Telehealth and new patients

donna.beaulieu@emoryhealthcare.org

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]


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KarenHurley

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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

donna.beaulieu@emoryhealthcare.org

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

KarenHurley

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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

donna.beaulieu@emoryhealthcare.org

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

kggarner@bellsouth.net

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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

donna.beaulieu@emoryhealthcare.org

BRILLIANT. Thank you so very much.

Donna

lisa.roche@providence.org

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