Provider FAQ on COVID-19 Information and resources for our healthcare provider community

Are FCH payors covering Telehealth services in lieu of face-to-face visits during the pandemic?

Yes. With the support of the Families First Coronavirus Response Act, First Choice Health (FCH) payors will cover all COVID-19 related diagnosis visits with no cost sharing (Co-pays, Deductibles, and Co-insurance) and non COVID-19 related services at the usual contracted allowable during the public emergency period.  

What Telehealth billing guidelines should I use?

Telehealth billing guidelines for members of First Choice Health Administrators: In order for services to be considered as Telehealth, they must be billed with either Telehealth modifier 95 for CPT codes in appendix P of the AMA CPT Book, or modifier GQ/GT for HCPCS codes in the CMS Telehealth Code List for 2020. In 2022 the POS for all telehealth will change to POS 10. For members with Medicare; POS code 10 will come into effect on April 1, 2022. CMS and AMA reference links can be found below. 

Telehealth billing guidelines for members of our PPO payors: We have recommended our PPO payors follow the same billing guidelines as listed above, for consistency. Each payor may have their own individual requirements. Please reach out to the payors directly if you have any Telehealth billing requirement questions or concerns. 

Will there be any claims processing delays due to COVID-19?

First Choice Health Administrators has historically maintained a greater than 90% virtual environment for claims processing standards. Remote workers have "life" happening in the background, but all efforts will be in place to ensure quality care and service continues to be provided. As FCH becomes aware of any significant payment delays with our PPO payors, we shall work with them to ensure timely and prompt resolution.

What will my reimbursement be for Telehealth services?

Payment for Telehealth services will be in accordance with your FCH provider agreement(s). There is no reduction to rates for performing care in a virtual setting.

Will Co-pays, Co-insurance, and Deductibles be waived for services related to COVID-19?

FCH is encouraging all FCH payors to waive patient responsibility for COVID-19 diagnostics, including testing services, performed in accordance with the Families First Coronavirus Response Act.

Record keeping for Telehealth services:

Medical records should be maintained in accordance with standard practices. Data capture such as the date and time of the encounter, and integration with electronic medical records and other health information technology, should be pursued when possible. Consistent with standard charting, templated identical notes are not acceptable for billable encounters.

Telehealth vs. Telemedicine:

Telehealth is the use of digital information and communication technologies, such as computers and mobile devices, to access health care services remotely and manage your healthcare. These may be technologies you use from home or that your doctor uses to improve or support healthcare services.

Telemedicine refers to the practice of caring for patients remotely when the provider and patient are not physically present with each other. Modern technology has enabled doctors to consult patients by using HIPAA compliant video-conferencing tools.

General resources for providers: