Quick, get reimbursed for digital health while you still can!
Telehealth is a winning long-term strategy but it also needs to be a short-term solution as well. For a limited time, CMS and private insurers will pay providers for more visits over more channels. Even more extended reimbursable services began being available December 1st. Providers will have a short window to share the risk of adopting next-generation workflows.
EXPANDING PATIENT ACCESS REQUIRES INVESTMENT
CMS reimburses specific services when delivered over specific channels.
The challenge is, in order to properly do this, new infrastructure and processes are required. For telehealth to truly work, it needs to be part of a digital transformation process that includes:
- Investment in consolidating data sources
- Investment in breaking down silos
- Investment in service automation
- Investment in digital front-door technologies
WHY IS SO MUCH INVESTMENT NECESSARY?
Healthcare as practiced today consists of a large number of individual services that are often delivered by different people using different tools.
Creating a “digital front door” doesn’t automatically resolve this fractured service structure.
In order to deliver on the promises of a digital front door, you have to architect what is behind the door.
The Difficult choice
As we mentioned, the government is willing for a limited time to reimburse patient access. Unfortunately, they are not reimbursing healthcare for building new infrastructure to make this viable. If you look at the Telehealth Maturity Model, organizations need to go through steps of establishing a basic platform, coordinating data sources and silos, and then automating the difficult services before digital front-door technologies can truly make a difference.
CMS is only reimbursing final delivery.
Healthcare providers have a choice
- invest in the infrastructure for digital delivery and continue to grow access channels
- simply make do with their current infrastructure and get whatever reimbursement they can
telehealth is a short term response
As organizations invest in this infrastructure, the benefits of telehealth reimbursements ramp up. While full benefits take years to realize, low-hanging fruit can be automated within just a few months. Telemedicine can become easier and less stressful. Clients are able to cut down phone time by 20-50% within 4 months. You can get 30% of appointments self-scheduled within 6 months.
telehealth is a long-term strategy
The fact that we are ramping up use during a pandemic, short-term need has hidden the long-term implications.
COVID EXPANSION - HOW TO GET REIMBURSED BY DIGITAL CHANNELS
HRSA defines telehealth technologies as:
“Technologies include videoconferencing, the internet, store and-forward imaging, streaming media, and landline and wireless communications.”
CMS determines reimbursement by channel-service pairs. In other words, the type of consultation, combined with the channel being used dictates the type of reimbursement the provider receives (if any).
A key step in pursuing a holistic telehealth strategy is to determine which reimbursable services your organization will provide and over which channels.
Synchronous communication technology
Video Visit - Apple FaceTime, Facebook Messenger video chat, Google Hangouts video, Whatsapp video chat, Zoom, or Skype.
- Services currently reimbursed over video visit:
Virtual check-in with (E&M) an established patient (G2012), determining if office visit is needed
Providers can be reimbursed for telehealth instead of POS codes at the same rate as in-person.
Digital evaluations (99421-99423)
- Many of these options are not fully HIPAA compliant. During the COVID crisis, there is a special waiver (see Safety and Quality below). The problem is that this is only temporary, leaving providers who use Facebook, Google Hangouts, Skype, and regular Zoom in danger of steep penalties.
Telephone (including video visit with low bandwidth) – landline, wireless, or internet real-time voice options.
- During COVID, some audio-only visits are reimbursed at the same rate as in-person visits. It is useful for providers to know what audio visits are reimbursable, even at reduced rates, in case technical difficulties, such as low bandwidth, keep the video portion of the video visit from working properly.
- Voice-only reimbursement: These are virtual check-in (E&M) - the patient must initiate, they must consent verbally to receive virtual check-in services, and the communications must be within a 7-day period.
Web chat - Signal, Jabber, Facebook Messenger, Google Hangouts, Whatsapp, or 5 iMessage. Typically, these platforms employ end-to-end encryption, which allows only an individual and the person with whom the individual is communicating to see what is transmitted.
- Web chat is unique in allowing real-time private discussions with people who are otherwise within earshot of others. Video visits and even audio conversations can lack privacy.
- Reimbursement: web chat is not approved as a distinct channel by CMS. It is viable for reimbursement for the same items as store-and-forward communication (see below).
See all CMS synchronous telehealth reimbursement codes, including which are available for audio-only, here: https://www.cms.gov/Medicare/Medicare-General-Information/Telehealth/Telehealth-Codes
Asynchronous messaging technology
Online messaging (“store-and-forward”) – asynchronous messaging can remove wait times, and overcome language and cultural barriers. It has been especially effective for specialties like dermatology or even urology where imaging is important. Advanced providers are using real-time chat, asynchronous texting, online messaging facilitated by web AI.
Store-and-forward includes streaming video messages, like MarcoPolo.me.
- Only a few services are currently reimbursed over store-and-forward: medicare part B has 3 codes for e-visits. Relegated to established patients, patients must initiate, consent to the evisit, and communications must be within a 7-day window. Medicaid is very limited for store-and-forward, with only 15 states reimbursing.
SMS messages & email
- Must be secure, or you will run afoul of HIPAA guidelines. See Safety and Quality below for more.
- Limited reimbursement as eConsult under Medicare codes 99451 and 99452
- Believe it or not, fax is still a major communication medium in healthcare!
As a patient channel, however, there is no reimbursement
For more information on reimbursement
Please refer to:
- CMS Official list of telehealth codes: https://www.cms.gov/Medicare/Medicare-General-Information/Telehealth/Telehealth-Codes
- MGMA COVID Coding Cheatsheet: https://www.mgma.com/resources/revenue-cycle/covid-19-coding-cheatsheet (MGMA membership required)
About Keona Health
At Keona Health, we believe that relationships matter. We know that a clinic’s triage system can test a patient-doctor relationship, especially if a patient cannot easily get the help he or she is seeking. Keona Health offers healthcare software and automation solutions to ease the burden of telephone triage on medical practices and help medical professionals better communicate with patients.