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Why Telemedicine Could Be The Next Frontier

By Valora S. Gurganious, MBA, CHBC, Partner, and Senior Management Consultant

Technology is ubiquitous in modern society, and just when we thought that computers could not replace the “human touch” of a healthcare provider, technology is making specialized care accessible to patients anywhere there is an internet connection. CMS has now approved “virtual visits” via bilateral video and audio communications between a provider and patients.

This will improve access to care for patients in geographically underserved areas or in areas where some specialists are not available. According to the American Hospital Association’s Trend Watch (January, 2015), an estimated 3.2 million patient visits are expected to be delivered via telemedicine by 2018. Below is a table containing the current telemedicine HCPCS Level II and CPT codes that have been set by the American Medical Association:

Sample of AMA-Approved Telemedicine Codes – 2017

Service HCPCS Level II CPT
Office or other outpatient visit 99201-99215
Annual wellness visit (#1 & #2) G0438-G0439
Telehealth consultation (ED or initial inpatient) G0425-G0427
Follow up hospital services 99231-99233
Follow up nursing care facility 99307-99310
Transitional care management 99495-99496
Kidney disease education
Diabetes self-management training services G0108-G0109
Individual psychotherapy 90832-90834 & 90836-90838
Family psychotherapy -with or without the patient present 90846-90847
Annual depression screening G0444
Annual alcohol misuse screening G0442

 

Work Group for Electronic Data Interchange. “Innovative Encounters Issue Brief: Introduction to Telehealth Codes,” December. 21, 2016.

Modifiers for telemedicine services

Per CMS, in 2017 a practitioner may submit claims for telehealth services using the appropriate CPT or HCPCS code for the professional service along with a modifier 95, to indicate that “synchronous telemedicine service rendered via real-time interactive audio and video telemedicine.”

For example, 99201-99205 may be billed for an initial Level 1 visit via telemedicine. The location where health services and health-related services are provided or received through telemedicine would be billed through Medicare as Place of Service code (POS) 2. Check with your commercial payers on their provider website to confirm that they are actively covering telemedicine services using these modifiers.

Here are five steps from AdvancedMD to successfully implement a telemedicine program in your practice:

  1. Determine your objective. Decide your goal. Do you seek to expand patient access to your practice into evenings and weekends? Or perhaps you would like to more closely monitor your chronic or elderly patients? Whatever your objectives, telemedicine can improve patient outcomes, provide additional revenues, and even attract new providers to your practice with this new care delivery medium.
  2. Appoint a telemedicine “Champion within the practice to promote its benefits to your staff, to select and implement the technology, to plan the telemedicine workflow, and to train and coach patients and staff during implementation.
  3. Market the benefits of telemedicine to patients. Use email and text message appointment reminders to create awareness of the telemedicine option to fill empty slots in your schedule and reduce no-shows. The Champion can guide patients on how to access and to use the telemedicine feature.
  4. Practice a telemedicine visit in the roles of both provider and patient. It can take practice to learn how to present well on camera. Be mindful of the background, ambient noise and your body language to make sure you come across professionally and credibly before you go live with real patients.
  5. Meet state licensing requirements. If the patient is located in another state, the originating state in which the patient is located is considered the “place of service”. Therefore, the physician must comply with that state’s licensing rules and regulations. Each state’s medical board has its own rules governing delivery of telemedicine services across state lines (and they are actively changing). Some are easing restrictions on providers in contiguous states, so be certain to check state regulatory requirements frequently.

Valora S. Gurganious, MBA, CHBC (vgurganious@drsmgmt.com). The author is a Partner and Senior Management Consultant at DoctorsManagement.