COVID-19 ECHO OFFICE HOURS 3 FAQ
- National Consortium of Telehealth Resource Centers (NCTRC): https://www.telehealthresourcecenter.org/
- Resources on all aspects of telehealth and
- Links to regional telehealth resource centers that are available to aide practices with telehealth best practices
- Training resources:
- American Telehealth Association Quick Start Guide: https://www.americantelemed.org/industry-news/atas-quick-start-guide-to-telehealth-during-a-crisis/
- AMA telehealth playbook: https://www.ama-assn.org/system/files/2020-04/ama-telehealth-playbook.pdf
- Checklists for telehealth:
What are the differences between e-visits, virtual visits, and telehealth?
- Based on the Medicare definition an e-visit typically is through some kind of patient portal while virtual visits are over the phone to qualify as telehealth the visit must be a synchronous audio/visual connected.
How do hospitals code differently for different types of remote health?
- It’s important to check with each payer program to correctly code each type of health care provision.
- Even different government programs are not standard in coding requirements, working with your bac
- The ACP has created a guide on common telehealth codes: https://www.acponline.org/practice-resources/covid-19-practice-management-resources/telehealth-coding-and-billing-during-covid-19
Who can provide telehealth services?
- Hospitals and clinics must check with payers, licensure bodies, and state regulations prior to many the initiation of providing services.
- For example, as of 4.22.2020 many Medicaid programs will not typically pay for many LMHPs via telehealth.
- These rules are constantly evolving, so keeping up to date with payer policies is imperative.
Can telehealth pay for new patients?
- For Medicare telehealth payments for new patients are eligible. Hospitals and clinics have check with different payers for more detailed information.
- AHIP has compiled a list of payer responses to the COVID crisis: https://www.ahip.org/health-insurance-providers-respond-to-coronavirus-covid-19/
How can hospitals and clinics promote telehealth in largely elderly communities?
- The Telehealth Resource Centers have a variety of resources on educating patient populations on all kinds of telehealth: https://www.telehealthresourcecenter.org/
- Implementation of telehealth can usually be made more successful by embedding it within already existing EMR that patients are experienced and comfortable with. For example, combining e-visits with an already existing patient portal may aide in the transition.
What are the costs of adopting telehealth?
- These costs vary greatly depending on the range of desired services and practice size.
- One major cost consideration is that of reimplementation. Even though HIPAA has been waived this crisis is a good time for adoption of best practices, which include HIPAA compliant telehealth. Consider saving your practice double costs by starting with a HIPAA compliant platform.
As a rural health clinic we have been using audio only, the CPT code we would use is G0071 for Medicaid and G2021 for Medicare, correct? Also, are there E/M codes for RHCs audio only visits as most of what I see are audio/visual and not for use of RHCs?
- The G0071 code is the option only for an RHC.
- Currently there are no audio only visits code; more guidance is needed from CMS and payers to understand how to code these.
Is there somewhere I could find a list of HIPAA compliant video conference software options to consider?
- The National Telehealth Technology Assessment Resource Center has resources available to compare telehealth resources: http://telehealthtechnology.org/
- Perform proper due diligence on any system; check with any similar practices to see their implementation.
What Revenue Code should be used when submitting both virtual and telehealth services to Medicare?
- During the crisis, all codes are done where the visit would have normally occurred (1) patient at home- 0521, (2) either 0524, 0525 for nursing homes depending on the state.
- Put the -95 and -CG modifiers to pay for the RHC all-inclusive rate; effective July 1st, these will be paid at a calculated national average.
When offering telehealth services, outside of codes and cost, what else should be considered during implementation?
- Check location of the provider’s licensure and the patient’s location. Providers must be licensed where the patient is located
- Make sure malpractice insurance will cover telehealth provisioning. Many insurance providers automatically cover telehealth, but ensuring that is the case, will help protect providers.
- Consider the personnel that will be providing telehealth and workflow integration:
- Train providers on how to do a virtual visit (see training links above)
- Run telehealth mock-ups to think through telehealth consultations.
- For example, an often overlooked consideration is where to look at the screen; ‘making eye contact’ requires looking at the camera not a patient’s face.
- Consider what business problems you solving by implementing telehealth.
- Will it make follow-up with patients easier?
- Will it aid reminding patients to refill medication.
Top 3 best practices for telehealth?
- There are a lot of resources – check professional society practice guidelines for all types of providers; see above for a handful.
- Document the location of the patient every time a call is made.
- Set expectations (and define a protocol) for outages – does the provider or patient calls back?
- Be prepared for emergencies – calling 911 at your location may be ineffectual, so knowing contact for EMS in your patient’s area may be critical.
- Make sure you have obtained consent.
- Many telehealth systems have built in consent.
- Pre-providing hard copy forms might help patients.
- Providers can document consent in the patient notes.
What kind of effort will a patient be required to put forward?
- This depends on the telehealth platform. It can involve creating an account or just opening an email.
- When purchasing telehealth try to think on how patients would feel using the system.
Is Medicare RHC allowing for both virtual and telehealth visits?
- Yes, they are allowed. The CARES Act allows RHCs to be a remote provider.
If it is financially OK for your facility, do you recommend holding your RHC claims for Telehealth until July 1. If so, then would we use G2025.
- Hopefully, but the answer remains unclear; financial considerations are the driving. More direction from CMS is required to clearly answer this question.
How to best train staff in telehealth?
- There is no set amount of training – beyond making sure that providers are comfortable with telehealth.
- The AAMC –is working on developing a set of core competencies but that has yet to be released.
- See above training resources.
What are the CPT codes that can be used for COVID and non-COVID?
- An RHC can use the G0071 code.
- Telephone only calls mean the use of the G2012. Medicare has added for the extent of the pandemic codes covering larger time ranges 99441-99443.
Since we will not be paid out AIR as an RHC, do we still bill on a UB or 1500?
- It is on the UB that remains the same. Even prior to the emergency, some RHC payments were paid on the fee schedule – like chronic care services so they were on the UB.
Can the COVID testing codes be submitted to Medicare and Medicaid?
What’s a place to begin with implementing telehealth?
- THRC (see above resources)
Is there a checklist that we can use to implement?
- Texas Medical AssocationTelehealth visit checklist: https://www.texmed.org/uploadedFiles/Current/2016_Practice_Help/Health_Information_Technology/Telemedicine/Telemedicine%20Visit%20Checklist.pdf
- Great Plains Telehealth Association https://www.telehealthresourcecenter.org/wp-content/uploads/2019/07/checklist190508-gpTRAC.pdf
What novel things are being done with telehealth?
- We used ours for registration in our hospital to eliminate the patient/staff from exposure to patients.
- Telemedicine is being used to screen patients for testing.
Can 99441-99443 codes be used in a CAH setting since not accepted in an RHC? This would also be for an audio only service?
- This depends on whether your practice used Method 1 or Method 2 billing
- G0071 – is typically the highest payment, so this would be the best for the RHC
- G2012 – is for audio only meetings
I am in a critical access hospital and have a consulting pharmacist. What do you think of the use of telepharmacy in rural hospitals that do not have a pharmacist in-house at all times?
- Many hospitals are doing it but state regulations vary.
- Two resource can be used to check state regulations