the Department of Health and Human Services (DHHS), HEALTH CARE FINANCING ADMINISTRATION (HCFA), on May 1, 2001, the note below is made with the subject: Revision of Medicare Reimbursement for Telehealth Services

To claim the facility payment, physicians/practitioners will bill HCPCS code “Q3014, telehealth originating site facility fee”; short description “telehealth facility fee.” The type of service for the telehealth originating site facility fee is “9, other items and services.” For carrier processed claims, the “office” place of service (code 11) is the only payable setting for code Q3014. There is no participation payment differential for code Q3014 and it is not priced off of the Medicare Physician Fee Schedule Database file. Deductible and coinsurance rules apply to Q3014. By submitting HCPCS code “Q3014”, the biller certifies that the originating site is located in either a rural HPSA or a non-MSA county.

  • The facility fee can only be billed by the facility where the patient is located (originating site)
  • This fee is billed much like other technical fees, such as those charged for blood draws (lab draw fee) or ECG fee
  • Not to be confused with the professional service charge, which is billed with other CPT codes
  • The facility fee is billed on the Uniform Bill (UB-92) form or the HCFA 1500
    • The primary difference between the two forms is related to the parties using them for billing. Medical facilities use the Uniform Bill (UB-92) and individual practitioners use the HCFA form (HCFA-1500). More specifically, the UB-92 medical claim form is used by medical institutions, such as hospitals, nursing facilities, and other facility providers.  The HCFA-1500 medical claim form is used by non-institutional healthcare service providers or medical professionals, such as individual doctors, nurses, and therapists.
  • Identify the Place of Service (POS) as code “02,” reflecting telehealth delivery as being where the PATIENT is located
  • The billing organization is the organization providing the facility rather than the clinician delivering the service

Facility fees are steadily being eliminated by the CMS as they increasingly move toward unbundling CPT Codes and value-based care. Be flexible. This is a learning process and every insurer is different. You will increase your success rate as you go.

What Are Your Thoughts?

Please leave your comments below.

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  1. Darryl T. White

    Hello Dr. Maheu,
    This information seems to be exactly what we need. We are a telemedicine company that provides behavioral health for substance use and co-occurring mental disorders. This means we provide services to our patients where ever they have the time for a 1 hour audio or video session with a counselor.
    In order to help more people, especially on regards to the opioid crisis (of the legal and illegal variety), we have to expand our services to include Medicaid/Medicare billing because most people simply cannot afford even our very reasonable fees with personal financing.
    We have compiled a list of 10 states to apply to for services, using info taken from SAMHSA and CMS sites. However, as you are well aware of, it can be quite the task navigating and understanding that material as each state has it’s own provider enrollment process and billing; though there are some similarities across the board.
    I’m going to delve into the materials above to continue our quest, and should we have further questions I hope myself or the office manager, who is actually doing the submission part can contact you for suggestions on mentoring through this process, get or info on is it best to hire a billing firm for a short time until we become more versed in these matters.
    PS…I tried to rate this post 5 stars, but accidentally clicked the first star.

  2. Carmen Rodriguez

    Great information and very useful! Thank you.

  3. Marlene Maheu, Ph. D.

    Mr. White,

    Thank you for your kind words. I’m glad to see that the time I spend writing has been of value to you. As for hiring a billing firm to do your work for a while, I’d be leery of the average billing firm. Several years ago, one of the groups I consulted with had the same interest. They polled 16 different billing services and found that none of them billed correctly. Rather, they said they knew exactly how to bill for telehealth, but in fact, they were using the same old codes as they had been using for in-person care. Unfortunately, deception among billing companies seems to be common when billing for telehealth.

    The heart of the problem, of course, is that the unwitting professional trusts these groups to know what they are doing. As you know, Those very same professionals are the ones who put their signatures on each of the HCFA 1500 forms used for reimbursement. (HCFA 1`500 forms are the official standard forms used by providers to submit bills/claims for reimbursement for health services. The HCFA 1500 contains patient demographics, diagnostic codes, CPT/HCPCS codes, diagnosis codes, units, etc.) The requirement that the treating professional sign each HCFA 1500 form submitted then, is the way that insurance companies legally assure that the professional has reviewed all reimbursement requests, and literally signed off on the codes being used, attesting to their accuracy. It falls on the professional then, to know how to bill correctly regardless of what the billing company claims to know.

    That’s why we have developed our 3-hour, 100% online reimbursement course. You’ll find it listed about 2/3 of the way down our individual course list, and entitled, Telehealth Reimbursement Strategies: Increasing Authorization & Payment” If you want to go to it directly, click this link. You, your clinical staff and your billing representative(s) can take it. TBHI gives 15% discounts to parties of three or more who take the same training, so if you have multiple providers who want to be sure to know the ins and outs of how to bill for telehealth, send your request to our contact desk with the names of all interested parties. We will send you a link for the group purchase. CMEs or CEs come with this course for everyone who needs them, except social workers. (We have approval from ASWB as the accrediting organization for social workers, but ASWB does not allow reimbursement courses to be given CE hours.) The course supplies the documents, codes and several strategies that you will need. It also allows you to ask questions of us and the TBHI community at the end of the course, in a community forum, as do all our courses.

    Two other options available to you are:

    1) Speak with the owner of the billing company to whom we refer. They are a separate group, so we do not accept responsibility for what they do, but we have trained them extensively and so far, everyone we have referred is quite pleased with their services. Their name is Coast to Coast Medical Solutions and the contact person there is Ann Stortz. Be sure to tell her that you received their name from us to get the TBHI bonus.
    2) If you want accurate, quick and private answers, engage TBHI for consultation. You can meet with us within a few days time by telephone or video. We can answer the bulk of billing questions with an hour of consultation and can do targeted research to get more specific answers if needed. To purchase, go to the TBHI consultation page.

    Regardless of how you proceed, I encourage you to keep asking questions until you get answers that make sense to you — and that lead to successful reimbursement!

  4. Crystal

    Do you need modifiers on facility fees billed on ub?

  5. Marlene Maheu, Ph. D.

    There’s no harm in adding the correct modifier to a facility fee.

  6. anncbd

    Can a Residential treatment center bill a facility fee? The Detox code is H0011, what other E&M codes are billable with this type of facility?

  7. Marlene Maheu, Ph. D.

    Ann, Yes, residential treatment centers can bill a facility fee to Medicare if the patient is on-site and the clinician is off-site. The E&M codes are profession-specific, depending on the type of medical care being given. You can scan this blog by using the search box to find the CPT code list and then decide what fits. Another option is to schedule a consultation for one of our consultants to help you if you have a more complex situation. Go to https://telehealth.org/fees.

  8. Marlene Maheu, Ph. D.

    Ann, The billable code is for Medicare providers. If your care provider can bill Medicare, and the patient comes to the facility, then yes, a facility fee can be billed. Additional codes to be used with the Facility fee codes are dependent on services delivered. Does this help?

  9. Brittney

    What about a Medicaid payer? Can the Q3014 code still be billed? Why would this be denied?

  10. Marlene

    Brittney, It is hard for anybody to say what a payor or payor will actually do. With state-based Medicaid, it is even more complex because different states have different ways of managing their Medicaid programs. Your best bet is to either contact them and get a response in writing (email) or try billing one session to see what happens. If rejected, you should get a reason code for the rejection. Then if you choose to contact them again, you have something to discuss with them and the state insurance commissioner if you decide to contact them for help enforcing your state’s laws about the Medicaid program’s administration by the payor.

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