By Gayathri Natarajan, Assistant Vice President - Operations, Access Healthcare
Telehealth Redefined - What is changing?
Like the rest of the world, I am probably quarantined for some time now at my doc’s desk. I now more often generate out of virtual interactions between my doctor and my patient.
Here is the list of most frequently posed questions and answers to facilitate my Journey through these unusual times or what we call the “new normal.” Our experts will help clarify the myths and facts around these grey areas in this series.
Telehealth vs Telemedicine: Do they mean the same?
The answer is NO, though these terms are more often used interchangeably, and definitions are evolving.
Telemedicine refers, specifically, to remote clinical visits; while Telehealth covers a broader scope to include remote non-clinical healthcare services additionally.
A remote doctor-patient consultation falls under Telemedicine. This involves the exchange of clinical information to improve a patient’s health between the originating/patient site (e.g., home) and a distant/provider site enabled by growing Telecommunication technologies.
Examples of non-clinical Telehealth services include provider training, continuing medical education, administrative meetings, etc.
Who can provide Telehealth Services?
A wide range of providers such as doctors, nurse practitioners, physician assistants, nurses, midwives, certified nurse anesthetists, clinical psychologists, licensed clinical social workers, registered dieticians and nutrition professionals, physical and occupational therapists and speech-language pathologists are all be able to offer Telehealth to their patients.
What are the different technology mediums available and allowed to offer Telehealth services?
They are broadly classified as a Synchronous vs. Asynchronous medium of interactions between the patient and the provider.
Synchronous Telehealth services are a real-time, two-way interaction, enabled by audio and video, between the patient and the provider. It almost mimics an in-person visit experience for both the patient and the provider facilitated through a technology-enabled face-to-face conversation.
Allowed technology would include FaceTime, Facebook Messenger Video Chat, Google Hangouts, Zoom video, Skype video, etc.
Asynchronous Telehealth services on the other hand involve the provider being able to access medical data collected, stored, and forwarded on a secure platform. This allows the providers access to information on their own convenient timeline.
What is Covered?
The Centers for Medicare & Medicaid Services (CMS) periodically update the list of covered Telehealth services (reference web link below). Some of these listed services are temporary additions in lieu of the COVID-19 pandemic and need to be reviewed periodically for changes.
https://www.cms.gov/Medicare/Medicare-General-Information/Telehealth/Telehealth-Codes
The listing below a gist of covered services:
Evaluation and Management (E&M)
Mental health counseling
Preventive health screenings
Remote Physiologic Monitoring Services to Patients with acute and chronic health conditions
Home Health and Hospice care is allowed if it is part of the Patient’s plan of care and does not replace required in-person visits
What are the waivers that apply to these virtual visits during the Public Health Emergency (PHE)?
Services are considered Telehealth when the individual physician or professional providing the services is not at the same location as the beneficiary. CMS has broadened access to Telehealth services so that beneficiaries can receive a wider range of services without having to travel to a healthcare facility given the Public Health Emergency. CMS is expanding this benefit on a temporary and emergency basis under the 1135 waiver authority and Coronavirus Preparedness and Response Supplemental Appropriations Act.
Provision of Coverage for New and established Patients that includes office, hospital, and other visits furnished via Telehealth across the country including Patient’s residence
Coinsurance and deductible generally apply. HHS OIG (Department of Health and Human Services - Office of Inspector General) is offering flexibility for healthcare Providers to reduce or waive cost-sharing for Telehealth visits paid by federal healthcare programs
Any Practitioner who can independently bill for Medicare services are eligible
Rural Health Clinics (RHC’s) and Federally Qualified Health Centers (FQHC’s) are authorized to provide distant site Telehealth Services
Critical Access Hospitals can report their Telehealth services under CAH Method II
Telehealth Services provided to Beneficiaries in a healthcare facility like nursing homes or home health agencies, the facility is eligible to bill for the originating site facility fee using HCPCS Code Q3014, HCPCS for Telehealth facility fee
What are the different types of Telehealth and other Virtual Visits?
Telemedicine E/M visit: An Evaluation and Management (E/M) visit comprising of live interactions enabled by audio and video technology facilitating the same extent of service as an in-person visit from one site to another. This includes office or outpatient visits, consultations that can be critical care, emergency, or inpatient.
Telephone Services/Audio only Services: An Evaluation and Management (E/M) visit furnished by a physician or qualified healthcare professional via telephone non-face-to-face.
Virtual Check-Ins: Technology-based services that include a brief (5-10 min) communication by a physician or qualified healthcare professional enabled by the exchange of information through telephone, video, or image.
E-Visit: Non-face-to-face online digital evaluation and management service through an online portal.
Remote Patient Monitoring of various parameters like vitals.
Interprofessional internet consultation: Assessment and management service provided by a consulting physician, including a verbal and written report to the patient's treating/requesting physician or other qualified health care professional.
In the next few online editions, our experts at Access Healthcare will walk us through the “need to know” coding guidelines and payor specifics around Telehealth. Until then, Be Safe and Stay Tuned for the next edition.
About the Author
Gayathri Natarajan, CPC, COC carries over 16 years of experience in leading large-scale medical coding teams across a diverse range of specialties. As the Head of Coding Operations, Gayathri oversees Service delivery, Continuous Coding Education, and Transitions at Access Healthcare.