Telemedicine & How to Get Paid Using It

Telemedicine and

How to Get Paid Using It

Benefits

222

6.5 %Increase in medical costs

projected in 2016

-PricewaterhouseCoopers Health Research Institute Patient Performanc

e

70%Of doctor’s visits can be handled via telephone or

video conference

-The American Medical Association

97%Telemedicine patients were

treated upon first dial-in attempt

-The American Medical Association-

Agenda

33

Provider Roles

Medicare Telemedicine Payment Policies

Medicaid/Private Payer Telemedicine Payment Policies

Telemedicine

What is Telemedicine?

Provider Documentation

Regulatory Compliance

What is Telemedicine?

• Telemedicine is a health care delivery method that links a patient and a provider who are not at the same location and is identical to a traditional healthcare visit except for the mode of delivery

Via real time video Sending clinical information or picture images to a provider for

evaluation, consult or treatment via store and forward

Telemedicine Technologies

• Live Video – Real-time patient provider evaluations, provider-to-provider discussions

• Store & Forward –Technologies electronically transmit patient information between primary care providers and medical specialists. Information could include digital images, x-rays, video clips and photos.

• Remote Patient Monitoring – Collection of medical data from patients in one location and electronically transmit to health care providers in a different location, either real-time or store and forward

Provider Telemedicine Roles & Technology

Telehealth Technologies: Remote Patient Monitoring• Hospital emergency departments, hospital intensive care units and skilled

nursing facilities• At-home management of patients with chronic conditions


Telehealth Technologies: Store and Forward• Often low bandwidth, still images, stored video clips• Best used in dermatology, ophthalmology, radiology


Telehealth Technologies: Live Video Consultation• Variety of high-speed digital telecom• Outpatient or inpatient specialty consultation


Two Patterns of Telehealth

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Store-and-Forward Mode of Delivery

Interactive Mode of Delivery

Referring Provider

Consulting Provider

Presenting Provider(Patient is Here)

Consulting Provider

ReferringProvider

Digital images, sounds,previously recorded video

Live Interaction with patientusing camera, video or audioconference equipment


Referring Provider Type (sending site)

• Performs face to face evaluation of patient

• Determines need for further consultation with another healthcare provider

• Develops media presentation (store and forward) including complete

information of evaluation


Presenting Provider (where the provider is physically located)• Face to face visit • Introduces a patient to consulting provider during an interactive telemedicine

session• This provider type is not required and would only be billable during a live

interactive session

Procedure Code

GT

Required Telemedicine Modifier

Appropriate Covered Procedure Code for Provider

Type


Distant Site (Consulting) Provider• Evaluates the patient and/or medical data/images using telemedicine mode

of delivery upon recommendation of the referring provider

Procedure Code Required Telemedicine Modifier

Appropriate Covered Procedure Code for Provider

Type

GT (Interactive Method)GQ (Store-and-Forward

Method)

Medicare Telemedicine Policies

Medicare Requirements• Live video is the only form reimbursed and originating site is located in:

A rural Health Professional Shortage Area (HPSA)

A county outside of a Metropolitan Statistical Area (MSA)

A federal telemedicine demonstration project (Alaska & Hawaii)


Medicare Requirements• The allowable types of facilities for the “originating site”:

Physician or Practitioner Office

Hospital

Federal Qualified Health Center and Rural Health Clinic

Hospital-based or CAH-based Renal Dialysis Center

Skilled Nursing Facility

o Community Mental Health Center


Medicare Requirements• Providers/practitioners who may receive reimbursement:

Physicians

Nurse Practitioners

Physician Assistants

Nurse Midwives

Clinical Nurse Specialists

Clinical Psychologists

Clinical Social Workers


Rural Counties in Florida


Reimbursable Services in Medicare:

• Tele-consultations-emergency or initial inpatient

• Office evaluations

• Follow-up inpatient in hospital or skilled nursing facility (SNF)

• Subsequent hospital care: 1 telehealth visit/3 days

• SNF subsequent care: 1 telehealth visit/30 days

• Individual psychotherapy, group behavioral assessment and intervention

• Individual and group diabetes self-management, training and medical

nutrition therapy

• Smoking cessation


Reimbursable Medicare Codes


Medicare Telehealth Payments

• Specific codes with modifier GT

• Payments to both distant site provider and originating site facility

Medicaid Telemedicine Policies

Medicaid Programs• CMS reimbursement policy

State may reimburse for telehealth under Medicaid so long as the service satisfies federal requirements of efficiency, economy and quality of care


Common Medicaid Reimbursement Policies

• 44 states reimburse for some live video

• 10 states reimburse for remote patient monitoring

• Only 7 states have partial store and forward reimbursement

• 17 states reimburse for transmission/facility fee

• Reimbursement policies vary for all states


AHCA - Florida Medicaid• For the purposes of reimbursement Florida Medicaid follows CMS guidelines

regarding the definition of telemedicine

• Only physicians can provide and receive reimbursement for telemedicine services

• Originating site does not receive reimbursement unless the provider at the site performs a separately identifiable service for the recipient on the same day as the telemedicine service

• The only codes reimbursed for telemedicine purposes are the consultation codes 99241 through 99255

• No mention of rural location requirement

Commercial Carrier Guidelines

Private Payers• Private payers today are embracing – and reimbursing – a broad range of

telemedicine services as a way to squeeze savings out of the current system

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0CAQQjRw&url=http://newportortho.com/2012/10/notice-to-our-aetna-ppo-patients/aetna-logo-2/&ei=-TdiVLFIhKaDBKnEgeAD&bvm=bv.79189006,d.eXY&psig=AFQjCNG5UPPeaKhK5CIEXO0ICE1TsSwShg&ust=1415809401344365

Provider Documentation

• Follow same requirements as face-to-face to meet CPT standards for coding – remember SOAP notes

• Always remember that the information you send/receive becomes part of the patient’s medical record

• As with all medical records, it is important to clarify the encounter so that coders aren’t making judgment calls

• Do not assume

Guidelines to Remember

• New Patient –Patient who has not received any professional services from the provider or another provider of the same specialty. Patient has not belonged to the same group practice within the past three years.

• Established Patient –Patient who has received professional services from the provider or another provider of the same specialty. Patient has belonged to the same group practice, within the past three years.

Regulatory Compliance

• Authentication• Issues regarding privacy and confidentiality in the medical realm are not

different in telemedicine

• HIPAA

• Rules and regulations

HIPAA and Telehealth

• Telemedicine services have the same duty to safeguard, store and maintain privacy records

• All transmitted data has to be via “secure” means - this excludes FaceTime and Skype applications as commonly used today

[email protected]

Thank You

Eduardo Porras CPC, CPMASr. Director, Operations

6100 Blue Lagoon Drive Suite 450

Miami, FL 33126786.621.3879

Telemedicine & How to Get Paid Using It

Healthcare

Transcript of Telemedicine & How to Get Paid Using It