Compiled Resources

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?

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?

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:
  • 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:
  • 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?

  • Yes

What’s a place to begin with implementing telehealth?

  • THRC (see above resources)

Is there a checklist that we can use to implement?

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?