Telehealth Implementation Roadmap · • Gastroenterology • Genetics • Hematology •...

Exploring Critical Success Factors for Telehealth Implementation

Deb LaMarche, PI, Program DirectorNorthwest Regional Telehealth Resource Center [email protected] www.nrtrc.org

Kathy Chorba, Executive DirectorCalifornia Telehealth Resource [email protected] www.caltrc.org

Mei Kwong, Executive DirectorCenter for Connected Health PolicyNational Telehealth Policy Resource [email protected] www.cchpca.org

mailto:[email protected]

http://www.nrtrc.org/


http://www.caltrc.org/


http://www.cchpca.org/

Presentation Overview

• Introduction to Telehealth and Telemedicine

• Critical success factors within each of the five elements of the Telehealth Implementation Roadmap

• Assess• Establish• Define• Implement• Improve

• Policy and reimbursement landscape updates

• Introduction to the Telehealth Resource Centers and free resources and technical assistance available for program development, implementation and sustainability

• Q&A

Introduction To Telehealth and Telemedicine

Deb LaMarcheNorthwest Regional Telehealth Resource Center

NRTRC

Telehealth or Telemedicine

What’s the difference?

TelehealthTelehealth is global term, which includes telemedicine and other uses of communication technologies

• Health professional education• Public health• Consumer education

TelemedicineTelemedicine is direct clinical care provided from a distance using electronic communication to provide or support clinical care.

See also: Virtual Care, Telepractice, Tele-X (specialties like telepsychiatry), Connected Care, Digital Health, Home Health, Remote Patient Monitoring, eHealth, eVisits, eConsult, etc.

The Telehealth Landscape

Drivers• Aging population• Consumer demand• Expanding • Reimbursement• Provider shortages• Payment reform• Readmission penalties• Competitive forces

Barriers• Access to

broadband/technology• Cost• Licensure• Limited reimbursement• Privacy and security

concerns• Provider resistance to

change• Legal/regulatory questions

Telehealth ValueIncreased patient

access to providers (travel)

Timelier access to providers

Improved continuity of care and case management

Reduced ER Utilization

Improved access to training and other

educational services

Cost savings in care delivery

Reduction or prevention of complications,

decreased readmissions

Patient Satisfaction

Provider Satisfaction

Value PerspectivesPatients

• Accessibility: care when and where they need it

• Affordability: reduces travel time, expense and time away from work/family

• Timeliness: reduces wait time to access specialists

• Integrated and coordinated, “team approach” to care

Communities

• Keeps patients local whenever possible

• Promotes rapid diagnosis and treatment linked to improved patient outcomes

• Improves outcomes and therefore improves health of population

Primary Care Providers

• Promotes coordinated care

• Reduces provider isolation

• Maintains primary relationship with patient

• Promotes greater patient satisfaction

• Generates revenue – visit reimbursement

• Access to education

• Working at top of scope

Specialists

• Extends reach to patients

• Teaching and partnership with PCP reduces the need for future, same-type referrals

• Promotes coordinated care

Health Plans

• Promotes timely access to care

• Increases “provider availability” in geographically challenged areas

• Cost savings• Prescriptions• Ancillary tests• Patient

transportation

Telemedicine is not a service, but a delivery mechanism for health care services

• Most TM services duplicate in-person care• Some are made better or possible with TM• Reimbursement equal to “in person” care

• Live Video• Store and Forward• Remote Patient Monitoring

Live Video Teleconsultation

Live Video is used for real-time patient-provider consultations, provider-to-provider discussions, and language translation services.

“The Primary Care Provider Can’t be an Expert in Every Field”

Javeed Siddiqui, MD, Infectious Disease Specialist

Referring Provider Benefits• Education catered to the

individual needs• Reduced Isolation• Revenue retention

Patient Benefits• Access to specialists• Team approach to care

Specialist Benefits• Relationship building• Teaching reduces the need for

future referrals

• Pediatric Otolaryngology• Pediatric PM&R• Pediatric Psychology• Pediatric Rheumatology• Pediatric Sexual Abuse QA• Pediatric Urology• Pharmacy• Physical Therapy• Plastic Surgery• Primary Care• Podiatry• Psychiatry• Psychology• Pulmonary• Radiology• Rheumatology• Stroke• Surgical• Transplant• Urology• Wound Care• And more!

Common Evidence-Based Telehealth Uses• Allergy• Burn• Cardiology• Child Development• Dermatology• Emergency Services/Trauma• Endocrinology• Gastroenterology• Genetics• Hematology• Hepatology (Hepatitis A-E)• HIV and Aids• Home Health• Infectious Diseases• Medication Adherence• Nephrology• Neurology• Neurosurgery• Nutrition

• OB/GYN• Occupational Medicine• Oncology• Ophthalmology• Orthopedic Surgery• Orthopedics• Otolaryngology• Pain Management• Palliative Care• Pediatric Cardiology• Pediatric Critical Care• Pediatric Dermatology• Pediatric Endocrinology• Pediatric Gastroenterology• Pediatric Genetics• Pediatric Hematology/Oncology• Pediatric Nephrology• Pediatric Neurology• Pediatric Obesity

Store and ForwardStore & Forward electronically transmits patient information between primary care providers and medical specialists. Information could include digital images, X-rays, video clips and photos.

• Utilizes low bandwidth, transmitting patient information, still images and video clips

• Best used in Dermatology, Ophthalmology, Pathology, Radiology

• Exploring new avenues in Psychiatry, Endocrinology, Hepatology, Orthopedics and many more specialties via eConsult

Home Health and Remote Patient Monitoring

Remote patient monitoring uses telehealth technologies to collect medical data from patients in one

location and electronically transmit that information to health care providers in a

different location, either real-time or store and forward.

Use cases include hospital emergency departments, intensive care units, and at-

home management of patients with chronic conditions.

Telehealth Equipment

Telemedicine Carts

Off-the-Shelf for providers and consumers

Peripherals

Telehealth Implementation Roadmap

Kathy ChorbaCalifornia Telehealth Resource Center

CTRC

Great Ideas

Telemedicine … Where

do I start?

Planning, implementation and integration requires a multidisciplinary team to be involved throughout each phase of the

project.

On the following slides, look to the left for team category suggestions!

Lead

ersh

ip *

Clin

ical

* T

echn

olog

y *

Ope

ratio

ns

Assess

Clinical and Administrative Service Needs

Leadership Support

Clinical Provider Buy-in

Relationships with Specialty Providers

Technology Infrastructure and Equipment Inventory

Ope

ratio

ns

Facility Information

Assess

Establish

Define

Implement

Improve

Ope

ratio

ns

and

Clin

ical

Current or Previous Telehealth Experience

Why is this information important?

• May be able to leverage existing program staff / equipment for expansion activities

• May be able to address barriers or adjust the approach to get the program back on track

Assess

Establish

Define

Implement

Improve

Lead

ersh

ipGo Live Expectations /

Timeline

Do you have a target date for go-live?• Having a target date for go-live is important for planning

purposes. • Milestones to incorporate into project plan:

– Policy and Procedure & workflow development, staffing allocation– Provider contracting– Data and connectivity infrastructure enhancement – Equipment procurement, installation, testing – Staff training

Assess

Establish

Define

Implement

Improve

• What are the unmet healthcare needs

• Specialties • Volume• Delivery Method

• Don’t rely on data alone –Ask your clinical team!

Ope

ratio

ns

and

Clin

ical

Clinical and Administrative Services

Assess

Establish

Define

Implement

Improve

Ope

ratio

ns

and

Clin

ical

Clinical Services

• What services do you wish to provide and how will you provide them?

• How is this information useful?• Specialty service provider selection & negotiation• Equipment, software and broadband consideration

SpecialtyAdult (Vol/mo)

Peds (Vol/mo)

Technology Model

Live Video

Store & Forward

Remote Patient Monitoring

Provider & Patient to Specialist

Provider to Provider (eConsult)

Direct to Consumer

Dermatology 20 x x

Endocrinology 30 5 x x

Mental Health 60 10 x x

Primary Care 50 75 x x

Assess

Establish

Define

Implement

Improve

• Program financing• Grant funding? For what, how much and how long?• Institutional funding commitment

• Staffing allocation• Program design, management and day to day operations

• Ongoing program support• Staffing, technology, change management

Lead

ersh

ipLeadership Support

Assess

Establish

Define

Implement

Improve

• Understand the value of telehealth to patients and clinical practice

• Willing to incorporate telehealth into daily practice• Patient identification and referral• Patient presentation and follow-up

Clin

ical

Clinical Provider Buy-in

Assess

Establish

Define

Implement

Improve

• In-house• Within your organization, practicing at a different location

• In the community• Providers in your referral network that would benefit from enhanced

services provided via telemedicine• Statewide / Nationwide

Clin

ical Existing and Potential

Relationships with Specialty Providers

Assess

Establish

Define

Implement

Improve

• Tele-communications• Secure, medical grade broadband in the staff meeting and clinic exam

rooms? Is it wired or wireless?• Equipment and peripherals

• Videoconferencing equipment• Peripherals (exam camera, stethoscope, otoscope)• Computer with webcam, microphone, speakers• Store and forward software, digital camera

Tech

nolo

gy Existing Technology Infrastructure and Equipment

Inventory

Assess

Establish

Define

Implement

Improve

Establish

Telehealth Team

Specialty Service Provider Partnerships

Technology Infrastructure

Revenue Cycle Management Program

Ope

ratio

ns

Executive LeadershipIncorporate telehealth into

the organization's strategic plan

Allocate staffing • Telehealth core team• Clinician practice time• Billing & compliance• Management oversight

Provide strategic direction

Goal: Financial sustainability of the

program

Clinician ChampionMaintains overall control

of the program

Brings partners to the table

Respected member of the clinician community

Incorporates telehealth into daily practice

Promotes telehealth to other clinicians

Goal: Quality and efficiency of medical

service

Telemedicine Coordinator

Program coordination, liaison and promotion

duties between patients, presenters and specialty

sites

Patient care scheduling and coordination

Education and outreach

Technology management

Goal: Program efficiency, patient and provider satisfaction

Technical Support

Telecommunications network planning and

maintenance

Equipment selection, installation, training and

troubleshooting

Equipment reliability and functionality – video

conferencing, store and forward software & medical peripherals

Goal: Maintain, user-friendly, reliable

technology

Telehealth Team

Assess

Establish

Define

Implement

Improve

Partnering with Specialty Service Providers

1. Specialties Available

2. Payment Model

3. Rates

4. Appointment times

5. Credentialing policy

6. Specialist bio / qualifications

7. Established referral guidelines

8. Staffing requirements

9. Direct patient care or consultation only

10. Medication refills

11. Specialist continuity

12. Turn around time for chart notes

13. Cancellation/no show policy

14. Patient double-booking

15. Back up plan for tech failure

16. Technical support available

17. Non-consult communication policy

18. Method of communication during consult

19. Post-consult correspondence policy

20. Onboarding process

Assess

Establish

Define

Implement

Improve

• Equipment and peripherals• To accomplish the administrative and clinical service goals

established by the needs assessment and specified by the specialty consultant

• Secure medical grade broadband to clinic and conference rooms

• Sufficient to support the equipment and/or software

Tech

nolo

gyTechnology Infrastructure

Assess

Establish

Define

Implement

Improve

Price Snapshot

• Simple Telemedicine cart with PC -$2,000 -$10,000

• Telemedicine cart with Pan/Tilt/Zoom camera, CODEC and peripheral capabilities -$18,000 -$30,000

Assess

Establish

Define

Implement

Improve

Price Snapshot

• General Examination Cameras• $3,000 -

$11,000

• Bluetooth Enabled Electronic Stethoscope• $500 -

$4,000

• Nasopharyngoscope• $6,000-$20,000

Assess

Establish

Define

Implement

Improve

• Payer credentialing and contracting• Research and understand your payer environment• Develop payer reimbursement chart indicating for each major payer if

they reimburse and which codes to submit• Financial modeling and Pro Formas

• Forecasting cost of program is critical for sustainability• Create a pro forma that estimates the monthly cost of the program over

the first year as both utilization and payer reimbursements mature

Busi

ness

&

Sust

aina

bilit

yRevenue Cycle

Management Program

Assess

Establish

Define

Implement

Improve

• Key pro forma data points• Payer mix of patient population served• Anticipated volume by specialty• Estimated payer reimbursement• Physician compensation and service fees• Technology platform and recurring infrastructure costs• Staffing costs• Related financial benefits to the facility

Busi

ness

&

Sust

aina

bilit

yRevenue Cycle

Management Program

Assess

Establish

Define

Implement

Improve

This is a very basic, yet illuminating tool

What this will do• Provide a high level, VERY BASIC overview

of how specialty provider selection decisions and other variables are likely to affect sustainability

What this will not do• Calculate for:

• sliding fee or commercial health plan payments

• Appointment slots filled by double booking

• Provide an accurate, detailed profit/loss statement for clinic financial modeling

NOTE: Clinic collection revenue on this form is based on PPS Medi-Cal patient billable visits only. Other payment sources cannot be predicted or calculated using this simple tool.

Appointment type: time (min) # of visits total hoursInitial #VALUE!Established #VALUE!Total number of visits per block of time purchased #VALUE! #VALUE!

#VALUE! #VALUE!

#VALUE!

#VALUE!

Adjusted clinic collection (after uninsured calculation) #VALUE!

#VALUE!#VALUE!

Clinic collection minus No Show rate

CTRC Sample Telehealth Sustainability WorksheetThis worksheet is provided as a basic tool to assist in business model development for

FQHC/RHC/IHS and is based on the model of purchasing blocks of timeInstructions: Insert your data in to the blue cells. All remaining cells will be automatically

populated based on the information entered.

Patient VolumeSpecialist hourly rateSpecialty cost per block of time reservedClinic collection rate per encounter (PPS rate)Amount clinic collects if 100% billableAverage No Show rate for clinic (or specialty)

For more information or assistance with this spreadsheet, please contact us! California Telehealth Resource Center, www.caltrc.org

Clinic uninsured rate

Staffing and overhead per hourStaffing and overhead per block of time purchasedVarianceNote: This calculation does not include sliding fee or private pay collection

To download this interactive worksheet, visit:caltrc.org/knowledge-center/best-practices/sample-forms/

Assess

Establish

Define

Implement

Improve

Busi

ness

&

Sust

aina

bilit

y

Appointment type: time (min) # of visits total hoursInitial 40 12 8.00Established 20 0 0.00Total number of visits per block of time purchased 12 8.00

12200.00$

1,600.00$ 165.00$

1,980.00$ 15%

1,683.00$ 5%

1,598.85$ 20.00$

160.00$ (161.15)$

Clinic uninsured rateAdjusted clinic collection (after uninsured calculation)Staffing and overhead per hourStaffing and overhead per block of time purchasedVarianceNote: This calculation does not include sliding fee or private pay collection


CTRC Sample Telehealth Sustainability Worksheet

Illustration of the start-up phase (typically months 1-3)This worksheet is provided as a basic tool to assist in business model development for

FQHC/RHC/IHS and is based on the model of purchasing blocks of timeInstructions: Insert your data in to the blue cells. All remaining cells will be automatically

populated based on the information entered.


Assess

Establish

Define

Implement

Improve

Busi

ness

&

Sust

aina

bilit

y

Appointment type: MinutesNumber of visits Hours

Initial 40 9 6.00Established 20 6 2.00Total number of visits per block of time purchased 15 8.00

15200.00$

1,600.00$ 165.00$

2,475.00$ 15%

2,103.75$ 5%

1,998.56$ 20.00$

160.00$ 238.56$ Variance

Illustration of the growth phase (typically months 4-8)This worksheet is provided as a basic tool to assist in business model development

for FQHC/RHC/IHS and is based on the model of purchasing blocks of timeInstructions: Insert your data in to the blue cells. All remaining cells will be

automatically populated based on the information entered.

Note: This calculation does not include sliding fee or private pay collection

Patient volumeSpecialist hourly rateSpecialty cost per block of time reservedClinic collection rate per encounter (PPS rate)Amount clinic collects if 100% billableAverage No Show rate for clinic (or specialty)Clinic collection minus No Show rateClinic uninsured rateAdjusted clinic collection (after uninsured calculation)Staffing and overhead per hourStaffing and overhead per block of time purchased

Assess

Establish

Define

Implement

Improve

Busi

ness

&

Sust

aina

bilit

y

Appointment type: time (min) # of visits total hoursInitial 40 4 2.67Established 20 16 5.33Total number of visits per block of time purchased 20 8.00

20200.00$

1,600.00$ 165.00$

3,300.00$ 15%

2,805.00$ 5%

2,664.75$ 20.00$

160.00$ 904.75$

Clinic uninsured rateAdjusted clinic collection (after uninsured calculation)Staffing and overhead per hourStaffing and overhead per block of time purchasedVarianceNote: This calculation does not include sliding fee or private pay collection


Illustration of the maintenance phase (typically months 9 & beyond)

This worksheet is provided as a basic tool to assist in business model development for FQHC/RHC/IHS and is based on the model of purchasing blocks of time

Instructions: Insert your data in to the blue cells. All remaining cells will be automatically populated based on the information entered.


Assess

Establish

Define

Implement

Improve

Busi

ness

&

Sust

aina

bilit

y

Define

Policies and Procedures

• Clinical guidelines • Referral forms• Process for patient consent• Workflow• Specialty services billing/payment• Exchanging medical information• Clinic scheduling• Patient insurance billing• Credentialing & privileging

Ope

ratio

nsPolicies and Procedures

Assess

Establish

Define

Implement

Improve

Ope

ratio

ns

Clinical guidelines for specialty referral

Policies and Procedures

Assess

Establish

Define

Implement

Improve

Process for Referral Request

Ope

ratio


Assess

Establish

Define

Implement

Improve

Process for patient consent

Ope

ratio


Assess

Establish

Define

Implement

Improve

Workflow

Ope

ratio


Assess

Establish

Define

Implement

Improve

• Clinical guidelines• Referral forms• Process for patient consent• Workflow• Specialty services billing/payment• Exchanging medical information• Clinic scheduling• Credentialing & privileging• Patient insurance billing

Ope

ratio


Assess

Establish

Define

Implement

Improve

Implement

Technology

Staff Training

Provider Orientation

Community and Patient Education

Go Live with Patient Consults

• Hardware, software, peripheral equipment and telecommunications configuration and testing

• And testing … and testing … and testing

Tech

nolo

gy

Technology

Assess

Establish

Define

Implement

Improve

• Who should you include in the staff training process?• Telemedicine coordinator, clinical staff, technical staff, billing, coding

and compliance staff

• What should be included in the staff training?• Referral protocols• Equipment usage and troubleshooting• Patient presentation techniques• Coding and billing• Medical records• Patient consent• Process flow

Ope

ratio

ns

Staff Training

Assess

Establish

Define

Implement

Improve

• Equipment demonstrations• Video meet and greet sessions with specialty providers to

discuss referral requirements and patient presentation techniques

• Place telehealth on the agenda at medical staff meetings to review patient selection and process flow

Clin

ical

Provider Orientation

Assess

Establish

Define

Implement

Improve

Equipment demo * Appointment fliers * Web site

Ope

ratio

ns

Community and Patient Education

Assess

Establish

Define

Implement

Improve

Ope

ratio

nsGo Live with Patient

Consults

Assess

Establish

Define

Implement

Improve

Improve

Revenue Cycle Analysis


Organizational Culture

Program Diversity

• Review and update the financial model based on the key data points used to establish the initial pro forma:

• Payer mix of patient population served• Anticipated volume by specialty• Estimated payer reimbursement• Physician compensation and service fees• Technology platform and recurring infrastructure costs• Staffing costs• Related financial benefits to the facility

Busi

ness

&

Sust

aina

bilit

yRevenue Cycle Analysis

Assess

Establish

Define

Implement

Improve

• Review claims and payments for potential areas of process improvement

• Assign a telemedicine lead or expert to own the process and ensure all codes are entered appropriately prior to submission

• Mine and analyze all denials received and continually update the billing policy based on new payers or change in existing payer policy

• Management reports• Provide and track monthly productivity, income and expense reports to

show trending over time

Busi

ness

&

Sust

aina

bilit

yRevenue Cycle Analysis

Assess

Establish

Define

Implement

Improve

• Are your specialty providers getting the information they need to provide patient care?

• Are your clinical providers getting the information they need to provide patient care?

• Are your clinical providers satisfied with the relationship with and services they are receiving from the specialty provider group?

• Is the technology adequate, reliable and easy to use?• Are there any changes to be made to the clinic flow process?

Clin

ical


Assess

Establish

Define

Implement

Improve

Clin

ical

Organizational Culture

Assess

Establish

Define

Implement

Improve

Ope

ratio

ns

Program Diversity

Assess

Establish

Define

Implement

Improve

Repeat the Process with Every New Initiative

“It takes 6 months to implement a program …

… and 10 years to become an overnight success!”Dean Germano, CEO Shasta Community Health Center, Redding CA

Resources discussed in this presentation are available on www.caltrc.org

Needs AssessmentStaff Roles and Job Descriptions

Considerations in Developing Partner RelationshipsContracting Model Pros and Cons

Credentialing GuidelinesBilling Guidelines

Sample Referral GuidelinesPatient Consent

Clinical and Operational WorkflowOvercoming Integration Barriers

How to Develop a Telehealth Marketing PlanAccess to Free Telehealth Implementation Workshops

NEW: Telehealth Coordinator On-line Curriculum ModulesMore!

http://www.caltrc.org/

June 2015 CENTER FOR CONNECTED HEALTH POLICY Mario GuttierezExecutive Director

TELEHEALTH IN A COMMUNITY HEALTH CENTER SETTING

NACHC FOR/IT CONFERENCEOctober 25, 2019

877-707-7172cchpca.org CENTER FOR CONNECTED HEALTH POLICY

Mei Wa Kwong, JDExecutive Director, CCHP


DISCLAIMERS• Any information provided in today’s talk is not to be regarded as

legal advice. Today’s talk is purely for informational purposes.

• Always consult with legal counsel.

• CCHP has no relevant financial interest, arrangement, or affiliation with any organizations related to commercial products or services discussed in this program.

CENTER FOR CONNECTED HEALTH POLICY© Copyrighted by the Center for Connected Health Policy/Public Health Institute


COMMUNITY HEALTH CENTERS & TELEHEALTH POLICY

CENTER FOR CONNECTED HEALTH POLICY

• Medicare Reimbursement• Medicaid Reimbursement• Federal Tort Claims Act (FTCA)• OUD & Telehealth

© Copyrighted by the Center for Connected Health Policy/Public Health Institute


MEDICARE – Telehealth & CHCs


Medicare limits FQHCs & RHCs to ONLY acting as the originating site for telehealth interactions

• CHCs will only be able to receive the originating site fee• CMS defines a “visit” for FQHCs and RHCs as “face-to-

face”



MEDICARE – Technology & CHCs


However, services that utilize telehealth technologies but are not labeled “telehealth” MAY be provided by CHCs• Chronic Care Management (CCM)• Transitional Care Management (TCM) • Virtual Communications



MEDICARE – Chronic Care Management (CCM) & Transitional Care Management


CCM


CCM services furnished between January 1, 2016 and December 31, 2017, CCM services can be billed by adding CPT code 99490 to an RHC or FQHC claim, either alone or with other payable services. Payment is based on the Physician Fee Schedule (PFS) national average non-facility payment rate for CPT code 99490. For CCM services furnished on or after January 1, 2018, CCM services can be billed by adding the general care management G code, G0511, to an RHC or FQHC claim, either alone or with other payable services. Payment is set annually at the average of the national non-facility PFS payment rate for CPT codes 99490 (20 minutes or more of CCM services), 99487 (60 minutes or more of complex CCM services), and 99484 (20 minutes or more of general behavioral health integration services). For CCM services furnished on or after January 1, 2019, CCM services can be billed by adding the general care management G code, G0511, to an RHC or FQHC claim, either alone or with other payable services. Payment is set annually at the average of the 3 national non-facility PFS payment rate for CPT codes 99490 (20 minutes or more of CCM services), 99487 (60 minutes or more of complex CCM services), CPT code 99491 (30 minutes or more of CCM services furnished by an RHC or FQHC practitioner).

Source: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/FQHCPPS/Downloads/FQHC-RHC-FAQs.pdf

https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/FQHCPPS/Downloads/FQHC-RHC-FAQs.pdf


MEDICARE – Chronic Care Management (CCM) & Transitional Care Management



TCMTCM services furnished on or after January 1, 2013, TCM services can be billed by adding CPT code 99495 or CPT code 99496 to an RHC or FQHC claim, either alone or with other payable services. If it is the only medical service provided on that day with an RHC or FQHC practitioner it is paid as a stand-alone billable visit. If it is furnished on the same day as another visit, only one visit is paid.

Source: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/FQHCPPS/Downloads/FQHC-RHC-FAQs.pdf

https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/FQHCPPS/Downloads/FQHC-RHC-FAQs.pdf


MEDICARE – Virtual Communications


Effective January 1, 2019, RHCs and FQHCs can receive payment for virtual communication services when at least 5 minutes of communication technology-based or remote evaluation services are furnished by an RHC or FQHC practitioner to a patient who has had an RHC or FQHC billable visit within the previous year, and both of the following requirements are met: • The medical discussion or remote evaluation is for a condition not related to an RHC or FQHC

service provided within the previous 7 days, and • The medical discussion or remote evaluation does not lead to an RHC or FQHC visit within the next

24 hours or at the soonest available appointment.

• Code used is G0071 but is not paid at the PPS rate.

Source: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/FQHCPPS/Downloads/VCS-FAQs.pdf


https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/FQHCPPS/Downloads/VCS-FAQs.pdf


MEDICAID REIMBURSEMENT BY SERVICE MODALITY

Live Video50 states and DC

Store and ForwardOnly in 11 states

Remote Patient Monitoring20 states

As of April 2019CENTER FOR CONNECTED HEALTH POLICY



REIMBURSEMENT REQUIREMENTS FOR PRIVATE PAYERS

39 states and DChave telehealth private payer laws

Parity is difficult to determine:-Parity in services covered vs. parity in payment

-many states make their telehealth private payer laws “subject to the terms and conditions of the contract”

As of April 2019

Some go into effect at a later date.



STATE MEDICAID


• MD Medicaid allows FQHC to register as a distant site provider

• GA allows FQHC to be both originating and distant site provider

• WV explicit prohibition on FQHC & RHC to serve as distant site providers

• Other state Medicaid programs are vague about FQHCs and RHCs




TELEHEALTH STATE-BY-STATE POLICIES, LAWS & REGULATIONS

Search by Category & TopicMedicaid Reimbursement• Live Video• Store & Forward • Remote Patient Monitoring

Reimbursement

Private Payer Reimbursement• Private Payer Laws • Parity Requirements

Professional Regulation/Health & Safety• Cross-State Licensing• Consent• Prescribing• Misc (Listing of Practice Standards)

Interactive Policy Map



FEDERAL TORT CLAIMS ACT


• Does not specifically address telehealth• Last policy update 2014• Potential problems when using telehealth – Physician/Patient relationship exists only when

the patient comes to the health center site. If the patient is not at the health center, would FTCA cover? For example: when CCM is used?

• If the FQHC has a contract with a provider, will FTCA cover that person?• Performs at least 32.5 hours of service/week for the period of the contract• If less than 32.5, provider must be licensed or certified in family practice, general internal medicine,

general pediatrics or OB/Gyn• Does not include psychology/psychiatry



OPIOIDS/SUBSTANCE USE DISORDER


• The SUPPORT for Patient and Communities Act required CMS to adjust their reimbursement policy of telehealth for treating individuals with SUDs or a co-occurring mental health disorder.

• Removed the originating site geographic requirements for telehealth services on or after July 1, 2019 for any existing Medicare telehealth originating site (except for a renal dialysis facility).

• Home was made an eligible originating site for purposes of treating these individuals, however the home would not qualify for the facility fee.

• Within 5 years a report of the impact of telehealth services on SUD must be submitted by the Secretary



OPIOIDS/SUBSTANCE USE DISORDER


• Within one year the DEA must have final regulations for a special registration to remotely prescribe Suboxone/Buprenorphine through telehealth.

• DEA will likely not finalize regulations until at the deadline of the end of 2019.

• Possibly see drafts/proposed regulations late-September/October.

OTHER SUD/OPIOID RELATED POLICIES



RESOURCES


Center for Connected Health Policywww.cchpca.org

Telehealth Resource Center www.telehealthresourcecenter.org



THANK YOU!

Where can you go to learn more about telehealth?

Deb LaMarcheNorthwest Regional

Telehealth Resource CenterNRTRC

The National Consortium of Telehealth Resource Centers (NCTRC) is an affiliation of the 14 Telehealth Resource Centers funded individually through cooperative agreements from the Health Resources & Services Administration, Office for the Advancement of Telehealth. The goal of the NCTRC is to increase the consistency, efficiency, and impact of federally funded telehealth technical assistance services. This presentation was made possible by 14 Telehealth Resource Centers and administered through grant #G22RH30365 from the Office for the Advancement of Telehealth, Federal Office of Rural Health Policy, Health Resources and Services Administration, Department of Health and Human Services.

TRC Fact Sheets

These are just a few!87

There’sMore!

• The NCTRC website houses additional fact sheets on policy, reimbursement, FDA approved technology, and more.

• We also have a collection of guides and research resources (catalogues and webliographies) from various TRCs to help your telehealth program.

• There are a wide variety of resources we can provide.

• Get in touch!

NCTRC Webinar SeriesEvery 3rd Thursday of the month from 11 AM – 12 PM (PST), the National Consortium of Telehealth Resource Centers provides a free webinar for those interested in telehealth.

• Schedule

89

The TRCs have an expansive network of professionals in the field of telehealth.

The monthly topics encompass various topics ranging from policy, business models, clinical workflow, telehealth program development, etc.

Content

Don’t worry.We record them.

Can’t make the live webinars? No problem! We record all webinars and post them on our YouTube page within 1 business day.

Find more educational webinars:https://www.youtube.com/c/nctrc

91

Hands-On Training Networking

RegionalConferences

TRCs host conferences year-round. Let’s look at what’s coming up in your region!

Education

Key Takeaways

1. TELEHEALTH IS AN EMERGING FIELD. Telehealth is a rapidly changing field, we’re expecting many changes in 2019.

2. CONNECT WITH US. Shoot us an email, give us a call, visit the website, or even better, register for our regional conferences. We’d be glad to chat, but even happier to meet you.

3. OUR RESOURCES. DIY kind of person? We have numerous resources and a reliable network to get your answer. We’re federally funded so our information and resources are at your disposal.

4. THE CONSORTIUM. Keeping development in mind, TRCs are prepared to connect with you and morph your telehealth program.

We’re here for you!

Let’s Talk!

TelehealthResourceCenter.org

Questions ??

Deb LaMarcheProgram Director

Northwest Regional Telehealth Resource Center

[email protected]

Kathy J. ChorbaExecutive Director

California Telehealth Resource Center

[email protected]

Mei Wa Kwong, JDExecutive Director

Center for Connected Health Policy

[email protected]

www.telehealthresourcecenter.org

@TheNCTRC TheNCTRC NCTRC

http://www.telehealthresourcecenter.org/

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