The COVID19 pandemic quickly—and fundamentally—altered how patients are seen in a medical practice. “Seen” is the operative term here, as physician-patient encounters have steadily moved to a non-face-to-face platform. Although many refer to the new method of treating patients in an ambulatory setting as “telemedicine,” the phrase conveys a specific category of services. Telemedicine is just one method of delivering services without the patient’s physical presence. Let’s review the services available for you to manage patients during the pandemic—and how to best schedule them:
CMS announced coverage of telephone calls (CPT codes 99441-3; 98966-8), retroactive back to March 1. eVisits (CPT codes 99421-3 and G2061-3) are useful for patient communications that don’t involve an encounter. G2012—known as the virtual check-in code—can be valuable for touching base with patients, noting that the time threshold is only five minutes of “medical discussion,” at minimum.
Several CPT codes are available for remote patient monitoring, to include the initial set-up and education (99453), and the 30-day monitoring (99454). 99457 represents the treatment, with 99458 available to bill on a unit basis if the treatment time exceeds 20 minutes. The consent for these digital services can be performed once per annum, and, according to the feds, “may be obtained at the same time that a service is furnished”—at least for now.
True telemedicine has—and still is—provided remuneration for many non-face-to-face services. The problem with telemedicine is that, historically, the patient had to be in a rural area experiencing a healthcare professional shortage. This feature has been waived for now, but the federal government continues to define the communication platform required in order to bill for services. According to the Centers for Medicare & Medicaid Services, it “…includes, at a minimum, audio and video equipment permitting two-way, real-time interactive communication.” A bit of good news; the federal government stepped in to announce that readily available tools like Facetime and Skype count.
For the time being, the feds are waiving HIPAA Privacy regulations as well as allowing both new and established patients to receive these services. Although a lot has changed, there’s no reason to fundamentally alter how you schedule patients. When a patient calls, inform the patient that you can schedule an appointment for them, noting that it will be from the comfort of their home (or wherever they are). Register them as you have done in the past, double checking insurance and verifying eligibility. Although this isn’t required, consider enrolling patients in your portal. This will allow you to communicate more efficiently during the crisis. Other questions to inquire of the patient: Do you have video capability on your phone or computer? Do you have sufficient WiFi to support a remote encounter? Do you have a complaint that can be assessed via a remote encounter? If applicable, request the patient’s email address to subsequently send them the details for logging in for their visit. Of course, be sure to locate an appointment that works for the patient—and provide the details of the date, time and how to log in. Although it pays to look at your reimbursement, in most cases, the best financial situation is to render and bill a telemedicine service so it’s ideal for your staff to have this lined up before the appointment itself.
The federal government is temporarily allowing physicians to waive the normal cost-sharing for Medicare patients, but it’s important to check with payers about their policies. Some differ based on the diagnosis; that is, whether it’s related to COVID-19. Many practices are simply waiting until they get the remittance; however, you may want to research this and perform copayment collections into your workflow particularly if you plan to extend these services into the future.
Much has changed in the past few weeks, but experts are saying that performing services remotely may be here to stay.
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