TeleMedicine/Telehealth COVID UPDATE March 26

New Patient Coding

The American Medical Association released the following yesterday.   “CMS will not enforce a requirement that patients have an established relationship with the physician providing telehealth.”

What this means:

CMS has clarified that they will not enforce the requirement that remote services be reported only for patients with whom the physician has a prior relationship.  Allowing you to provide New Patient visits remotely (99201-99205).  Documentation requirements are the same regardless if the service is provided face to face or remotely.  It is therefore expected that a comprehensive physical examination is unlikely, thus level 4 and 5 codes are not supported for these visits, unless you are billing based on time. Report qualifying encounters with the appropriate E/M code with place of service 02.

Forms typically required for New Patients including release forms, HIPAA policy explanation, and financial policies, can be obtained through patient portals.  In urgent situations, where forms cannot be obtained prior to the encounter and for patients that are established with a practice that have not signed forms acknowledging remote treatment provisions, a verbal consent should be obtained and documented in the patient record.  As not all patients are well versed in the portal or use of the internet, under the relaxation of HIPAA during the crisis, you should be able to use services like DocuSign to acquire patient signatures and other documents normally required when a new patient joins the practice.  It also appears that you would be able to send forms via email and receive a scanned document (encrypted if possible) or returned via picture and secure messaging to the office, use this as a last resort.  There are numerous applications that can be used such as What’s App that allow pictures to be sent in an encrypted format directly from a phone to a computer instead of using mobile phones in the office. 

Co-Payment Updates

The Medicare FAQs for Telemedicine state “Medicare beneficiaries are generally liable for their deductible and coinsurance; however, to reduce the potential financial burden on Medicare beneficiaries,  the HHS Office of Inspector General (OIG) stated that they would provide  flexibility for healthcare providers to reduce or waive cost-sharing for telehealth visits paid by federal healthcare programs.

What this means

You may choose to waive a co-payments for these services, be careful to be consistent when offering this to patients.  One of the circumstances that we see frequently is that the co-payment is seen as a barrier to care, this is a legitimate reason for waiving a patient co-pay for the encounter regardless of other circumstances.  And therefore can be exercised on a patient by patient basis.  The option to waive the co-payment has been announced by the President and may be expected by patients.   You may wish to develop a process for Telemedicine visits such as:

  1. having the front desk speaking with the patient with regard to billing and payment, 
  2. having an MA or nurse assisting the physician to collect relevant history and complaints
  3. having staff make sure that the video and audio connection is of sufficient quality
  4. protocol for the visit with the physician

The first two steps up until the establishment of the connection can be conducted with audio (telephone) only and can be accomplished prior to the visit similar to the flow established for an in-office visit. 

Commercial Payers

Many of you are finding out from payers directly that co-payments and Telemedicine/Telehealth visit coverage is being expanded to meet the new rules put forth by Medicare. 

What this means

We have now seen most of the larger payers open coverage for Telemedicine/Telehealth visit for both new and established E/M visits and are stating they will be paid based at the same level as standard office visits in the office. 

Some payers have gone farther and allow for telephone only encounters to be reported for these services as long as appropriate care is provided. 

PRS Recommendation:  Be careful –  first attempt to provide care using true Telemedicine (audio and visual interaction) and document the reasons that the Video component cannot be used for the visit and why in addition to documenting the care that was provided including the update of Hx and the MDM provided.   

NOT all payers are ready to process claims with Place of Service 02.

Some payers in some parts of the country are asking physicians to hold claims until their systems are ready to process these claims.  This may result in initial clearinghouse rejections of claims.  Check with the payer website for updated information .  As noted, some will request holding claims, others are asking for modifier -95 or -GT and others are asking the you use POS 11 with modifier -GQ -GT or –95. 

More to come as the situation unfolds.

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Mark N. Painter is a managing Partner of PRS Consulting, LLC, the CEO of PRS, LLC and the Vice President of Coding and Reimbursement Information for Physician Reimbursement Systems, Inc. (PRS). Since co-founding PRS in 1989, Mr. Painter has served as the primary coding resource for the PRS products including Hotlines, Coding Manuals and quick reference tools, the Internet based application codingtoday.com and seminars. He has lectured to a variety of groups concerned with health care reimbursement. Mr. Painter's extensive knowledge of physician reimbursement issues has allowed him to assist insurance companies, physicians and their staff members, legal counsel, actuaries, Specialty Societies and consultants on a daily basis. He has serves has an expert to legal counsel, bio device companies and pharmaceuticals. He was a co-chair of the Colorado Clean Claims Task Force, a committee of nationally known industry experts charged with the development of single payment edit database for the state. Mr. Painter is a CPMA. Mr. Painter received his B.A. from Grinnell College at Grinnell, Iowa.