Archive for April, 2020

UNDERSTANDING TELEHEALTH TODAY

Posted by Samantha Serfass on April 24, 2020 in Blog, News

CMS has broadened access to coverage and payment of all telehealth services due to the COVID-19 Health Emergency.  On March 30, 2020 CMS published the 1135 IFR (Interim Final Rule) Waiver stating Medicare will reimburse for office, hospital, and other visits furnished by telehealth across the country.  The IFR is retroactive to date of service 3/1/2020 on a temporary and emergency basis for the duration of the public health emergency. 

Prior to this waiver, Medicare would only pay for telehealth on a limited basis.  The most notable exception put into place is that patients no longer must travel to a designated facility in order to initiate telehealth services; these services can now be provided from a patient’s home.  Various common communication technologies can be used in good faith, such as FaceTime or Skype for the duration of the emergency.  The HHS Office for Civil Rights (OCR) will waive penalties for HIPAA violations against health care providers serving patients I good faith through these technologies.  However, communication platforms that are not private (i.e., Facebook Live, TikTok, Twitch) are still considered to be HIPAA violations.

Telemedicine visits are defined as real-time, interactive audio, and video communication between the patient and the provider.  Previously, telemedicine visits were only approved for established patients but that requirement has been relaxed and can now include Evaluation and Management services (common office visits) for new patients also. Evaluation and Management levels may be selected based on Total Time spent or MDM.  They can also perform mental health counseling and preventative screenings.  A complete list of services that qualify for telemedicine is located here.

Virtual check-ins are allowable.  These are defined as brief communication technology-based services and can be conducted with a broader range of communication methods including synchronous discussion over a telephone or exchange of information through video or image.  Virtual check-ins can be provided to both new and established patients, and the appropriate HCPCS codes are G2010 or G2012.

E-Visits are generally done through an online patient portal and is considered a non-face to face encounter that is initiated by the patient and may span over a 7-day period. Total time spent must be accurately documented. Codes for these services are 99421-99423 for physician or mid-level provider and HCPCS G2061-G2063 for Qualified Non-physician Healthcare Professional (Clinical Psychologists, Physical, Occupational, and Speech Therapists).

Telephone Visits must be initiated by the patient and cannot be related to an E/M service provided in the previous 7 days nor leading to an E/M service or procedure within the next 24 hours.  Documentation should reflect total time spent.  Report CPT codes 99441-99443.

As time progresses, there may be additional advice given or changes made to the guidelines.  Because they were initiated fairly quickly, it should be viewed as a “work in progress”.  Therefore, everyone should continue to monitor for subsequent changes as they are published.

Robyn McCoart, RHIT

Managing Auditor, Excite Health Partners

A PARTNER FOR YOUR TELEHEALTH NEEDS

Posted by Samantha Serfass on April 20, 2020 in Blog, News

A PARTNER FOR YOUR TELEHEALTH NEEDS

As telehealth continues to make significant strides during today’s pandemic, Excite Health Partners has the resources and experience to help healthcare organizations identify their telehealth needs. 

Our telehealth solution, SnapMD, was developed by an ER physician and endorsed by the American Academy of Pediatrics. SnapMD is a secure HIPAA compliant enterprise wide telehealth solution with a rich feature set, ready to be fully integrated with your health system’s EHR.

CMS has implemented new rules and guidelines which impact the use of telehealth for hospital systems to better respond to the COVID-19 pandemic. Below are the are three major acts approved by congress.

  • CMS-1744-IFC (Applicability date of March 1, 2020)
    • CMS 1135 Blanket Waiver for Providers (Effective Date March 1, 2020)
    • Blanket Waiver of Section 1877(g) of the Soc. Sec. Act.  (Effective Date March 1, 2020)

Although variance can occur state-by-state, these new telehealth rules and guidelines, set forth by CMS, provide flexibility within the overall health systems and specialty practices. This allows a broad range to provide services using remote communication and permits licensed practitioners to order home health services outside of the hospital.   

CMS has defined interactive telecommunication systems as equipment that can, at minimum, transmit both audio and visual displays to allow for a real time two-way interactive discussion. The HHS has waved penalties for HIPAA violations during this time to encourage telehealth communication. Platforms such as FaceTime and Skype are now accepted as appropriate applications.  

The recent CARES (Coronavirus Aid, Relief and Economic Security) Act, includes funding for the support of telehealth solutions, like Snap MD.  The Office of Inspector General (OIG) is also waiving any costs sharing obligations that federal health care program beneficiaries may owe for telehealth.  This also allows for hospitals to cover the cost of telehealth systems for affiliated physicians and to include remote patient monitoring.

Telehealth systems are now being permitted to communicate and treat both new and established patients while also allowing various types of practitioners to bill for services (social workers, psychologists, physical/occupational therapists, language pathologists, etc.) 

SnapMD’ s platform allows for up to 6 different individuals to join in a virtual meeting space. From patient and family members to supervising physicians, through SnapMD multiple participants can weigh in on the visit to help provide the best service from home.  

As healthcare systems continue to adapt during these unprecedented times, Excite Health Partners can help ease the burden of implementing the best telehealth solutions to meet your organization’s needs while driving revenue.

Todd Klein, CIO, VP of EHR Services & Digital Solutions

PUBLIC HEALTH EMERGENCY RESPONSE: IDENTIFYING ORGANIZATIONAL AND SPECIALTY STRATEGIES

Posted by Samantha Serfass on April 8, 2020 in Blog, News

PUBLIC HEALTH EMERGENCY RESPONSE: IDENTIFYING ORGANIZATIONAL AND SPECIALTY STRATEGIES

With the growing number of COVID-19 cases arise across the nation, analytics can prove to be a vital element in helping to track the pandemic.

By leveraging data, we can monitor the COVID-19 virus using Early Detection and Rapid Response Outreach programs.  These programs operate to:

  1. Decrease costs while still generating revenue 
  2. Oversee and manage patient flow
  3. Track and manage hospital resources

Data analytics also allow us to identify potential at-risk patients and target demographics. According to the CDC, at-risk patients include:

  1. Older adults, particularly those over 65
  2. People with asthma or other chronic lung diseases
  3. Groups who are at higher risk for severe illness, such as people who are diabetic or immunocompromised
  4. People with HIV

Effective as March 1st, 2020, the CMS has created guidelines for health systems to use Telehealth solutions to assist, track and monitor these at-risk patients and receive reimbursement later. These services typically provided in-person are allowed to use Telehealth –many are still using codes that describe “face to face” services. This helps health systems in various ways. First, by using Telehealth solutions, providers are able to quickly and efficiently provide care. Second, it helps to expand care to new services which helps the population respond better to the virus. Lastly, it helps generate revenue.

An Emergency Response Plan starts by identifying the correct patient populations for specific services to be offered to. To meet the immediate needs, Data warehouses and marts can also be established rapidly. Utilizing an agile approach and integrations tools – such as FHIR – databases can be set up in days/weeks rather than months.

Call center staff can leverage patient data to identify patients who need medication refills but are in the at-risk populations, allowing for medication to be delivered to homes.

Different services lines or specialties can respond to the pandemic in different ways.   Mental and Behavioral Health can reach out to patients to schedule their (now) virtual Telehealth session, or the call center can identify patients that weren’t using the service before.

Diabetes is one of the underlining conditions that increase a patient’s risk for the virus. CMS 1744 allows the Medicare Diabetes Prevention Program (MDPP) to extend allowing beneficiaries to obtain MDPP services more than once per lifetime. This provides patients with virtual educational sessions.  It’s also important for the call center to look for diabetes patients who aren’t performing well and see if they need medication, would like to schedule a virtual visit with their endocrinologists (or psychiatrist) and/or offer them additional virtual educational sessions.  

Every hospital needs to make changes rapidly across the organization, such as expanding beds, increase supplies, setup new triage workflows, etc.  However, each specialty should have a strategy to continue to provide patient care while maintaining revenue and decreasing the impact of COVID-19. 

Excite Health Partners can help. We can help health organizations identify proper COVID-19 pandemic preparation and address additional operational support needed to help patient populations during emergencies. For more information on implementing an Emergency Response Plan, check out our webinar on Emergency Response Management Planning.

Todd Klein, CIO, VP of EHR Services & Digital Solutions