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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 telemedicine and telehealth, analyze the effectiveness and challenges of telehealth, understand reimbursement of telehealth services and identify available resources.

Although the terms are often used interchangeably, there's a distinction between the two.

Telehealth refers broadly to the 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 distant site.

While telemedicine refers specifically to remote clinical services, telehealth care refers 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 efficiency of health care delivery networks.

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.

Why is telehealth effective?

The convenience, receiving care in the privacy of one's home, less time in the waiting room, less time being exposed to others who may be contagious, cost efficiency.

Telemedicine can reduce travel expenses and loss of work hours.

Expedited transmissions of MRIs or X-rays for a second opinion.

Telehealth can improve communication between patients and their medical practitioners and privacy assurance.

Telemedicine complies with all HIPPA laws, which aim to prevent private or secure medical documents from being breached.

The challenges of telehealth are:

Privacy and security concerns. Consider that all potential threats to the integrity of electronic protected health information.

Electronic glitches. Technology is only as reliable as the electrical current that keeps it running.

Technical support may be expensive.

Inadequate assessment. Having the ability to interface is a plus, however, nonverbal cues found through a hands-on exam maybe missed.

And organizational culture. Gaining the buy-in of stakeholders.

According to the telehealth survey conducted by J.D. Power in 2019, customer satisfaction with telehealth services is high.

Overall customer satisfaction for telehealth services on a 1,000 point scale was 851.

These scores were among the highest of all healthcare insurance and financial service industry studies conducted by J.D. Power.

Positive word-of-mouth is key to increasing telehealth.

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

Telehealth works for most consumers using technology.

More than 84% of telehealth users were able to completely resolve their medical concern during the visit.

73% did not experience any issues or problems during the service.

While nearly half, 49% of the users say there were no barriers that made using telehealth difficult.

87% describe the enrollment process as somewhat easy.

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

Now, let's take a look at reimbursement.

Horizon has identified telemedicine services when using modifiers 95 or GT are appended to CPT, HCPCs codes that ordinarily describe face-to-face services, including, but not limited to, office or other outpatient visits, inpatient visits or individual psychotherapy visits.

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 and 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 providers are subject to this state’s jurisdiction.

If either the patient or provider is located in New Jersey, the provider is subject to regulation about the appropriate New Jersey state licensing board and must act in compliance with existing requirements of maintaining liability insurance.

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

Now, let's talk about coding for telemedicine.

NCQA has made adjustments to many of the HEDIS measures to include telehealth services because of the destruction 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 part of the R&R programs.

These changes also align with 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 the modifier GQ which signifies services provided via telecommunication system, as these sources do not include direct in-person, patient contact.

Any service that is not eligible for a separate reimbursement or rendered to the patient in-person.

Presentation, origination site, facility fees and CPT codes 99441 through 99444 are not eligible for services rendered.

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

Healthcare providers providing this service will be subject to the same practice standards as applicable in in-person settings.

Providers who utilize telemedicine systems must consider security, patient confidentiality and privacy.

A secure electronic channel is required to be utilized by a telemedicine provider.

All transactions and data communication must be in compliance with HIPPA.

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

By coding and billing modifiers 95 or GT for the covered procedure code, the providers certify that the member was present at the original site where the provider furnished the telemedicine service.

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

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

Payments will be made at the same rate as that of the existing professional agreement allows.

Now, let's talk about some best practices.

One, identify staff to conduct telehealth interaction with patients.

Develop protocols so that the staff can triage and assess patients quickly.

Second, practice using technology first with the other staff before you use it with the patient.

Three, create a backup plan, and establish protocols in case escalation of care is required or if technology fails.

Documentation and record keeping.

Maintain a complete and accurate record of all telemedicine services performed in the member’s medical record based on your interaction, including any assessments or treatment plans at the time of visit.

And finally check in with patients to find out if and where the trouble areas are for them.

Here is a screenshot 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 is a good resource for you, and it provides a lot of information that I'm sure you will find useful.

There is information related to COVID-19 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 started using telemedicine, but maybe you're planning to.

The CDC.Gov is always a great place to obtain current information on the happenings of healthcare.

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

Located below this webinar and the transcript is a link to our Survey Monkey.

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