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Review of telehealth versus telemedicine, effectiveness and challenges, reimbursement, suggested best practices.



Hello and welcome to the Quality Program's presentation on Telehealth.

Here are our objectives for this webinar. We are going to differentiate between telehealth and telemedicine.

Analyze the effectiveness and challenges of telehealth.

Understand reimbursement of telehealth services and identify available resources.

Telehealth versus telemedicine.

Although the terms are often used interchangeably, there is a distinction between the two. Telehealth refers broadly to electronic and telecommunication technologies and services used to provide care and services at a distance.

Telemedicine is a subset of telehealth that refers solely to the provision of healthcare services and education over a distance through the use of telecommunication technology, so for example, a physician in one location uses telecommunications infrastructure to deliver care to a patient at a distance site.

While telemedicine refers specifically to remote clinical services, telehealth can refer to remote non clinical services such as provider training, administrative meetings, continuing medical education, in addition to clinical services.

Both of these areas are part of the larger effort to expand access to care making health management easier for patients and improving the efficacy of the health care delivery network.

So, what is telehealth? Again, telehealth is a little different from telemedicine because it refers to a broader scope of remote health care services than telemedicine and it allows long distance provider and patient contact, education, intervention and remote admissions. Some examples of telehealth include:

Health education services, remote, monitoring of vital signs, ECG or blood pressure, and remote doctor/patient consultations.

According to the World Health Organization, telehealth includes surveillance, health promotion and public health functions.

So, why is telehealth effective? Telehealth is proving to be very effective for a number of different reasons.

First convenience, it reduces no shows and cancellations.

There is an ability for virtual check-ins that allows patients to talk to their providers using a device like a phone, integrated audio video system, or captured video image without going to the doctor's office.

The patient can receive care in the privacy of their own home.

There's less time in waiting rooms, which decreases the risk of people being exposed to germs bacteria and viruses.

The need for physical distancing has also led to the rapid adoption of telehealth solutions globally.

Telehealth is cost efficient because it reduces travel expenses or lost work hours for health care personnel as well as patients.

Telehealth offers expedited transmission of diagnostic exams when needed for a 2nd opinion, and it helps to improve communication between providers and their patients.

It also complies with HIPAA laws, aiming to prevent secure medical records and other documents from being leaked.

Let's take a look at some of the challenges of telehealth.

First privacy and security concerns. We need to consider all potential threats to the integrity of that electronic protected health information.

Next, when you are dealing with technology, at some point you are bound to encounter electronic glitches along the way. It's only as reliable as the electrical current that keeps it running.

Which takes us to the next point of having technical support.

This can be an expensive undertaking, but it is a service that should be efficient and cost effective.

Although having the ability to interface is a great thing, not being able to perform the usual hands on assessment and picking up on some of those non-verbal cues, can be a bit of a challenge.

Lastly, is organizational culture and gaining the buy-in of stakeholders,

so that everyone is on the same page about embracing a culture of change specifically with this technology and service.

According to a telehealth survey conducted by JD Power in 2019, customer satisfaction with telehealth services is high. Overall customer satisfaction for telehealth services on a 1000 point scale was 851.

These scores were among the highest of all healthcare insurance and financial services industry studies conducted by JD, Power. Positive word of mouth is key to increasing adoption.

Nearly 2 thirds of telehealth users use the service because of positive recommendations from family friends, their health plan, or some other source.

Telehealth works for most consumers using the technology. More than 84% of telehealth users were able to completely resolve their medical concern during the visit.

73% experienced no issues, while 49% stated no barriers, and 87% described the enrollment process as fairly easy.

So, just looking at these numbers and statistics, telehealth truly has a positive impact across these different areas.

Let's take a look at reimbursement. Horizon has identified telemedicine services when modifiers 95 or GT are added to CPT or HCPCS codes that usually describe in person face to face visits. Reimbursement for this service may be available for real time telemedicine services that meets the requirements of a face to face visit between the provider and the patient.

Reimbursement may also apply when telemedicine is limited to services using interactive real time audio video technologies to diagnose, consult or treat according to the patient's contract.

A couple of other areas related to reimbursement. The provider who is performing the telemedicine service must be licensed in the state where the patient is physically located at the time of the telemedicine encounter.

We are in New Jersey, so the provider is subject to this states jurisdiction. If either the patient or provider is located in New Jersey the provider is subject to regulation by the appropriate New Jersey state licensing board and must act in compliance with the existing requirements of maintaining liability insurance.

Also, any service rendered via an interactive communication technology as part of the health plans benefit is also eligible for reimbursement to that provider rendering the service.

Let's talk about coding for telemedicine. NCQA has made adjustments to many of the HEDIS measures to include telehealth services because of the disruption brought on by COVID 19.

And they did this as a way to obtain compliance for these measures because many providers and patients have had to rely on this service.

A few of those HEDIS measures are noted here.

And these measures are a part of the Results and Recognition programs.

These changes also align with the telehealth guidance from CMS and other federal and state regulators.

So, what services are not eligible? Non-direct patient services, for example, coordination of care rendered before and after patient interaction will not be considered for reimbursement.

Also claims submitted with modifier GQ, which signifies services provided via asynchronous telecommunication systems as these services do not include direct in person patient contact.

Any service that is not eligible for separate reimbursement when rendered to the patient in person is also not eligible. Presentation origination site facility fee HCPCS code Q3014, is not eligible and CPT codes 99441 through 99444 are not eligible.

So let's go over some important things to know for telemedicine.

Health care providers, providing this service will be subject to the same practice standards as applicable to in person settings.

Providers who utilize telemedicine systems must consider security, patient confidentiality and privacy. A secured electronic channel is required to be utilized by a telemedicine provider.

All transactions and data communication must be in compliance with the Health Insurance Portability and Accountability Act known as HIPAA.

Documentation in the medical record must be maintained and must support the services being rendered.

By coding and billing modifiers 95 or GT, with a covered procedure code, the provider is certifying that the member was present at the originating site when the provider furnished the telemedicine service.

Now, originating site means a site at which a patient is located at the time that health care services are provided to the patient by means of telemedicine.

Providers are authorized to charge a deductible, co-payment or coinsurance for a healthcare service delivered through telemedicine provided that that amount charged does not exceed the charge for an in person consultation.

Payment will be made at the same rate as that of the existing professional agreement allowances.

So, let's talk about some best practices.

Identify staff to conduct telehealth interactions with patients and develop protocols so staff can triage the patients in a timely manner.

Practice using the technology first internally.

You should also create a backup plan because again, as I mentioned previously, you may encounter technical glitches.

Documentation and record keeping. You should be keeping a complete and accurate record in the member's medical record of all interactions.

Just because the service is not being performed in person does not mean the documentation does not matter.

In addition to your staff doing a test run to prepare for telemedicine services, the patients should do the same.

Here is a screen shot of the Horizon Blue website.

If you have never visited this site, when you have a little downtime, I suggest going in and exploring it a bit.

It's a good resource for you all and provides a lot of information that I'm sure you'll find useful.

There's information there specifically related to COVID19, such as billing and policies. There is also information related to telemedicine services. So again, it would be worth your time to explore this site, especially if your practice hasn't yet started telemedicine, but maybe you're planning to.

You'll get some good information here. Here's another resource, which you can access and it is the CDC website. They have information related to telehealth and telemedicine. is always a great place to obtain current information on the happenings of health care.

Thank you for attending this recorded webinar. If you have any questions, please email the quality department at

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