How BCBSKS is Responding to COVID-19
Updated 05/11/2020 - After evaluating our current state status on COVID-19, BCBSKS is expanding waived cost-share for telehealth/virtual services until June 30,2020.
Blue Cross and Blue Shield of Kansas (BCBSKS) has announced a new policy regarding telehealth services that ensures members have swift access to the care need to get and stay healthy – at no cost to them.
In conjunction with the other 35 independently-operated Blue Cross Blue Shield (BCBS) companies and the Blue Cross and Blue Shield Federal Employee Program® (FEP®), BCBSKS will expand coverage for telehealth services, which includes waiving cost-sharing for all telehealth services for members. We are also advocating for physician and health system adoption of social distancing-encouraged capabilities such as video, telephone, chat and/or e-visits. Members are encouraged to use contracted providers in-network. This builds on the commitment previously announced to ensure swift and smooth access to care during the COVID-19 outbreak.
Cost-sharing (co-pays, deductibles) are waived for the next 60 days for:
- Telehealth services for visits that are medically reasonable to be done using telehealth. It must be patient initiated. The visit does not have to be specific to COVID-19 testing. Telehealth visits are also available for mental health services. The use of telehealth will help to lower the spread of germs and lessen the burden on the Kansas healthcare system.
- E-visits, done within an established patient and provider relationship, and initiated by the patient, specifically related to diagnosis and treatment and requiring medical decision making. Scheduling appointments would not be included.
“In this challenging moment, we need everyone to do their part,” said Matt All, president/CEO. “Making telehealth easier to use and less expensive will help keep patients and doctors safe, and ensure everyone gets the care they need.”
In accordance with the Families First Coronavirus Response Act signed into law March 18, BCBSKS will be waiving member cost-share (co-pays, deductibles) for the following services associated with the testing of COVID-19:
- Medically necessary diagnostic tests related to COVID-19.
- Cost of visit to doctor’s office, urgent care, telehealth, and emergency room used for diagnostic testing of COVID-19.
- Related services (flu tests, respiratory illness tests) provided during urgent care, emergency room, or in-person or telehealth provider visits that result in an order for or administration of a covered diagnostic test for COVID-19.
Note: As decisions to expand coverage occur quickly, it does take time to allow for our claims and billing departments to update their systems. This brief lag as things are getting set up may cause co-pays to be charged at time of service. BCBSKS will adjust claims on an ongoing basis.
Company soft close
As members of the healthcare community, BCBSKS is doing our part to help slow the spread of the virus by having employees practice social distancing at our offices and by working remotely from home. Most employees are being set-up to work from home and transitioned out of the office, if they choose. Extra precautions have been put in place for those who stay including no face-to-face meetings, safe social distancing, extra cleaning of buildings and work areas.
Through this office soft close, BCBSKS will work to make sure that members have access to the care they need, that claims are paid, and questions are answered. BCBSKS is also working closely with healthcare providers across the state and putting plans in place to allow them to stay focused on patient care. While response times may slow during this time period, we hope to minimize disruptions.
COVID-19 Provider Frequently Asked Questions (FAQ)
Q- What does Blue Cross and Blue Shield of Kansas (BCBSKS) consider to be "medically necessary" when administering a COVID-19 test?
A- BCBSKS is following guidance from the Blue Cross and Blue Shield Association (BCBSA) which is consistent with Centers for Disease Control and Prevention (CDC) guidance. Current CDC guidance on testing individuals suspected to be at risk for COVID-19 can be found on the CDC's website. Testing should be ordered in cooperation with the Local/State Health Departments for suspected COVID-19.
Q- Kansas Department of Health and Environment (KDHE) states diagnostic testing for COVID-19 must be prior approved by KDHE, is BCBSKS requiring prior authorization for COVID-19 testing?
A- BCBSKS is not requiring and doesn't have any plans to require prior authorization on COVID-19 lab tests. BCBSKS will also not require proof of prior approval from KDHE for reimbursement of the COVID-19 test.
Q- Are providers required to perform a respiratory viral panel and wait for the results prior to performing a COVID-19 test? Will COVID-19 testing not be eligible for reimbursement without a respiratory viral panel being performed first?
A- BCBSKS is not requiring a respiratory virus panel to be performed prior to the COVID-19 testing. If it is suspected that a patient has been exposed, the hospital may conduct the COVID-19 test without delay in collaboration with the local/state public health department. However, if the provider chooses to conduct a nucleic acid test for a respiratory pathogen such as a respiratory virus panel, this will be considered medically necessary. We encourage providers to review the medical policy, Identification of Microorganisms Using Nucleic Acid Testing. BCBSKS will not require cost share on the COVID-19 testing for our members or related services (flu tests, respiratory illness tests) provided during urgent care, emergency room, or in-person or telehealth provider visits that result in an order for or administration of a covered diagnostic test for COVID-19. (Updated 03/20/2020)
Q- If the patient or family requests reduced home health nursing visits due to COVID-19 concerns, will the home health agency still receive reimbursement?
A- If the patient or family elects to receive fewer services than what is pre-certified, BCBSKS will only reimburse for the services the home health agency actually provided to the patient.
Q- What is BCBSKS contingency plans for serving members and processing claims in the case a high number of BCBSKS staff need to be quarantined?
A- As members of the healthcare community, we are doing our part to help slow the spread of the virus by having employees practice social distancing at our offices and by working remotely from home. Our goal is to continue supporting members, employers, and healthcare providers. Many customer service representatives currently work from home and have already begun this work. We will be transitioning all employees who support membership, customer service, claims and EDI to work from home by the end of the week. We know that while response times may slow during this time period, we hope to minimize disruptions to our core business.
Q- Will BCBSKS expand telehealth to help protect from the spread of COVID-19?
A- Please see our telehealth expansion provider communication (Updated 03/20/2020)
Q-Will BCBSKS have a dedicated hotline for COVID-19 inquiries?
A- At this time, members should continue to contact our customer service center at 1-800-432-3990 for any questions related to COVID-19. Providers should channel any COVID-19 questions to their provider consultant/representative.
We also encourage all providers to continue to collaborate with the local/state health departments and KDHE as the COVID-19 outbreak progresses.
Newly Added FAQs 03/20/2020
Q-Is BCBSKS modifying precertification requirements for inpatient, home health or hospice services?
A- BCBSKS will continue to require precertification for these services.
Q- Will any consideration be given to expanding influenza testing during the COVID- 19 public health emergency? Is the COVID-19 testing not going to be eligible for reimbursement without an influenza test being performed first?
A- BCBSKS is not requiring an influenza test to be performed prior to the COVID-19 testing. If it is suspected that a patient has been exposed, the hospital may conduct the COVID-19 test without delay in collaboration with the local/state public health department. However, if the provider chooses to conduct an influenza test, we have expanded our coverage criteria to cover the influenza test as medically necessary for any individual regardless of risk. BCBSKS will not require cost share on the COVID-19 testing for our members. BCBSKS will not require cost share on the COVID-19 testing for our members or related services (flu tests, respiratory illness tests) provided during urgent care, emergency room, or in-person or telehealth provider visits that result in an order for or administration of a covered diagnostic test for COVID-19.
Given the public health emergency related to novel coronavirus influenza testing under policy criteria number 1 in the BCBSKS medical policy," Influenza Virus Diagnostic Testing and Treatment in the Outpatient Setting", testing any individual experiencing flu like symptoms will be considered medically necessary.
Q- Will BCBSKS allow telehealth for the social work portion of a hospice visit?
A- Please contact your provider consultant, Beth Morrow for information. (Updated 03/26/2020)
Q-Dental services generally bill with CDT codes. What code should be used?
A- Dentistry services that can be performed virtually will be billed to BCBSKS using the CDT code D0140 and the place of service 02. Reimbursement will be at the same rate as that for an in-person service as long as the service is medically necessary and occurs on or after March 16, 2020. This change will remain in effect for a 60-day period. At that time, BCBSKS will re-evaluate the situation for possible extension. (Updated 04/01/2020)
We will continue to update the FAQ document as additional questions surface relating to COVID-19.