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Don’t Leave Money on the Table...Leverage Billable Telehealth Virtual Services

Posted on Apr 09, 2020 by Hilary Melander

      Telehealth visits are critical during COVID-19The COVID-19 pandemic has caught the world by surprise. While in-person visits have been reduced or even halted to slow the spread, you can keep income coming in by offering a variety of billable virtual telehealth services. 

      Maintaining your service continuity is both critical to your community and keeping your business afloat during this storm. The purpose of this article is to provide further clarification on the types of virtual services you can offer and provide additional billing and coding insights so you can get paid. We also encourage you to review the chart below that summarizes codes and current payment standards from CMS and other major payors.

      Government regulations and payer policies during COVID-19

      To encourage the adoption of virtual services TODAY, regulations and policies around telehealth and HIPAA have been relaxed or waived to ensure your patients get access to healthcare they need and so you can keep the lights on. The Center of Medicare and Medicaid Services (CMS) announced major policy changes to broaden both access and the types of billable services. 

      There are four main types of billable virtual services physicians and other professionals can provide patients— telehealth visits, virtual check-ins, e-visits, and telephone. Because laws vary from state to state, payer to payer, and are in many cases still evolving, we recommend you continuously monitor new developments. Make sure to regulary review the CMS Current Emergency resource page to help you monitor new policy changes.

      Don’t forget: provider enrollment is required

      What many providers and practitioners don’t realize is that CMS Provider Enrollment is still required for payment during COVID-19. Physicians, nurse practitioners, physician assistants and other Part B practitioners can enroll by calling Provider Enrollment hotline. For a list of hotline numbers and frequently asked questions around Provider Enrollment, see 2019-Novel Coronavirus (COVID-19) Medicare Provider Enrollment Relief Frequently Asked Questions (FAQs)

      Double don’t forget: inform your patients 

      Before launching into services, it is important to point out a common requirement among most virtual Patients must initiate telehealth visitsservices. They must be patient initiated. While that is true, practices are still allowed to let patients know that a service is provided and available. Reach out to your patients via text message, email, and newsletters to make sure your patients are aware of the virtual services you provide. Solutionreach customers can use SR Conversations, Newsletters, and group messages to do this.  

      Types of virtual services you can offer today

      While it is important to plan and create internal policies and process as a show of good faith, don’t get too caught up in the planning. Speed is of the essence right now. You will refine your tools and processes over time.

      Telehealth Visits

      By now, most practitioners are familiar with the need to transition as many in-person appointments into telehealth appointments where possible to mitigate the spreading of COVID-19. To encourage the adoption of telehealth, the Office of Civil Rights opened the doors for non-public facing tools like Zoom, Apple Facetime, Facebook Messenger, Google Hangouts to be used during the COVID-19 Pandemic. 

      Soutionreach customers may not know that we can easily support telehealth appointments through the use of pre-visit instructions. We recommend using a secure video tool that allows you to create a single URL for each provider and includes a setting for the provider to grant access to the meeting once they are ready to begin. This is critical for maintaining patient privacy. It is the equivalent to allowing a patient to leave the room before allowing another to enter. Once you have the provider specific URL, simply include it in the pre-visit instructions. You may want to include information such as encouraging the patient to log in 10 minutes early to ensure there are no technical difficulties, remind them to find a private space, encourage headphones for additional privacy, etc. 

      What you need to know:

      • Now available for new and established patientsTelehealth visit
      • Patient geography restrictions have been removed 
      • Qualifying practitioners include physicians, nurse practitioners, physician assistants, nurse midwives, certified nurse anesthetists, clinical psychologists, clinical social workers, other Plan B providers
      • Practitioners may provide telehealth services from their home 
      • Practitioners do not have to be licensed in the state the patient lives in 
      • Restrictions around the number of inpatient telehealth visits have been lifted
      • Eighty-five additional services have been added to the list of approved telehealth services.
      • Cost-sharing for telehealth visits paid by federal healthcare programs may be waived 
      • Use the place of service that would have been used if the patient had been seen face-to-face, not POS code 02. This allows you to receive the non-facility payment rate which can be between 20 and 60% higher than the facility rate. 
      • Use the modifier 95 on the claim to indicate a video telehealth visit. 

      Virtual Check-ins

      Virtual check-ins create an opportunity for providers to get paid to screen patients to determine whether a telehealth or in-person office visit is required or if the patient should just call back in three days. During COVID-19, check-ins may be done over the phone or through a two-way text messaging application. 

      For Solutionreach customers, SR Conversations is our two-way text messaging platform. When using SR Conversations, be sure to use the built-in HIPAA consent tool before communicating PHI so that you can remain HIPAA compliant. Patients simply text a picture to the provider to review and determine if an in-person or telehealth visit is recommended. Office staff (virtual or on location) can use the flagging feature to assign the virtual check-in to the provider to respond to between in-person and telehealth visits. Virtual check-ins are a great way to give patients peace of mind during these stressful times.

      What you need to know: 

      • Visits must be patient-initiated, however practices are allowed to inform patients the service is now available
      • Now available to new and existing patients
      • Duration 5 - 10 minutes
      • Must be provided by a practitioner authorized to perform E&M services
      • Must confirm patient identity (e.g., name, date of birth or other identifying information as needed)Dental telehealth
      • Must be an issue that is not tied to any other issue already reported within the last 7 days
      • Did not result in a subsequent office visit in within 24 hours or the next available appointment
      • HCPCS code G2012 (phone) G2010 (text/image aka store and forward)
      • Place of Service (POS) code 11 (for CMS, other payers may vary)

      Documentation required:

      • Patient consent
      • Details about what occurred during the communication 
      • Document the total amount of time spent in communicating with the patient 
      • Document that the issue being reported was not tied to a face-to-face office visit or procedure that occurred within the last 7 days.
      • Document that a subsequent office visit for this particular issue was not indicated within 24 hours or the next available appointment.

      Online Digital Services or E-visits

      Widen your net with e-visits. Not everyone has access to bandwidth to support telehealth video, but they do have access to the internet for patient portals or secure email. One of the advantages of incorporating e-visits into your services is that providers are able to bill for the amount of accumulated time over a seven-day period. 

      What you need to know: 

      • Initiated by new or established patients
      • Accumulation of time over 7 day period
      • Billable codes only available for physicians
      • Not to be used for:
        • Scheduling appointments
        • Conveying test results

      Telephone Office Visits 

      During COVID-19, it is critical that everyone get the care that they need. To reach those patients who do not have reliable WiFi or internet services, the CMS has recently broadened the level of services practitioners are able to provide over the phone. 

      What you need to know: 

      • New and established patients 
      • Standard documentation applies

      Again, maintaining your service continuity is both critical to your community’s health and keeping your business afloat during and after this storm. We will continue to monitor policy updates and update the blog accordingly. Do remember that actual payment for services during COVID-19 is still untested. Let’s learn as we go together. Please let us know how you are handling billing and coding or share ideas with us on how we can continue to serve you by emailing Hilary Melander, Sr. Product Marketing Manager at  hmelander@solutionreach.com.

      CPCS/CPT Codes

      Type of Service

      Service Summary 

      HCPCS/CPT Code

      Note: Coverage varies by payer

      Telehealth Visits

      Real time, synchronous audio and video telecommunications technology. 

      New and established patients 

      Medical

      CPT 99201-99215 (most common)

      See CMS full list

      Vision

      CPT 99201 - 99205;

      99211 - 99215 

      Modifier: 95

      POS: 11

      Virtual Check-in (phone)  

      Brief (5-10 minutes) check in with physician via telephone or other device to decide whether an office visit or other service is needed


      Qualifications

      • Services rendered by E&M health care practitioner
      • Issue is not related to E&M service provided within the previous 7 days 
      • Does not lead to an E&M service or procedure within the next 24 hours 

      New and established patients

      Medical and Vision

      Code:

      G2010 (audio/phone only)

      POS: 11 

      Modifier: none

      Virtual Check-in (text, images, video) 

      Review of patient recorded video and/or images submitted by an established patient (e.g, store and forward)


      Qualifications

      • Issue may not be related to an E/M service provided within the previous 7 days 
      • Does not lead to an E/M service or procedure within the next 24 hours or soonest available appointment

      New and established patients


      Medical and Vision 

      Code: 

      G2012 $11.91 for 5 - 10 minutes

      (text, images, video)

      POS: 11 

      Modifier: none

      Coverage varies by payer

      E-visits 

      Communication between patient and provider traditionally through a patient portal or secure email. 


      Qualifications

      • Initiated by new or established patients
      • Accumulation of time over 7 day period

      Medical and Vision

      New and established patients 

      Codes

      • 99421  $15.5 for 25-10 min
      • 99422  $31.04 for 11-20 minutes
      • 99423  $50.16 for 21 or more minutes

      Non-physicians service codes will result in $0 payment

      Telephone 

      Communication between patient and provider traditionally through a telephone

      Qualifications: 

      • Initiated more than 7 days after a visit 
      • There is more than 24 hours before a scheduled appointment

      New and established patients

      Medical/Vision

      • 99441 $14.44 for 5-10 minutes of medical discussion
      • 99442 $28.15 for 11-20 minutes of medical discussion
      • 99443 $41.14 for 21-30 minutes of medical discussion

      PAs and NPs will also be paid for their code family 98966-98968 at the same physician allowable.

      POS: 11 

      Modifier: none

       


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      Additional sources:

      The Center of Medicare and & Medicaid Services (2020) Medicare Telemedicine Health Center Care Provider Fact Sheet Retrieved on March 27, 2020.

      The Center of Medicare and & Medicaid Services (2020) Trump Administration Makes Sweeping Regulatory Changes to Help U.S. Healthcare System Address COVID-19 Patient Surge Retrieved on March 30, 2020 

      The Center of Medicare and & Medicaid Services (2020) Non-Emergent, Elective Medical Services, and Treatment Recommendations Retrieved on April 6, 2020

      Hilary Melander

      Hilary Melander

      One of the most empowering moments in her career came from an "ah-ha" or "lightbulb" moment when she realized that creativity is simply problem solving. This realization sparked an enthusiasm deep inside for problem solving and has been the impetus driving her career as a Sr. Product Marketing Manager. Hilary has a Masters in Business Administration from the University of Utah and a Masters degree in Sociology from Brigham Young University. She values community involvement and just completed 4 years as a squad leader on Salt Lake County Sheriff’s Office Search and Rescue team and the Friends of SLC Search and Rescue 501(c)3. She currently serves on the board of the neighborhood HOA.

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