As a child, I never dreamed I would be able to communicate with a person several thousand miles away while looking at their face via video. Now, we can not only communicate via video with our family and friends, we can receive medical treatment from our providers.
Telemedicine is here and being utilized. Though there are some uncertainties regarding if, how, or when private payers are going to cover telemedicine; Medicare and Medicaid programs are utilizing the advances in technology to assist in treating our rural communities.
Medicaid coverage and eligibility varies by state. However, Medicare is clear on their coverage and position. Medicare does consider a telecommunications system to substitute for a face-to-face encounter in specifically allowed situations and areas.
Here is how it works:
The Originating Site is considered to be the location of the Medicare beneficiary at the time the service is being furnished via telecommunications. This site must be located in a rural health professional shortage area (HPSA) or in a county outside of a Metropolitan Statistical Area (MSA).
If you are located in an MSA, remember you can still participate by creating a relationship with a facility that is located outside of an MSA. These locations need qualified specialists to assist with their patients. Many times, patients living in rural communities need specialized care but do not have the means to travel. There are many opportunities for both sides.
The Distant Site is considered to be the location where the practitioner is furnishing and receiving payments for the telehealth service. Eligible practitioners include:
- Nurse practitioners
- Physician assistants
- Nurse midwives
- Clinical nurse specialists
- Clinical psychologists/clinical social workers (cannot bill for CPT 90792, 90833, 90836, and 90838)
- Registered dietitians or nutrition professionals
An interactive audio and video telecommunications system must be used that utilizes real-time communication (exceptions: Alaska and Hawaii).
A few of the services covered by Medicare telehealth include:
- Office or other outpatient visits
- Individual psychotherapy
- Psychiatric diagnostic interview
- Follow-up inpatient telehealth consultations
- Subsequent nursing facility care services, with the limitation of 1 telehealth visit every 3
- Smoking cessation servicers
- End-Stage Renal Disease – related services included in the monthly capitation payment
The distant provider submits the claim utilizing the same CPT/HCPCS codes they would normally with a modifier "GT" which alerts Medicare that it was a service provided via telemedicine (Alaska and Hawaii utilize the modifier "GQ").
The originating site is allowed to bill for the service by utilizing the HCPCS code Q3014. The allowed reimbursement amount is minimal, but the ability to treat patients with a specialist who would not normally be available raises the quality of care level higher than ever before.
If your practice is interested in tapping into the telemedicine market, here are a few things to investigate and consider:
1. Equipment can vary from a few hundred dollars to several hundred thousands of dollars.
- Webcam, computer & Facetime/Skype – this is the most cost effective process. The investment would range between $200 and $500.
- Mobile unit – $20,000 to $50,000
- Room unit – approximately $100,000
2. Internet Connection - The key is being sure you have high speed Internet that will allow you to effectively communicate in a live environment, as well as an appropriate router with security functionalities.
3. Licensure and Credentialing - Providers would need to be credentialed for the facility they are providing services.
4. Medicare requires an 855I & 855R if the provider is located in another state.
5. Other payers vary, so be sure to check before providing services.
States vary on licensures and would need to be investigated.
- Malpractice does vary and should be investigated.
- Policies and procedures should be developed to cover telemedicine processes, along with appropriate forms and consents.
- Staff would need to be trained on all policies, procedures, and best practices.
- Market opportunities with FQHCs, RHCs, hospitals and other providers with needs.
Even though at times the concept is hard to grasp, providers such as radiologists have been utilizing telemedicine for years just not in a live video environment. The sky is the limit to where the advances in technology are going to take the medical field. After all, 10 years ago who would believe we would be utilizing e-mail and the Internet to the magnitude we do today.
Written by Chastity Werner, RHIT