Telemedicine in the time of COVID-19: The Rules Are Changing

It seems like yesterday that tech enthusiasts were complaining that too few physicians were embracing telemedicine, and doctors who did use telemedicine were complaining about how hard it was to get paid for it. That’s just one more thing coronavirus changed in an instant. According to a recent survey by the physician recruiting firm Merritt Hawkins, almost half of all physicians are now treating patients via telemedicine. That’s up from 18 percent in 2018. Meanwhile, CMS is relaxing the rules about what they will pay for. 

If you’re new to practicing virtually, here are some tips for making telemedicine work for you-and getting paid for it. 

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Pick Your Platform

The first decision you face once you’ve decided to practice telemedicine is which platform to use. And as it has done with almost every other aspect of life, the coronavirus has changed this, too. The Office for Civil Rights has relaxed some of the HIPAA requirements for telehealth. However, that doesn’t mean anything goes. “CMS is still guarded about platforms to use,” says Veronica Bradley, CPC, CPMA, Senior Industry Advisor with the Medical Group Management Association (MGMA). “You can use Facetime and Facebook Messenger, but you can’t use Tik Tok or Facebook Live. Basically any kind of public facing program is not OK.”

Other aspects of HIPAA regulations remain in place. “Even though the use of non-HIPAA compliant platforms has been loosened, HIPAA rules should be followed as closely as possible,” advises Carol Self, coding and compliance strategist with the American Academy of Family Physicians (AAFP). “Medical conversations should take place in a private space, and communication should be patient authorized and patient initiated.” 

It’s also important to keep in mind that these relaxed guidelines are temporary. “You’ll need to use a service that’s HIPAA compliant once the public emergency is over,” says Bradley.

The AAFP does not recommend or endorse any particular platform, but products their members use include doxy.me, eVisit, SimpleVisit, VSee, MEND, and Spruce Health. Both Zoom and Google now have health care platforms as well. The AAFP suggests helpful features to look for when choosing a telemedicine vendor are out-of-office messaging, the ability to schedule appointments, and the ability to queue up patients. Bradley also recommends choosing a platform that can be integrated with your electronic health records system. 

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Code it Carefully

Once you’re up and running with a telemedicine platform, whether it’s an ad hoc solution or something more permanent, you need to make sure you get paid for these visits. Fortunately, CMS is also loosening restrictions about how much they will pay and what they will pay for. “Medicare previously paid telehealth services at parity, but it was at the lower facility rate,” says Self. “As part of the flexibilities granted during the public health emergency, Medicare will pay telehealth visits at parity using the non-facility rate.”

In addition, CMS is not enforcing the established relationship rule, and services can be provided to Medicare beneficiaries by phone (even without video capability) during this time. 

But in order to get paid at all, you must be sure to use the proper codes. “If you don’t bill with the correct POS [Place of Service], you may not be paid at the same rate as a face-to-face visit,” says Brennan Cantrell, Commercial Insurance Strategist with the AAFP.  The codes for these services are typically evaluation and management codes, along with a Place of Service code and any necessary modifiers. 

Getting the codes right is equally important with private payers. “If you use a CPT code a payer doesn’t recognize, you’ll get a denial,” says Cantrell. Despite recent changes, billing for telehealth isn’t that much trickier than billing for any other service as long as you pay attention. “The only likely hiccups,” says Andrew Hajde, CMPE, Assistant Director of Association Content, MGMA, “would be not using the proper modifier or service code and confusing telephone with video visits. Both are allowed now, but they have two different codes.” 

Private payers are generally falling in line with CMS, but there are some variations. The MGMA has a site with links to the major payers’ coronavirus billing policies. You can also check the website America’s Health Insurance Plans, an industry trade group, for policies of specific insurers. If your payers aren’t included on these sites, be sure to contact them directly, and stay on top of emails from payers with policy updates. Things are changing quickly these days. 

Coronavirus has pushed the medical community over the cliff into telemedicine, but the fall is not that steep, and CMS is helping to make it a soft landing. 

References:

Telemedicine survey:
https://www.merritthawkins.com/news-and-insights/media-room/press/-Physician-Practice-Patterns-Changing-as-a-Result-of-COVID-19/

OCR statement re: HIPAA regulations:
https://www.hhs.gov/hipaa/for-professionals/special-topics/emergency-preparedness/notification-enforcement-discretion-telehealth/index.html
https://www.hhs.gov/coronavirus/telehealth/index.html

MGMA payer site:
https://www.mgma.com/landing-pages/covid-19-resource-center/financial-assistance-and-guidance-for-practices