Developing a flow map that allows you to identify roles/responsibilities for each step of a patient encounter will provide your teams standards and expectations.
We have provided a sample of a telehealth visit flow below.
Planning for maintaining telehealth and in person services is a bit difficult since there is not a Centers for Medicare and Medicaid Services (CMS) timeline and we don't know what this will look like post COVID. We do know telehealth services will not be the same in our post world. Looking at expanding visits for out of hospital patients is an option, TCM has been approved as a CMS telehealth services. We recommend establishing a workgroup to focus on the technology challenges, varying reimbursement guidance and back-end denials, etc. ?
Based on continued areas of question or concern the following illustrates what we know now about these areas in telehealth.Visit the CMS Current Emergencies website for up-to-date information. Sign up for CMS’ weekly teleconferences that address frequently asked questions.
CMS issued additional flexibilities for providers and payors. On April 30, CMS revised the blanket waivers and issued a new interim final rule with a comment period. Review MedAxiom's rule summary here. The expansion of practitioners that may furnish services via telehealth continues to provide safety for patients and care teams while offering many needed services for physical, speech and occupational therapies. CMS will provide comparable reimbursement for some telephone only services. This will assist us with patients who do not have access to video services and ramp up our necessary visit volumes. Additionally, programs with provider-based billing or HOPD clinics will be able to bill for the facility portion of there services as the originating site during the PHE.
Telephone codes (99441–99443) are now defined as telehealth services. CMS reimbursement rates for these services were increased to match the reimbursement for 99212-99214 effective March 1, 2020, through the end of the PHE, which is undetermined. This table below outlines updated national facility and non-facility fees and wRVUs. It is important to verify with your state Medicare Carrier (MAC) guidance regarding re-processing claims and payment.
The audio only (telephone) visit codes have parameters that are imperative to operationalizing. Below are the top considerations for coding and billing these services as outlined in AMA CPT® Guidelines.
In addition to coding guidelines for the audio services, documentation remains a key part to supporting the medical necessity of these services during the PHE. For telephone codes 99441-99443, below are some documentation tips to share with providers.
The CMS list of approved telehealth services was also updated to include a status and audio only requirement. The expanded list is available in MedAxiom's Virtual Services Coding Tool.
In the March 2020 rule, CMS released different times for selecting CPT codes for 99201–99215 which caused some confusion. The second interim-final rule released on April 30, 2020, provided clarification to use CPT EM code times. On an interim basis, CMS is allowing these rules to be applied to office/outpatient visits performed via telehealth during the time of the PHE.
For other virtual services including RPM, there have been limited changes to flexibilities. The only change is for reporting RPM services for suspected or confirmed diagnosis of COVID-19. These RPM services during the PHE do not require a 16-day period of monitoring in order to bill.
Over the last few years, CMS has reimbursed for many virtual services. With COVID-19 these services have come to the forefront. The U.S. Food and Drug Administration has provided expanded guidance for remote patient monitoring (RPM). The intent of RPM devices is to digitally connect and support monitoring of symptom progression, etc. AMA CPT and CMS have provided guidance on the billing and coding for these services.
RPM does require clinical documentation to support the ordering, medical necessity and services provided. The following areas are recommended as a best practice to include in the documentation. Education for the clinical teams and providers is important.
CMS recognizes Chronic Care Management (CCM) as a critical component that contributes to better health and care of patients. Across all specialties claims data largely show that these services have been under utilized. This is an opportunity to offer improved care coordination and reimbursement for care team time providing proactive engagement with patients. Several studies have shown that the impact of revenue for providers is $75,000 plus annually and the savings in length of stay, readmissions, etc. Is evident. MedAxiom will continue to explore these initiatives and the opportunities for CV practices post COVID-19.
CCM and PCM have many regulatory and operational impacts. CMS offers guidance for patients and providers: