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MMA : Telemedicine Provider Information

Telemedicine

Improving Access to Quality Care
 
Find out how two new telemedicine programs
are improving both access to care and health outcomes for Marylanders participating in the Medicaid program.
 
Telemedicine will expand beginning October 1, 2014; more information coming this summer.
 
 
During the 2012 legislative session, the Department of Health and Mental Hygiene (DHMH) was commissioned by the State legislature to study delivery models, fiscal impact, and the effects of telemedicine on the Medicaid population.
 
It was determined that DHMH would implement two telemedicine programs—one to improve rural access to care, the other to improve access to consultation for cardiovascular disease and stroke when appropriate specialist consultation is not available.
 
Using “Hub-and-Spoke” models, providers mutually approved by DHMH will engage in agreements to both deliver care and bill Medicaid for approved telemedicine services, using fee-for-service reimbursement practices.

 

 
Rural Access
Telemedicine Program
 
Providers eligible to participate as rural access originating (“spoke”) providers include:
 
 

FQHCs; hospitals; Local Health Departments; nursing facilities; nurse practitioners; nurse midwives; physicians; renal dialysis centers.

 
  
 
 
 
 
 
Rural access originating sites must be located within one of the following counties:
 
 
Allegany; Calvert; Caroline; Cecil; Charles; Dorchester; Garrett; Kent; St. Mary’s; Somerset; Talbot; Queen Anne’s; Worcester; Wicomico; Washington.
 
 
 
 
 
 
 
 
Medicaid will reimburse eligible originating site providers for medically necessary Evaluation and Management (E&M) services 99201-99205; 99211-99215; 99281-99285; and 99288, as well as an approved originating site facility fee.
 
Rural access distant site (“hub”) providers will be reimbursed for the eligible E&M consultation codes.
 
Hospitals will bill standard facility fees, only.
 
All providers may refer to the 2013 Telemedicine Provider Manual for complete billing instructions.
 
 
Cardiovascular Disease and Stroke
Telemedicine Program
 
Hospitals may be approved for participation as originating site providers if no specialist is available to provide timely consultation and diagnostic evaluation for cardiovascular disease or stroke care. There is no geographic location limitation associated with becoming an originating site provider for this particular telemedicine program as long as a provider is in Maryland, DC, or any contiguous state.
 
Medicaid will reimburse originating site providers for medically necessary eligible E&M services rendered in a hospital emergency department setting, and for appropriate hospital facility fees.
 
Distant site providers will be reimbursed for professional consultation fees, as appropriate.
 
All providers may refer to the 2013 Telemedicine Provider Manual for complete billing instructions.
 
Providers participating in this particular telemedicine program are encouraged to contact their MCOs for information concerning pre-authorization.
 
 

Eligible Providers and Enrollment in the Telemedicine Program

Providers interested in participating in a telemedicine program must already be enrolled as Medicaid Providers. If you are not enrolled as a Medicaid Provider, visit:
 
Interested providers enrolled in the Medicaid Program must complete and submit a Telemedicine Provider Addendum for the telemedicine program which they wish to enroll. Providers are expected to outline their plan for participation using this addendum. Each Telemedicine Provider Addendum is included in the “Resources” section of this provider information page, as well as the 2013 Telemedicine Provider Manual.
 
For complete information on the two telemedicine service models, provider and participant eligibility, and covered services and reimbursement, please refer to the 2013 Telemedicine Provider Manual.