Telehealth and new patients

Good afternoon-

We are working on creating our process for telemedicine with Medicare. Of course we have reviewed all the information available out there. My question is this-Medicare shows 99201-99215 as billable codes for Telemedicine (we have some HPSA locations), but how would we meet the requirement of hitting all 3 key components if the patient is not physically onsite to examine? Would we go to time-based billing? I am in a quandary over this, so any/all opinions are most welcome (and needed!).

Thanks in advance,

Donna

Donna M. Beaulieu, CRC, C-CDIS, CPC-I, CPMA, CPC, CEMC, CIMC, CEDC, CFPC, CCP-P, CRP
Certified Green Belt Lean Six Sigma
Assistant Director, Patient Financial Services

[Emory Healthcare]


________________________________

This e-mail message (including any attachments) is for the sole use of
the intended recipient(s) and may contain confidential and privileged
information. If the reader of this message is not the intended
recipient, you are hereby notified that any dissemination, distribution
or copying of this message (including any attachments) is strictly
prohibited.

If you have received this message in error, please contact
the sender by reply e-mail message and destroy all copies of the
original message (including attachments).

Comments

  • edited May 2017
    ------=_NextPart_001_03B1_01D20925.82726260
    Content-Type: text/plain;
    charset="us-ascii"
    Content-Transfer-Encoding: 7bit

    If I were responsible for developing a telemedicine protocol, it would be
    for *all* plans, and established patients only.



    Just my opinion.



    Karen A. Hurley, BS, CMM, CPC, CNA

    President, HPMSI

    PO Box 409

    Parrish, FL 34219-0409

    Tel: (941) 776-4822

    Fax: (240) 368-0059

    Web: www.hpmsi.com



  • Agreed-but adhering to Medicare guidelines allows us to feel more "comfortable" since they typically have the strictest rules. I am just having difficulty figuring how you can hit all 3 key components from a distance. And luckily, this is a collaboration between a physician champion, associate professor, VP of Ops, Project Office, patient access, a revenue A.D. and myself.

    Thanks Karen!

    Donna

  • edited May 2017
    ------=_NextPart_001_03E3_01D2092B.7D79E570
    Content-Type: text/plain;
    charset="us-ascii"
    Content-Transfer-Encoding: 7bit

    Have them review the exam components of 99201 - 99205 and see if they can
    meet those through telemedicine without fear of non-compliance and
    malpractice. Since that is always a factor no matter what is presented,
    they can set their limits on what makes them comfortable.



    If I were providing input to a group, I would restrict it to established
    patients only and with specific, written medical parameters for follow-up.



    But, that's just me :)



    Karen A. Hurley, BS, CMM, CPC, CNA

    President, HPMSI

    PO Box 409

    Parrish, FL 34219-0409

    Tel: (941) 776-4822

    Fax: (240) 368-0059

    Web: www.hpmsi.com



  • Thanks Karen-agreed that there is less risk when dealing with established. I would be interested in seeing how a new patient could be billed without an exam component by the distant site-who is the professional billing entity. I will research time-based and see if that could be an alkternative.

    Appreciate the feedback,

    Donna

    From: Karen Hurley CMM CPC [mailto:karenhurley@hpmsi.com]
    Sent: Wednesday, September 7, 2016 5:16 PM
    To: Multiple recipients of list PARTB-L
    Subject: RE: [partb-l] Telehealth and new patients

    Have them review the exam components of 99201 - 99205 and see if they can meet those through telemedicine without fear of non-compliance and malpractice. Since that is always a factor no matter what is presented, they can set their limits on what makes them comfortable.

    If I were providing input to a group, I would restrict it to established patients only and with specific, written medical parameters for follow-up.

    But, that's just me :)

    Karen A. Hurley, BS, CMM, CPC, CNA
    President, HPMSI
    PO Box 409
    Parrish, FL 34219-0409
    Tel: (941) 776-4822
    Fax: (240) 368-0059
    Web: www.hpmsi.com

  • ------=_NextPart_001_01F4_01D209C8.60044F10
    Content-Type: text/plain;
    charset="us-ascii"
    Content-Transfer-Encoding: 7bit

    There is some exam that is done by sight/sound not touch - skin tone, mental
    status, general appearance, etc.



    Kim



    Kim Huey, MJ, CHC, CPC, CCS-P, PCS, CPCO

    KGG Coding and Reimbursement Consulting, LLC

    PO Box 1804

    Alabaster, AL 35007

    Phone: 205/621-0966

    Toll-free: 877/893-5583

    Fax: 781/723-5558

    mailto:kim@kimthecoder.com



  • BRILLIANT. Thank you so very much.

    Donna

  • I would encourage you to do more research. A number of consultation and new patient services can be performed via telehealth. (stroke, psych etc.) A provider cannot always reach the same level of service that they normally would if they could lay hands on the patient but depending on the circumstances (patient location/payer policy) they can still bill.

    Two national organizations involved with telehealth a Ctel & the ATA. The ATA has a good website and they have regional representatives who might know more about the legislation & parity laws for your specific state. The ATA has regional conferences which are very informative too. (Ctel has a national conference but it is pretty expensive to attend) Medicare also has a telehealth Guide you can find on-line.

    In order to consider a telehealth model you have to know;

    1) What is your business case (ROI vs. expenses for equipment & anticipated reimbursement)

    2) Where are your patients (originating site)? (home, rural clinic etc.) Medicare coverage is based in part on the patient being at a qualified originating site. Your Medicaid program may have limitations too.

    3) What services will Medicare, Medicaid and your commercial payers cover and at what rate? Some states have laws regarding parity in coverage but not parity in the rate of coverage.

    Good Luck!

    Lisa

Sign In or Register to comment.