Often used interchangeably with telehealth, telemedicine is the delivery of certain healthcare services, most commonly follow-up visits and consultations, with direct communication between a provider and patient via the Internet or other communication portal taking the place of an in-person visit. As more healthcare providers integrate telemedicine into their practices, they may find that increased patient engagement, compliance, reduced patient health care costs and improved bottom lines are well worth the effort. There are, however, a number of factors that have left many patients or providers unable to take advantage of this convenient option:
Barriers to Implement Telemedicine
Problem: A March 2016 HealthMine survey showed that over half of the 500 patient respondents wouldn’t use telemedicine either because they prefer in-person visits or they mistrust the technology while more than a third of respondents had never even heard of it. Their data also revealed that 28 percent of those surveyed didn’t know when using telemedicine was appropriate, and 14 percent didn’t know whether it was covered under their insurance plan. Another 42 percent felt more comfortable with the traditional in-person doctor visit.
Solution: The 90 percent of those who have used it agree that it reduced their healthcare expenses. Both providers and payers need to become more pro-active in educating insured patients about telemedicine as a care option, according to Bryce Williams, president and CEO of the Dallas-based data company HealthMine.
Problem: Lack of affordable and sufficient Internet and technology infrastructure was another problem for potential healthcare consumers, This is true especially those living in rural communities where there is a shortage of doctors as well as an aging population and greater distance between communities and available healthcare facilities, according to a letter by John Windhausen, Jr., executive director of the Schools, Health and Libraries Broadband (SHLB) Coalition. Lack of funds for computers or mobile devices and Internet service is another factor that hinders access to telemedicine. More than 60 percent of non-urban clinics functioned with a broadband width of less than 10 Mbps, which is far below the 50-100 Mbs range needed for maintaining a strong enough connection to support telemedicine.
Solution: Congress may be persuaded to increase finding for broadband access to rural and under-served areas. The above coalition of health care providers with schools, libraries and health care centers have been urging Congress to double the funding allotted for expanding broadband services. By offering telemedicine through nearby community centers such as libraries, schools and clinics, patients in otherwise-underserved areas should be able to avail themselves of this option.
Problem: Inability or inexperience of patients with navigating online, including either lack of access to mobile or other devices or locations where telemedicine may be available.
Solution: This is usually more of an issue for older seniors, and may call for assistance by more tech-savvy family members or other care-givers. Younger seniors, especially those who are more affluent and are already accustomed to computer technology, are more willing and able to benefit from telemedicine.
Problem: Telemedicine coverage often lags behind in payer reimbursement in many areas, further reducing access, according to the HealthMine survey. Of the responders to the above survey, fully a third stated that their plans did not cover it. To complicate things further, related issues such as state license requirements and validation by healthcare providers themselves have delayed telemedicine’s inroads to becoming an acceptable option.
Solution: With over half of the states currently mandating telemedicine coverage as of early 2016, more will eventually get on board, especially since the CMS has already spelled out coding and other guidelines for approved telemedicine services.
Problem: Small or solo practices may have concerns about incorporating telemedicine into practices due to perceived cost as well as finding the right platform.
Solution: Ask whether the service quality will be as good as in-person visits, supportable on most devices and addresses security and HIPAA issues. Major platforms include MDLive, Teladoc and Doctor on Demand.
Related Article: Telemedicine Billing Must Know CPT Codes and GT Modifiers
Most telemedicine studies have been conducted with those already living in senior living facilities, rather than in their own homes, and while those usage outcomes appeared successful overall, there is much less information about care received by elderly patients via ED-base telemedicine as well as how older home bound seniors are faring in utilizing any sort of technology.
Telemedicine Billing Basics
- Because more payers are offering coverage of telemedicine, your front desk should always confirm whether telemedicine is a covered service. Many patients are unaware of this option, let alone whether it is covered.
- Ask payers which type of telemedicine services are covered, including live video visits and consultations.
- Ask about any conditions or restrictions, such as minimum or maximum distance from a facility or provider, whether patients must give written consent or limits on the number of telemedicine visits allowed during a year.
- Ask payers about which are eligible codes: for example, depending on the state, some payers prefer the use of code 99444 with the (Medicare) GT (telemedicine visit) modifier, while other payers advise practices to use the evaluation and management (E&M) codes 99301-05 or 99211-15 plus the GT modifier.Other payers may use the QT modifier or 95 to indicate telemedicine visits.
A Medical Billing Service Company Can Help Providers overcome Telemedicine Challenges
Thanks to the rapid changes in technological advances within the past decade, even some newer EHR systems are having trouble keeping pace with the addition of new codes and billing procedures. Working with M-Scribe, an experienced medical billing with great coding experience can offer assurance that even challenging telemedicine claims will be correctly coded and submitted right the first time. In business serving practices of all specialties and sizes since 2002, M-Scribe is a leader in claims processing and innovative practice management.
Contact our consultants for a free analysis of your practice’s needs and revenue goals by email or call 770-666-0470 to learn more about we can ensure coding and documentation compliance while helping your practice thrive.