Blue Cross Blue Shield Telehealth – Overview
Blue Cross Blue Shield (BCBS) Telehealth companies work to expand coverage and improve access to virtual healthcare solutions. BCBS has played a significant role in the healthcare industry since its inception, continually adapting and responding to challenges.
The Blue Cross Blue Shield Association is a federation of 36 independent, community-based and locally operated Blue Cross and Blue Shield companies.
About Blue Cross Blue Shield (BCBS) Telehealth and Telemedicine Services
Following the onset of the COVID-19 pandemic, BCBS expanded access to its telehealth and telemedicine services. This has greatly helped to give members better access to virtual healthcare. BCBS members can easily access any medically necessary coverage benefits from healthcare providers who deliver their services through telehealth technology. Numerous BCBS members also have easy access to various BCBS-licensed telehealth vendors, such as MDLIVE.
What is Covered Under BCBS Telehealth
The terms and conditions of every member’s benefit plan will determine the telehealth and telemedicine services provided under the BCBS Telehealth and Telemedicine initiative. Additional coverage is also provided to self-funded employer group members, PPO members, and fully insured HMO members. These members have access to providers recognized by the American Medical Association (AMA) and follow the Centers for Medicare and Medicaid Services (CMS) guidelines.
Besides this, BCBS members also receive the following coverage under telehealth benefits:
- PHO (Partial Hospitalization Programs)
- IOP (Intensive Outpatient Program) Services
- PT (Physical Therapy)
- OT (Occupational Therapy)
- ST (Speech Therapy)
For the full list of BCBS telehealth benefits, please refer to the official BCBS website or contact your local BCBS company.
Remember, the self-funded employer group customers can make decisions for their employee benefit plans. So, check your eligibility for any differences in member plan benefits.
BCBS telehealth and telemedicine services are recommended for the following:
- Choose telehealth as a mode of healthcare delivery that can provide reasonably equivalent results to in-person visits to the doctor’s office.
- Select telehealth services when they can enhance healthcare and care integration and continuity once a strong patient-provider relationship is established.
- You can integrate telehealth/telemedicine records into electronic medical record systems and enhance the efficiency of healthcare services. This helps to maintain strong clinical documentation and also improves patient outcomes.
Who is Eligible for Blue Cross Blue Shield Telehealth Services
Any telehealth-centered care provided to eligible members is consistent with the terms and conditions of the member’s plan benefits. The following types of benefit plans are allowed access to BCBS-licensed telehealth services:
- Blue Cross Medicare Advantage (except Part D)
- Medicare Supplement
- State-regulated fully-insured PPO and HMO plans
Every BCBS telehealth provider will follow the state and federal requirements.
How to Submit Claims for BCBS Telehealth Services
The telehealth provider is responsible for accurately coding and documenting services performed. These claims are submitted for medically necessary healthcare services through telehealth technology using the appropriate codes and/or Place of Service (POS) 02 and modifiers (95, GT, GQ, G0).
Incorrectly billing telehealth service claims with modifier POS 02 may result in denial or the need for resubmission. The healthcare provider must then re-submit the claim with the correct POS.
Remember, even when telehealth services are provided to members at their homes, the healthcare provider must use POS 02 when filing telehealth claims. If a claim is filed with the code POS 10, it may be rejected.
How Much Does it Cost to Use BCBS Telehealth Services
CMS regulations guide the specifics of coverage for BCBS telehealth services. BCBS covers telehealth/telemedicine costs under certain conditions, including during the Public Health Emergency (PHE) for Medicare Advantage and Medicare Supplement members.
BCBS will waive cost-sharing for Medicare Advantage members for telehealth visits for the duration of the PHE. Thus, members do not owe any deductibles, coinsurance, or copays for their telehealth or telemedicine visits.
For Medicaid members, BCBS follows the state-specified guidelines for Medicaid and CHIP policies. Additionally, some telemedicine/telehealth providers will require the patient’s referrals or prior authorizations, which should be based on the member’s plan benefits. So, make sure to check the eligibility and benefits for each member.
How is Blue Cross Blue Shield Telehealth Service Provided
Blue Cross Blue Shield Telehealth – How is BCBS Telehealth Service Provided?
The BCBS Telehealth service providers offer telehealth/telemedicine visits through:
- Asynchronous telecommunications (involving captured images and recorded videos).
- Live interactive 2-way telephone communication for digital video consultations with audio and video capabilities.
- Any other telemedicine/telehealth method allowed by state and federal laws.
Conclusion
BCBS Telehealth providers use interactive audio and video telecommunication technology that allows real-time interactive communication. This ensures optimal and efficient telehealth services. In specific circumstances, CMS permits using audio-only communication as a component of telehealth/telemedicine services.
See Also
Blue Cross Blue Shield Telehealth Grants
How to Become a Telehealth Nurse
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