Telemedicine and Telehealth Services 101: Master the Fundamentals

Posted on 15 Dec, 2017 |comments_icon 3|By Elizabeth
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telehealth

Did you know that telemedicine covers more than just the virtual consultation that most people think of when they hear “telehealth?”

Let’s break down telehealth services into four distinct areas:

  1. Real-time online visits – Involves the patient and his or her primary care physician or other healthcare professional interacting via video-conferencing or other real-time telehealth technology
  2. Recorded and saved interactions – Transmission and retrieval of medical or health information (e.g., data, image, sound, video), such as lab results, prescription orders, or an X-ray, from one provider to another for a consultation or interpretation
  3. Mobile reminders and monitoring – Transmit text messages or email reminders and updates from providers and pharmacies to aide with managing the patient’s health; it can also involve the patient providing data, such as a voice recording, or video to providers, to remotely monitor their health status
  4. Long-term observation via telehealth tools – Medical devices in the patient’s home that capture data (e.g., weight, blood pressure, blood oxygen levels, heart rate, or glucose level) and then transmit the information to a provider via the Internet

What technology delivers telehealth services? Let’s look at basic descriptions of telemedicine and telehealth technological connections providers use to deliver these services:

  1. Synchronous telehealth – Refers to the real-time virtual delivery of telemedicine using audio and video technologies to perform the visit.
  2. Store-and-Forward (SFT) data collection – A telecommunications tool that allows the physician to share data and the recorded visit with other providers, usually a specialist, who may be needed to help diagnose the patient. This could include providing a second opinion on a set of images to diagnosis a disease.

Important: Asynchronous SFT technology is only permissible for Medicare in federal telemedicine demonstration programs in Alaska and/or Hawaii.

  1. Remote Patient Monitoring (RPM) – Monitoring patients with chronic conditions so that the provider checks in with the patient periodically and remotely observes changes in his health using monitoring equipment.
  2. Mobile Health (mHealth) – Smartphone apps designed to foster health and well-being, ranging from programs which send targeted text messages aimed at encouraging healthy behaviors, to alerts about disease outbreaks, to programs or apps that remind patients to adhere to specific care regimens; smartphones may use cameras, microphones, or other sensors or transducers to capture vital signs for input to apps and bridging into RPM.

What specialties use telemedicine/telehealth? Let’s review some examples:

  • Psychiatric diagnostic evaluation
  • Psychoanalysis
  • End-stage renal disease (ESRD) related services
  • Medical nutrition therapy (MNT)
  • New or established outpatient office visits
  • Subsequent hospital care
  • Smoking and tobacco use cessation counseling
  • Advance care planning
  • Diabetes outpatient self-management training services
  • Alcohol and/or substance abuse structured assessment
  • Annual depression screening

Who Can Provide Telehealth Services?

Is there a limit to who can use telehealth services? The short answer is no. Only the following providers, though, can receive reimbursement for delivering care using telehealth technology:

  • Physicians
  • Nurse practitioners (NPs)
  • Physician assistants (PAs)
  • Certified nurse midwives (CNMs)
  • Clinical nurse specialists (CNSs)
  • Certified registered nurse anesthetists (CRNAs)
  • Clinical psychologists (CPs) and clinical social workers (CSWs). CPs and CSWs cannot bill for psychiatric diagnostic interview examinations with medical services or medical evaluation and management services under Medicare. These practitioners may not bill or receive payment for Current Procedural Terminology (CPT®) codes 90792, 90833, 90836, and 90838.
  • Registered dieticians (RDs)
  • Nutritionist

Nail Down Where Telehealth Services Can Take Place

Where can you render telehealth services? Telehealth services can take place in several different locations. An originating site is the location of the facility where the patient is located at the time the service is provided via a telecommunications system. Medicare beneficiaries, for example, are eligible for telehealth services only if they are from an originating site located in:

  1. A county outside of a Metropolitan Statistical Area (MSA)
  2. A rural Health Professional Shortage Area (HPSA) located in a rural census tract

The Health Resources and Services Administration (HRSA) determine HPSAs, and the Census Bureau determines MSAs. You can access HRSA’s Medicare Telehealth Payment Eligibility Analyzer to verify a potential originating site’s eligibility for Medicare telehealth payment at https://datawarehouse.hrsa.gov.

Note: Each calendar year, the geographic eligibility of an originating site is established based on the status of the area as of December 31st of the prior calendar year. This eligibility continues for the full calendar year.

Originating sites authorized by law to deliver telehealth services include:

  • The offices of physicians or practitioners
  • Acute care hospitals
  • Critical Access Hospitals (CAHs)
  • Rural Health Clinics Federally Qualified Health Centers (RHCs-FQHCs)
  • Hospital-based or CAH-based Renal Dialysis Centers (including satellites)
  • Skilled Nursing Facilities (SNFs)
  • Community Mental Health Centers (CMHCs)

Caution: Independent renal dialysis facilities are not eligible as telehealth delivery sites.

Have You Tapped into the Benefits of Telemedicine & Telehealth

What are you waiting for? Here are a few reasons why you should seize this opportunity.

Accessibility and Convenience. Telehealth makes access to healthcare far easier for the homebound and elderly patient. Telehealth also provides a portal to services and healthcare professionals if patients are in a rural area and would not be able to access these services without telehealth.

Affordability and Time Saving. Telehealth saves both you and your patient time and money. By addressing a patient’s concern remotely, your physician is saving the patient travel costs and the time it would take to drive to his appointment. As the provider, you are also saving the expenses that go along with the cost to provide care, including costs for the physician to provide that care on-site, and associated operational costs. Long-term healthcare cost savings also result when patients receive reminders to take prescribed medications, which helps alleviate further medical problems from noncompliance.

Consultations with Specialists Across the Country. When a diagnosis is rare or difficult to treat, telehealth can help tremendously, by connecting patients with specialists from all over the country (and worldwide) without the need to travel directly to the specialist. Furthermore, facilities can also save money by sharing the services of a specialist, such as a radiologist.

Improvement in Patient Interactions. Your patients expect a personalized experience from their physicians more now than ever. Through telehealth, they can have direct access to your physicians on an as-needed basis, making them feel empowered and in charge of their health. Not unlike house calls of the past, telehealth technology is bridging the gap between the provider and the patient in many new and innovative ways.

Increased Quality of Care. The quality of a patient’s care greatly increases when the proper follow-up is maintained. Your physicians or office staff can monitor patients with a variety of devices. They can also check in with patients periodically to make sure they are following their treatment plans, ultimately leading to better long-range health outcomes.

Learn More

If you’re not optimizing your telemedicine options, let us put you on the path to ethical reimbursement with The Telemedicine & Telehealth Handbook for Medical Practices. This indispensable resource covers billing, coding, denials, and everything between. Capitalize on advice and guidance regarding new telehealth options from CMS, POS codes, how to ace your E/M telemedicine services, when to use modifier 95 to capture synchronous telemedicine services, and so much more!

Author

Elizabeth


Elizabeth works on an array of projects at TCI, researching and writing about modern reimbursement challenges. Since joining TCI in 2017, she has also covered the nuts and bolts of cybersecurity, compliance with federal laws, and how to tap into the advantages of telehealth services.

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