Transcript Slide 1

Thank You For Joining Us!
Tuesday 11/11/2014
Women’s Physician Telemedicine Event
Thank You To Our Sponsors!
Tuesday 11/11/2014
Women’s Physician Telemedicine Event
Thank You To Our Sponsors!
Tuesday 11/11/2014
Women’s Physician Telemedicine Event
Thank You To Our Sponsors!
Tuesday 11/11/2014
Women’s Physician Telemedicine Event
Thank You To Our Sponsors!
Tuesday 11/11/2014
Women’s Physician Telemedicine Event
Marnique Sparago and Carol Hakemian-Felt
Thank You To Our Sponsors!
Tuesday 11/11/2014
Women’s Physician Telemedicine Event
TELEMEDICINE AND HOW
TO GET PAID USING IT
Eduardo Porras CPC, CPMA
AHIMA Certified ICD-10 Instructor
Tuesday 11/11/2014
Women’s Physician Telemedicine Event
Benefits
6.5 %
70%
Increase in medical costs
projected in 2015
Of doctor’s visits can be
handled via telephone
or video conference
-PricewaterhouseCoopers Health Research
Institute
-The American Medical Association
97%
Telemedicine patients
treated upon first dial-in
attempt
-The American Medical Association
- How to Get Paid Using It
Telemedicine and
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Agenda
What is Telemedicine?
Provider Roles
Regulatory
Compliance
Provider
Documentation
Medicare
Telemedicine
Payment Policies
Medicaid/Private Payer
Telemedicine Payment
Policies
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WHAT IS TELEMEDICINE?
What is Telemedicine?
• Telemedicine is a health care delivery method that
links a patient and a provider who are not at the
same location and is identical to a traditional
healthcare visit except for the mode of delivery
• Via real time video or by
• Sending clinical information or picture images to a
provider for evaluation, consult or treatment via store
and forward
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Telemedicine Technologies
• Live Video – Real-time patient provider evaluations,
provider-to-provider discussions
• Store & Forward – technologies electronically transmit
patient information between primary care providers
and medical specialists. Information could include
digital images, X-rays, video clips and photos.
• Remote Patient Monitoring – Collection of medical
data from patients in one location and electronically
transmit to health care providers in a different
location, either real-time or store and forward
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PROVIDER TELEMEDICINE
ROLES AND TECHNOLOGY
Telehealth Technologies: Remote Patient
Monitoring
• Hospital emergency depts and
intensive care units, and skilled
nursing facilities
• At-home management of
patients with chronic conditions
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Telehealth Technologies:
Live Video Teleconsultation
• Variety of highspeed digital
telecom
• Outpatient or
Inpatient specialty
consultation
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Telehealth Technologies: Store & Forward
• Often low bandwidth,
still images, can store
video clips
• Best used in
Dermatology,
Ophthalmology,
Radiology
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Two Patterns of Telehealth
Store-and-Forward Mode of Delivery
Referring Provider
Digital images, sounds,
previously recorded video
Consulting
Provider
Interactive Mode of Delivery
Referring Provider
Presenting Provider
Live Interaction with patient
(Patient is Here)
using camera, video, or audio
conference equipment
Telemedicine and How to Get Paid Using It
Consulting
Provider
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Referring Provider Type (sending site)
• Performs face to face evaluation of patient
• Determines need for further consultation with
another healthcare provider
• Develops media presentation (store and forward)
including complete information of evaluation
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Presenting Provider
(Where the Patient is Physically Located)
• Face to Face visit
• Introduces a patient to consulting provider during
an interactive telemedicine session
• This provider type is not required and would only
be billable during a live interactive session
Procedure Code
Required Telemedicine Modifier
APPROPRIATE COVERED
PROCEDURE CODE FOR
PROVIDER TYPE
GT
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Distant Site (Consulting) Provider
• Evaluates the patient and/or medical
data/images using telemedicine mode of delivery
upon recommendation of the referring provider
Procedure Code
APPROPRIATE COVERED
PROCEDURE CODE FOR
PROVIDER TYPE
Required Telemedicine Modifier
GT (Interactive Method)
GQ (Store-and-Forward Method)
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MEDICARE TELEMEDICINE
POLICIES
Medicare Requirements
• Live Video is the only form reimbursed and
originating site is located in:
– A rural Health Professional Shortage Area (HPSA);
– A county outside of a Metropolitan Statistical Area; or
– Or in a federal telemedicine demonstration project
(Alaska & Hawaii)
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Medicare Requirements
• The type of facility the “originating site” can be,
are:
– Physician or practitioner offices
– Hospitals
– Federal Qualified Health Centers and Rural Health
Clinics
– Hospital-based or CAH-based Renal Dialysis Centers
– Skilled Nursing Facilities
• Community Mental Health Centers
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Medicare Requirements
• Provider/Practitioners who may receive
reimbursement:
– Physicians
– Nurse Practitioners
– Physician Assistants
– Nurse Midwives
– Clinical Nurse Specialists
– Clinical Psychologists
– Clinical Social Workers
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Rural Counties in Florida
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Reimbursable services in Medicare:
•
•
•
•
•
•
Tele-consultations-emergency or initial inpatient
Office evaluations
Follow-up inpatient in hospitals or SNFs
Subsequent hospital care: 1 telehealth visit/3 days
SNF subsequent care: 1 telehealth visit/30 days
Individual psychotherapy & group behavioral
assessment and intervention
• Individual and Group diabetes self-management
and training and medical nutrition therapy
• Smoking cessation
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Reimbursable Medicare Codes
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Reimbursable Medicare Codes
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Medicare Telehealth Payments
• Specific codes with modifier GT
• Payments to both distant site provider, and
originating site facility
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MEDICAID TELEMEDICINE
POLICIES
Medicaid Programs
• CMS reimbursement policy
– State may reimburse for telehealth under Medicaid so
as long as the service satisfies federal requirements of
efficiency, economy, and quality of care
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Common Medicaid Reimbursement Policies
• 44 states reimburse for some live video
• 10 states reimburse for remote patient monitoring
• Only 7 states have partial store & forward
reimbursement
• 17 states reimburse for transmission/facility fee
• Reimbursement policies vary for all states!
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AHCA – Florida Medicaid
• For the purposes of reimbursement FL Medicaid
follows CMS guidelines regarding the definition of
telemedicine
• Only physicians can provide and receive
reimbursement for telemedicine services
• Originating site does not receive reimbursement unless
the provider at the site performs a separately
identifiable service for the recipient on the same day
as the telemedicine service
• The only codes reimbursed for telemedicine purposes
are the consultation codes 99241 through 99255
• No mention of rural location requirement
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COMMERCIAL CARRIER
GUIDELINES
Private Payers
• Private payers today are embracing – and
reimbursing – a broad range of telemedicine
services as a way to squeeze savings out of the
current system
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PROVIDER
DOCUMENTATION
Provider Documentation
• Follow same requirements as face to face to meet CPT
standards for coding – remember SOAP notes
• Always remember that the information you
send/receive becomes part of the patient’s medical
record
• As with all medical records, it is important to clarify
the encounter so that coders aren’t making judgment
calls
• Do not assume!
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Guidelines to Remember
• New Patient – A new patient is one who has not
received any professional services from the provider
or another provider of the same specialty who
belongs to the same group practice, within the past
three years
• Established Patient – An established patient is one
who has received professional services from the
provider or another provider of the same specialty
who belongs to the same group practice, within the
past three years
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REGULATORY
COMPLIANCE
Regulatory Compliance
• Authentication
• Issues regarding privacy and confidentiality in the
medical realm are not different in telemedicine
• HIPAA
• Rules and Regulations
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HIPAA and Telehealth
• Telemedicine services have the same duty to
safeguard, store and maintain privacy records
• All transmitted data has to be via “secure” means
- this excludes Face Time and Skype applications
as commonly used today
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CLOSING THOUGHTS
Thank You
If you would like more information on this topic or other ways
to increase your reimbursements, contact us directly.
• Call us: 1-877-AVISENA
• E-Mail: [email protected]
• Visit us at www.avisena.com
Presenter:
Eduardo Porras CPC, CPMA
Director of Operations
Avisena, Inc
Phone 786-621-3879
[email protected]
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