Making the Most of Video Patient Visits
Whereas some doctors have become enthusiastic about video patient visits (often referred to as "telemedicine"), others prefer to avoid it.
Many practices want to implement office visits via telemedicine, yet the stumbling block is nonpayment by Medicare and commercial payers. Although these new services aren't the equivalent of an office visit using telemedicine, they are a start to payment for more non–face-to-face care.
In fact, there are existing and new codes that allow for three new ways that physicians can get paid for telehealth services, including:
Medicare-covered, traditional telemedicine available to patients in underserved areas;
New brief virtual check-in codes, which includes phone calls and payment to review images sent by the patient; and
New codes for remote monitoring and management of physiologic data, not requiring a face-to-face service.
On the one hand, practices have the technology needed to perform telehealth and the desire of physicians to provide—and patients to receive—services using telehealth. But reimbursement has lagged.
However, the Centers for Medicare & Medicaid Services (CMS) recently unveiled two new Healthcare Common Procedure Coding System (HCPCS) codes for non–face-to-face services and new remote monitoring Current Procedural Terminology (CPT) codes. All of these head in the right direction, even if the pace of change is slow.
Primary care practices that are already providing and billing for care management services could begin providing remote monitoring, once the technology is set up. And cardiology practices can partner with the company that provides other cardiac monitoring services for them, in implementing remote monitoring.
Here's what physicians need to know to get started with video visits or add on to their current services. But first, let's review traditional Medicare-covered telehealth services.
Medicare-Covered Telehealth Services
Medicare covers many evaluation and management (E/M) services via telehealth. The catch is that these services are only provided to patients in an underserved area by medical practitioners who are remote from the patient. Medicare does not cover telehealth for routine care provided by the patient's own physician.
For example, a patient in a rural area needs a neurology consult, but the nearest neurologist is a 3-hour drive from the patient's home. The patient presents at the local hospital, and is connected to the neurologist using real-time audio and video. The hospital, the originating site, is paid a small fee for providing the space and the equipment. The neurologist bills for the new patient visit.
An underserved area is defined as a rural Health Professional Shortage Area (HPSA) located either outside of a Metropolitan Statistical Area (MSA) or in a rural census tract or in a county outside of an MSA. Practices can download the list of HPSA-designated areas through the CMS website and MSA areas via the US Health Resources & Services Administration.
The patient must be in the underserved area at the originating site. The distant-site physician or practitioner who provides the service via a telecommunication system bills for the service performed. There are a limited number of services that may be provided in this way, and they are listed in CMS's telehealth fact sheet and indicated in the CPT book by a star symbol. Use place of service 02 and modifier 95 for telehealth services.
There are some insurance plans that offer telehealth to its members. This typically allows a patient to have a telehealth visit with a physician or other practitioner who is contracted with the health plan, not with the patient's own physician.
Neither of these—Medicare's telehealth services, nor the contracted telehealth service provided by an insurance plan—meets the needs of a physician who wants to provide, and a patient who wants to receive, telehealth services that would replace an ordinary patient care exam or office visit.
In fact, Medicare states they do not have the statutory authority to pay for telehealth services that do not originate in an underserved area provided by a distant site practitioner. There are two CPT codes that describe online medical evaluation. 99444 is for services provided online by physicians, and 98969 is for online services provided by nurse practitioners (NPs) and physician assistants (PAs). Both have noncovered status in the Medicare Physician Fee Schedule, and neither is assigned relative value units (RVUs). A group could use these and bill the patient for the service, but Medicare and most private payers will not reimburse them.
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Cite this: Betsy Nicoletti. More Income for You, as New Codes Cover Video Patient Visits, Virtual Check-in, Remote Monitoring - Medscape - Feb 18, 2019.