Webinar On Telemedicine health in 2018 coding

1. Telemedicine Health for 2018 ONLINE AUDIO TRAINING Terry Fletcher Consulting, Inc. By: Terry Fletcher CPC, CCC, CMC, CMSCS, CMCS, CCS-P, CCS, CEMC, ACS-CA, SCP-CA www.onlineaudiotraining.com

2. Question & AnswerFormat Due to Telemedicine and Telehealth services being in the formative stages, information is very new and specific. Many payers have not even begun to address this topic for reimbursement. Based on this, and our commitment to provide accurate information and maintain the integrity of the Webinar format, we will not be fielding live questions after or during the Webinar, but will allow attendees to email one question to the Webinar Instructor and collectively these questions will be researched and responded to as an FAQ’s for Telemedicine Health by December 1st. You can find these responses at http://www.terryfletcher.net on our Blog page. 2

3. 2017 E/M and Miscellaneous services update for Telemedicine (2018) Physician practices should note several changes to E/M codes, which includes a new “star” symbol added to CPT to designate possible “Synchronous Telemedicine Health” code inclusions, and several revised code descriptor sections. Appendix P 2017 CPT Professional Edition (p.797) and pay close attention to modifier -95. Plush Care VIP Care Telehealth eVisit • • • • 3

4. What is Telemedicine?  “Telehealth” - telehealth is the use of medical information exchanged from one site to another via electronic communications to improve a patient’s health status. Telehealth includes a growing variety of applications and services using two- way video, email, smart phones, wireless tools and other forms of telecommunications technology. Telehealth is not a separate medical specialty. It is a delivery tool or system. Closely associated with Telehealth is the term “Telemedicine," which may be used interchangeably with Telehealth, but is sometimes used to encompass a broader definition of health care that uses telecommunications technologies. Videoconferencing, transmission of still images and other data, e-health including patient portals, m-health, remote monitoring, continuing medical education, and medical call centers, are all considered part of telemedicine   and telehealth. 4

5. What is Telemedicine? – AMAPosition A recent news release from AMA regarding the use of Telemedicine states, “Telehealth and Telemedicine are another stage in the ongoing evolution in new models for the delivery of care and patient-physician interactions.” AMA Board member Jack Resnick MD also added, “The new AMA ethical guidance notes, that while new technologies and new models of care will continue to emerge, physicians’ fundamental and ethical responsibilities do not change.” Because physicians and practices are using Telemedicine more commonly as technology advances, many regulators are pushing for tighter telemedicineguidelines. 5

6. Telemedicine Objectives: Should you engage? Advancement in technology has improved healthcare in ways you may have never imagined. Telemedicine and Telehealth, allow you, as a provider, to virtually interact with your patients, In a way that can improve quality and delivery of care you furnish, especially for those patients that are unable to come into your office for a face-to-face encounter. The convenience and instant feedback your patients’ receive are among the driving factors Behind this rapidly growing branch of medicine. Telemedicine involves the remote diagnoses and treatment of patients using telecommunications technology- most often via a secure, HIPAA-compliant video conference or other means. To take an informal or unprepared approach to telemedicine using SMS messaging (texting), Skype or FaceTime, or other consumer technologies can result in low patient adoption, frustration for staff, potential HIPAA violations, and limited, if any reimbursement. Adopting telemedicine in a healthcare practice requires planning, training, and partnering with a technology provider that can offer the right level of expertise and support to ensure success. 6

7. Telemedicine Requirements & Defining Organizational Goals.(A) Physician practices do face challenges when it comes to telemedicine, which is why many providers have hesitated to move forward. Different states have different requirements when it comes to reimbursing providers telemedicine visits, and not every commercial insurance plan clearly outlines how to bill for these encounters. Despite these challenges, physician practices and other providers can benefit greatly from telemedicine strategy if executed appropriately. Technology shouldn’t be deployed for its own sake-it should solve specific problems and/or needs in a practice in a way that can’t be otherwise addressed through more effective means. A practice considering the telemedicine strategy should first define why they are considering the technology and what they hope to accomplish? It is also critical to define clear goals. Identify the issues you want to address, map out how Telemedicine, in your practice, can help to alleviate those pain points, and define how you will measure success against those goals. 7

8. Telemedicine Requirements & Defining Organizational Goals.(B) While organizational goals will vary based on specialty, size and type of practice, and geographical location, below is a list to common practice goals to get you started that can be achieved via telemedicine:  Improve accessibility  Improve outcomes and care plan compliance  Reduce hospital readmissions  Improve patient satisfaction scores  Attract new patients  Improve patient loyalty  Increaserevenues Once your goals are outlined, you will need to ensure that the practice is able to support a telemedicine adoption with access to desktop computers, laptops, mobile smart phones and tablets with reliable web cameras. There also needs to be reliable high speed internet connection available to ensure video calls with patients can be completed without delays, latency, or other problems that could make the experience unpleasant. 8

9. Telemedicine Requirements & Defining Organizational Goals.(C)  Organizations and health professionals providing telehealth services, shall ensure compliance with relevant local, state and federal (or international if appropriate) legislation, regulations, accreditation and ethical requirements for supporting patient/client decision-making and consent, including the protection of PHI. Organizations should have a mechanism in place for ensuring that patients and health professionals are aware of their rights and responsibilities with respect to accessing and providing healthcare via telehealth technologies (whether within a healthcare institution or other environment such as the patient’s home, school or work), including the process for communicatingcomplaints. Organizations providing Telehealth and Telemedicine service shall respect patients requests for in-person care whenever feasible. Always remember, that while Telehealth visits are convenient to the provider and the patient, there is still a concern that nothing compares to an in-person visit to assess the patient’s overall health. You should view telehealth monitoring and visits as a supplement to in-person visits and not a replacement for them.    9

10. Fundamentals of Telemedicine and Telehealth services and the technology connection providers that provide this service. 1.Synchronous Telehealth: Refers to the real-time delivery of telemedicine using audio and video technologies to perform thevisit. 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 a patient. (e.g. second opinion). 1.Real-Time online visits: Involves the patient and his or her own primary care physician or specialty physician or other healthcare professional interacting via video conferencing or other real-time telehealthtechnology. 2.Recorded and saved Interactions: Transmission and retrieval of medical and/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 in 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 healthstatus. 4.Long-term observation via Telehealth tools: Medical devices in the patient’s home that capture data, (e.g. weight, blood pressure, heart monitors, etc.), and then transmits the information to the provider via the internet. Asynchronous (SFT) technology is only permissible for Medicare in federal telemedicine demonstration programs in Alaska andHawaii. 3.Mobile Health (mHealth): Smart phone Apps designed to foster health and well-being, ranging from programs that send targeted text messages, aimed at encouraging healthy behaviors, to alerts about disease outbreaks, apps to help patients to adhere to specific regimens, Smart phones may use technology or other sensors to capture vital signs bridging the gap to RPM. 4.Remote Patient Monitoring (RPM): Monitoring patients with chronic conditions so that the provider checks in with the patient periodically and remotely observes changes in health status, using monitoringequipment.