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Telemedicine: Embracing the New Normal and Getting Paid for It

Posted on Jul 08, 2020 by Elizabeth W. Woodcock, MBA, FACMPE, CPC

    As the pandemic extends, the reality of this new normal is rapidly setting in. Between the fact that many Americans are anxious about entering a medical facility and younger generations hate waiting for an appointment, we may never return to the traditional face-to-face office schedule. You stood up your telemedicine infrastructure in a matter of days, but it’s time to start planning for a long-term integration of remote care into your practice. The question is: how do you get started?

    Discover your best workflow
    If your front office has never functioned effectively for you or your patients, it is an opportune time to get rid of it altogether. Deploy a pre-visit workflow for registration and consents with electronic signatures, with patients “signing in” from their cars. Keep your schedulers, who play an essential role in making sure that your templates are balanced between your in-person and remote visits. Train your medical assistants to “room” patients virtually. To get it right, conduct a role-play with someone on your team acting as the patient, another the scheduler, and so forth. Some of your team may have departed during the pandemic; that’s not always a bad thing. There may be opportunities to use the crisis to gain better talent. The “silos” that each of your functional areas had before the pandemic—nursing, billing, etc.,—simply must come down.

    Where have all my patients gone?
    Volumes dipped to near zero soon after the public health emergency was declared, but encounters are again on the rise with many practices reporting volumes just short of the pre-COVID era. Take three steps to make sure your curve is going the right direction:

    (1) Reach out to your patients proactively, and tell them you’re seeing patients (how else will they know?); you’re ready, you’re safe—and you’re open!

    (2) Give staff scripts on how telemedicine works and the safety measures your office is taking, if applicable; check out this link for great suggestions for scripts.

    (3) Pull records from the appointments that were cancelled by you or your patients during the pandemic, incoming referrals that couldn’t be processed at the time, or patients who may have missed preventive services. Proactively reach out to those patients and ask them to reschedule.

    Get paid for your hard work
    The coding and reimbursement rules for telemedicine are confusing. For Medicare, check out this list for services that can be rendered by telemedicine and still be paid at the full, in-person rate. Use the place of service that you would normally have used—a -11, for example, for a doctor’s office—and append a -95 modifier to signal the telemedicine. Other payers vary in their rule, with some requiring a different place of service code (-02) and/or modifier (-GT). Have your staff create a grid of the rules, and ask them to look for the end date. Some of the payers have already announced that coding and reimbursement rules will revert to pre-COVID days when the federal government ends the public health emergency. Others—like Tennessee Blue Cross Blue Shield—have declared their intention to maintain coverage in perpetuity. The bottom line—the medley of rules related to coding for telemedicine visits isn’t going away.

    Look for other opportunities
    It’s easy to get frustrated, but the declaration of the public health emergency ushered in a new era of relaxed rules. It’s doubtful that they’ll all be reversed. For example, the federal government agreed to allow physicians to work from home without re-enrolling in Medicare; and physicians can now work across states lines. Sequestration, that lousy two percent cut you had taken from every Medicare payment, is suspended until the end of 2020. Although there are no guarantees, it will be incredibly challenging for the feds to roll back all these changes. Other physicians are finding opportunities in remote services—like eVisits, virtual visits, and remote patient monitoring. These codes were in place pre-COVID, but were rarely used. Now, the feds are even encouraging physicians to use them.

    Experts agree that COVID won’t be eradicated in the near-term. Take the opportunity now to consider how you’d like your practice to operate under this new normal—let the construction begin!

    For more tips on how to successfully implement telemedicine in your organization, download this complete guide.

    Elizabeth W. Woodcock, MBA, FACMPE, CPC

    Elizabeth W. Woodcock, MBA, FACMPE, CPC

    Elizabeth Woodcock, MBA, FACMPE, CPC is the principal of Woodcock & Associates and the founder of the Patient Access Collaborative. This organization includes 85 of the nation’s most prominent academic medical centers and children’s hospitals, focused solely on patient access in the ambulatory enterprise. She is the author of Mastering Patient Flow, and co-author of The Physician Billing Process: Navigating Potholes on the Road to Getting Paid, both industry best-sellers. She is widely considered an industry leader in medical practice operations and revenue cycle management. She is frequently published and quoted in national publications including MGMA Connection and Medical Economics. She has focused on medical practice operations and revenue cycle management for more than 25 years and has led educational sessions for the American Medical Association, Healthcare Financial Management Association, and the Medical Group Management Association. She is a Fellow in the American College of Medical Practice Executives and a Certified Professional Coder. In addition to a BA from Duke University, she completed a MBA degree in healthcare management from The Wharton School of Business of the University of Pennsylvania.

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