Pennsylvania

State behavioral health guidelines and updates due to COVID-19

State-specific guidelines

Effective 3/20/2020

The Office of Medical Assistance Programs is announcing preference for the use of telemedicine as a delivery method for medically necessary healthcare services beyond physician consultations and will pay for MA covered services when rendered via telemedicine if the provider determines it is medically necessary because the patient is quarantined, self-quarantined, or self-isolated due to exposure or possible risk of exposure to the COVID-19 virus. During this state of emergency, telephone only services may be utilized in situations where video technology is not available. Services rendered through telemedicine will be paid at the same rate as if they were rendered in-person at an enrolled location.

Understanding new Commercial Payer guidelines

Many commercial payers have also issued important updates explaining their expansion of telehealth services. While expanded coverage includes more services, looser restrictions put the responsibility on the provider to determine appropriate services. This shift can significantly increase the risk of payer denials later on. An informed interpretation of these new guidelines is essential to avoid issues with your revenue cycle in the coming weeks. We are available to further discuss our findings and analysis with you. To learn more about recent updates regarding commercial payer guidelines, please contact us directly.