LUTZ BUSINESS INSIGHTS
telehealth and telemedicine: what you need to know
kim kaye, healthcare consulting senior
Telehealth and telemedicine have made it so providers and patients have a new way to communicate. Telehealth is defined as the provision of healthcare remotely by means of telecommunications technology. Telemedicine is defined as the remote diagnosis and treatment of patients by means of telecommunications technology.
Telemedicine can be performed by different applications, for example, real-time or face to face communication. Store and forward video conferencing is typically used by healthcare providers to share patient diagnostic and treatment information. This is popular with specialties like dermatology, ophthalmology and radiology. Remote Patient Monitoring or ‘telemonitoring’ is a method that allows providers to track a patient’s vital signs and activities from a distance. This is typically used for patients who are at high risk for health-related complications, for example, cardiac patients. The American Medical Association (AMA) reports the top three specialists who use telemedicine the most as of January 2019 are:
- Radiologists—39.5 percent
- Psychiatrists—27.8 percent
- Cardiologists—24.1 percent
Telehealth services bring value to providers and patients in many ways. Telemedicine increases access to care, especially those patients who do not have access to transportation. Studies have shown it improves the quality of care for patients. Telemedicine is cost-effective compared to face to face in-office visits. Patients value the convenience, flexibility and real-time care with their providers.
There are certain barriers to overcome in telehealth. For example, limited access to smartphones and high-speed internet in rural areas. Also, state requirements for licensing and credentialing of telehealth providers vary widely. Lack of reimbursement is a key barrier to the use of telehealth services. Each state has different rules and regulations about the types of services that can be reimbursed by Medicaid. In addition, Medicare strictly regulates the types of providers who are reimbursed for providing telehealth services
Per the Centers for Medicare and Medicaid Services (CMS), Medicare pays for specific Part B provider services furnished through a telecommunications system. Telehealth services substitute for an in-person encounter, and the beneficiary must go to an originating site for services. An originating site is the location where the Medicare beneficiary gets medical services through a telecommunications system.
To be eligible, the originating site must be located either in a county outside a metropolitan statistical area or a rural health professional shortage area. Authorized originating sites include; physician and practitioners’ offices, hospitals, critical access hospitals, rural health clinics, federally qualified health centers, hospital-based or CAH-based renal dialysis centers (including satellites), skilled nursing facilities, community mental health centers, renal dialysis facilities, home of beneficiaries with end-stage renal disease receiving home dialysis and mobile stroke units.
Distant site practitioners who can furnish and get payment for covered telehealth services (subject to state law) include physicians, nurse practitioners, physician assistants, nurse-midwives, clinical nurse specialists, certified registered nurse anesthetist, clinical psychologists and clinical social workers, registered dietitians and nutritional professionals. Clinical psychologists and clinical social workers cannot bill Medicare for psychiatric diagnostic interview examinations with medical services or medical evaluation and management services. They cannot bill or get paid for CPT codes 90792, 90833, 90836, and 90838.
Per CMS, you must use an interactive audio and video telecommunications system that permits real-time communication between you at the distant site, and the beneficiary at the originating site. Transmitting medical information to a provider who reviews it later is permitted only in Alaska or Hawaii federal telemedicine demonstration programs.
Submit professional telehealth service claims using the appropriate CPT or HCPCS codes. If you performed telehealth services through a store and video telecommunications system, add the telehealth GQ modifier with the professional service CPT or HCPCS code (for example, 99202 GQ). Submit telehealth service claims, using place of service 02-Telehealth, to indicate you furnished the billed service as a professional telehealth service from a distant site. Distant site practitioners billing telehealth services under the CAH Optional Payment Method II must submit institutional claims using the GT modifier. HCPCS code Q3014 describes the Medicare telehealth originating sites facility fee. Bill your Medicare Administrative Contractor (MAC) for the separately billable Part B originating site facility fee, per CMS.
CMS also noted how the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (SUPPORT Act) statutorily removed the geographic limitations for telehealth services furnished to individuals diagnosed with a substance use disorder (SUD) to treat the SUD or a co-occurring mental health disorder. The change also allows telehealth services for the treatment of a diagnosed SUD or co-occurring mental health disorder to be furnished to individuals at any telehealth originating site (other than a renal dialysis facility), including in a patient’s home. No originating site facility fee is paid when the beneficiary’s home is the originating site. These changes became effective July 1, 2019.
On July 29, CMS proposed the 2020 Physician Fee Schedule rule, which contains new telehealth services covered under Medicare. CMS proposed adding three codes to the covered Medicare telehealth service list:
GYYY1: Office-based treatment for opioid use disorder, including development of the treatment plan, care coordination, individual therapy, group therapy and counseling; at least 70 minutes in the first calendar month.
GYYY2: Office-based treatment for opioid use disorder, including care coordination, individual therapy, group therapy and counseling; at least 60 minutes in a subsequent calendar month.
GYYY3: Office-based treatment for opioid use disorder, including care coordination, individual therapy, group therapy and counseling; each additional 30 minutes beyond the first 120 minutes (List separately in addition to code for primary procedure).
These services are expected to be added to the list of Medicare telehealth services when the final rule is published and would go into effect January 1, 2020.
CMS Medicare Learning Network MLN Booklet, ICN 901705, January 2019
Rural Health Information Hub, Online
ABOUT THE AUTHOR
KIM KAYE + HEALTHCARE CONSULTING SENIOR
Kim Kaye is a Healthcare Consulting Senior at Lutz with 16+ years of experience. She is responsible for providing professional coding assistance, chart audits and chargemaster reviews for clients with a focus on the healthcare industry.
AREAS OF FOCUS
- Coding Assistance
- Chart Audits
- Chargemaster Reviews
- Healthcare Consulting
AFFILIATIONS AND CREDENTIALS
- Certified Professional Coder
- Certified Evaluation & Management Auditor
- American Academy of Professional Coders, Member
- National Alliance of Medical Auditing Specialists, Member
- BA, Bellevue University, Bellevue, NE
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