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Telehealth

March 26, 2020

We are encouraged by the telehealth services we are seeing taking place by our clients.  We hope this has been a smooth process.  We are very optimistic as we are seeing payments come in at the same office rate for Cigna, Aetna and BCBS.

Our teams are focusing on your accounts.  We are seeing business as usual with payors; however, note anything that requires a phone call to the payor we are seeing our wait time on the phone quadruple.  We are really focusing on ensuring we have online access for account management.

Below we are going to explore the 3 types of services Medicare has approved for telehealth including telehealth visits, virtual check ins and e-visits.

1. Medicare Telehealth Visit

  • Requires synchronous audio-visual communication
  • Patient and provider can both engage in the visit from their homes
  • Consent must be provided by the patient – verbal consent is ok
  • Document as you would a normal in-office visit
  • Can be used to perform any appropriate visit
  • Qualified Healthcare Provider (QHP)*
  • Bill using appropriate E/M code
  • Be sure to use Place of Service (POS) code 02
  • Check to ensure you know what codes are needed for insurance visits, some insurers require a modifier 95 or a GT modifier

2. Virtual Check-In

  • Can be performed through synchronous or asynchronous communication; text, email, telephone
    • Does not require video
  • Must be an established patient
  • Consent must be provided by the patient – verbal consent is ok
  • Qualified Healthcare Provider (QHP)*
  • Patient and provider can both engage in the visit from their homes
  • Used to determine if the patient needs to be seen for a visit
    • Patient not seen for the same issue within previous 7 days
    • Check in does not lead to a visit within the following 24 hours
  • Document service in a visit note and indicate that it was a virtual check-in
    • Note method of communication and whether you recommend patient be seen
    • must have the start and end time
  • Be sure to use Place of Service (POS) code 02
  • Codes:
    • G2012: Brief Communication technology-based service, e.g. virtual check-in, by a physician or other QHC 5 – 10 minutes
    • G2010: Remote evaluation of recorded video and/or images submitted by an established patient

3. E-Visit

  • Only performed through asynchronous communication; patient portal, or other secure digital application
    • Does not require video
  • Must be an established patient
  • Communication must be initiated by the patient
  • Consent must be provided by the patient – verbal consent is ok
  • Patient and provider can both engage in the visit from their homes
  • Patient cannot have had an E/M service within the past 7days for the same issue
  • Patient cannot have a face-to-face E/M service within the 7 days of the initiation of the online service
  • Codes:
    • 99421: Online digital evaluation and management service, for an established patient for up to 7 days cumulative time during the 7 days; 5 – 10 minutes
    • 99422: Online digital evaluation and management service, for an established patient for up to 7 days cumulative time during the 7 days; 11 – 20 minutes
    • 99423: Online digital evaluation and management service, for an established patient for up to 7 days cumulative time during the 7 days; 21 or more minute
  • Additional Codes if the provider cannot bill E/M services, such as a physical therapist
    • G0261: Qualified non-physician health care professional online assessment, for an established patient, for up to seven days, cumulative time during the 7 days; 5 – 10 minutes
    • G0262: Qualified non-physician health care professional online assessment, for an established patient, for up to seven days, cumulative time during the 7 days; 11 – 20 minutes
    • G0263: Qualified non-physician health care professional online assessment, for an established patient, for up to seven days, cumulative time during the 7 days; 21 or more minutes
  • Example: Day 1: Patient calls, 5 min on the call; Day 2patient sends a picture , provider reviews:  2 min, physician calls patient: 4 min on the call; physician sends prescription to pharmacy 2 min; Day 5: Physician calls patient : 5 min.  Total minutes allowed to bill for = 18  
  • Document service in a visit note and indicate it was a virtual check-in
    • Note method of communication
    • Note cumulative time spent on the issue for the client in the 7-day window
    • Time includes time reviewing records, test, etc. related to the current concern

Limitations on Allowed Services

  • Some states may have limitations, so there could be barriers to using telehealth
  • For example, Pennsylvania Medicaid limits the use of telehealth to only mental and behavioral services.
  • To review state requirements, visit CCHP’s 50 State Report

https://www.phi.org/?resource=state-telehealth-laws-and-medicaid-program-policies        

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