Tag: Telemedicine

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POET will showcase ideas on Telehealth work flow as we find them. Be sure and check the comments for new ideas or add your own ideas!

Resource MGMA community
Does anyone have a tested and working workflow for telemed?   Something like the following?  
1. Review appointment list for appropriate diagnosis and problems to perform telemed
2. Reminder call to patient includes survey to see if they would qualify for telemed visit
3. If video capable, Send patients instructions to install app to phone and request confirmation via email that they have received the invite
4. If not video capable, review if patient is appropriate for televisit only
5. When appointment arrives, staff person pulls up video conf on designated laptop or pc and does initial intake of questions for the physician
6. when completed patient waits for physician to enter the room
7. physician performs video visit and documents in the record.

Another MGMA community resource. From an office manager in Ohio. Zoom (a meetings and workplace app) for example is very easy to use but it is not on the list suggested by CMS  The problem with Skype and Messenger is that they generally require setting up user specific accounts on both ends. My test run with Zoom was simple and we just sent the meeting link to the phone or to the email of the test recipient.  Other opinions would be welcome.  

Texas Medical Board announcement regarding telemedicine http://www.tmb.state.tx.us/page/coronavirus

To view the FAQs

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Governor Abbott Waives Certain Regulations For Telemedicine Care In Texas

Governor Greg Abbott today waived certain regulations and directed that the Texas Department of Insurance (TDI) issue an emergency rule, all relating to telemedicine care for patients with state-regulated insurance plans to help doctors across Texas continue to treat their patients while mitigating the spread of COVID-19. The suspensions and emergency rule will work together to allow telemedicine visits for patients with state-regulated plans to be paid the same as in-office visits for insurance purposes. These actions build upon waivers the Governor issued last week of portions in the Occupations Code to expand provider flexibility in providing medical services over the phone.

“As the State of Texas responds to COVID-19, we continue to work to maintain regular health care services and operations throughout the state, and telemedicine is one of the most valuable tools we have to ensure Texans continue to receive the health services they need,” said Governor Abbott. “Expanding telemedicine options will help protect the health of patients and health care professionals, and help Texas mitigate the spread of COVID-19.”

Doctors will be eligible for payment from insurance plans regulated by TDI for medical visits they conduct over the phone instead of in-person at the same rate they would receive for in-person visits. 

Medical providers seeking guidance on the impact of the new rule can expect guidance from the Texas Medical Board to be issued in the coming days, including administrative guidance for billing to ensure that claims are processed smoothly.

Insurers seeking guidance on implementation of the emergency rule should contact TDI or visit their webpage for more information.

This coordinated efforts between the Office of the Governor, the Texas Department of Insurance, the Texas Medical Board, and health insurance plans will increase access to health care for all Texans. Today’s action will expand telemedicine options by giving health care providers greater flexibility to perform audio-only telephone consultations with their patients.

As a reminder, Texans covered by CHIP or Medicaid will not be charged copays for test or telemedicine consults. Individuals covered by Medicare or large employer plans should check with their health plan administrator to determine their specific benefits. 

From American Academy of Family Practice

Getting Paid – A Blog from FPM Journal

Tuesday
Mar 10, 2020

Coronavirus
(COVID-19): new telehealth rules and procedure codes for testing

Last
week, Congress passed the Coronavirus Preparedness and Response Supplemental AppropriationsAct.(www.congress.gov) 
The legislation will allow physicians and other health care professionals to
bill Medicare fee-for-service for patient care delivered by telehealth during
the current coronavirus public health emergency.

In
particular, the legislation gives the U.S. Department of Health and Human
Services (HHS) secretary the authority to waive or modify certain telehealth
Medicare requirements when the President has declared a National Emergency, or
the HHS Secretary has declared a Public Health Emergency, as Sec. Alex Azar did in January(www.phe.gov).
For instance, the legislation gives the HHS secretary the authority to
waive the originating site requirement(www.cchpca.org) for
telehealth services provided by a qualified provider to Medicare beneficiaries(www.cms.gov) in
any identified emergency area during emergency periods. The legislation also
allows telehealth services to be provided to Medicare beneficiaries by phone,
but only if the phone allows for audio-video interaction between the qualified
provider and the beneficiary. This expansion is limited to qualified providers
who have furnished Medicare services to the individual in the three years prior
to the telehealth service (or another qualified provider under the same tax
identification number that has provided services within three years). The
patient must initiate the service and give consent to be treated virtually, and
the consent must be documented in the medical record before initiation of the
service.   

As noted,
the waiver of the originating site requirement and expansion of telemedicine
modalities is limited to emergency areas identified by the President and HHS
Secretary during emergency periods. Accordingly, as a practical matter, this
expansion of payment is very limited. Further, health care providers must still
comply with state telehealth laws and regulations, including professional
licensure, scope of practice, standard of care, patient consent(www.cchpca.org),
as well as other payment requirements for non-Medicare beneficiaries.

The codes
that will be billed for what Medicare actually defines as Medicare “telehealth
services” will typically be evaluation and management (E/M) codes (for example,
99213, 99214) along with a telehealth Place of Service (POS) code(www.cchpca.org) and
potentially a modifier (if required by commercial payer). However, there are
additional services available for payment that are not ever restricted by
originating site and other Medicare telehealth regulations. The Medicare “communications-based technology” codes(www.cchpca.org) (e.g.
G2012) are not deemed by the Centers for Medicare & Medicaid Services (CMS)
to be Medicare “telehealth services,” which means they are not subject to the
statutory restrictions regarding originating site and rural geography. These
services can be furnished even when patient are in their homes, regardless of a
national emergency declaration. There are also time-based, online digital E/M
codes (99421, 99422, 99423) for established patients. Similar codes (G2061,
G2062, G2063) are available for online patient-initiated assessments provided
by qualified non-physician health care professionals.

Last week
CMS also announced that Medicare Part B would cover a test to determine if
beneficiaries have coronavirus for dates of service on or after Feb. 4, 2020.
But providers of the test will have to wait until after April 1, 2020, to
submit a claim to Medicare for the test. Most physician offices will not have
access to the test to perform it themselves, but may be ordering it for their
patients or collecting specimens (e.g. nasal swab or sputum) for testing. In
general, if the patient is in the office for an E/M service, the specimen
collection is bundled in that service. Otherwise, many contracts don’t include
specimen collection. You will need to check with the payers in your area on
this point.

CMS has
created two Healthcare Common Procedure Coding System (HCPCS) codes to report
testing for coronavirus. Labs that test patients for the new coronavirus using
the Centers for Disease Control and Prevention (CDC) 2019 Novel Coronavirus
Real Time RT-PCR Diagnostic Test Panel may bill for that test using the new
HCPCS code (U0001). This code is used specifically for CDC testing laboratories
to test patients for SARS-CoV-2. The second HCPCS billing code (U0002) allows
laboratories to bill for non-CDC laboratory tests for SARS-CoV-2/2019-nCoV
(COVID-19). On Feb. 29, 2020, the Food and Drug Administration (FDA) issued a
new, streamlined policy for certain laboratories to develop their own validated
COVID-19 tests. This second HCPCS code may be used for tests developed by these
additional laboratories when submitting claims to Medicare or health
insurers. Diagnosis coding for coronavirus is also
available.

What is
happening in the private health insurance sector remains unclear and may vary
from payer to payer. An industry trade group, America’s Health Insurance Plans, issued its own
statement last week(www.ahip.org). CMS also
issued a fact sheet on “Information Related to COVID–19 Individual
and Small Group Market Insurance Coverage.”(www.cms.gov)

For more
information, please see CMS’s frequently asked questions(www.cms.gov) for
health care providers regarding Medicare payment for laboratory tests and other
services related to the 2019 novel coronavirus. CMS has also provided related
fact sheets pertaining to Medicare(www.cms.gov) and Medicaid and the Children’s Health Insurance Program(www.cms.gov).

Coverage,
payment, and other aspects of getting paid for services related to the
coronavirus are continuously evolving. Stay tuned to the “Getting Paid” blog
for further updates. AAFP has more information about how to prepare for
COVID-19 here: https://www.aafp.org/patient-care/emergency/2019-coronavirus.html

— Kent
Moore, AAFP Senior Strategist for Physician Payment

Posted
at 04:30PM Mar 10, 2020 by Kent Moore