Recently a question was asked by a rural county service.
Question: Can we receive TennCare reimbursement for TN-T2 if we use our local ER physician as the Qualified Healthcare Partner (QHP) – even if the QHP chooses not to charge for the consultation?
Answer: We have reviewed this question with TennCare officials and their answer is YES:
- The EMS will still be reimbursed for their assessment and not for mileage as described under Scenario 2, regardless of if the QHP ‘treats’ the member or not or regardless of if the QHP bills for their service or not, as long as the EMS provider bills using the “W” modifier to indicate the use of telehealth and engaging a QHP (ED Physician) and;
- the ED Physician/QHP is assessing the member and advising as whether to complete Treatment-In-Place (TIP), Transport to Alternate Destination (TAD), or transport the member to the ED
- the ED Physician/QHP should sign off on the ambulance ePCR in cases of TIP or TAD
The summary of the requirements for this scenario are:
- consult with the ER physician as your QHP (Qualified Healthcare Professional) for direction on treatment/transportation
- ER physician/QHP does not have to bill for the consult
- it is recommended that the ER physician/QHP sign off on the ePCR (if TIP or TAD is utilized)
- EMS should bill the claim using the “W” modifier to indicate the use of telehealth/consultation with a QHP (ED Physician)
Download the complete TN-T2 Guidance and FAQ’s
