Zulfiqar Rana, MD, MPH, FACP

This post is for providers interested in telemedicine, especially in Alabama.

What is telemedicine?

Need to document full note in the EMR like a usual face-to-face visit (minus the Vitals and Physical Examination).

1. How is telehealth different from telephone outreach?
   Coded differently. See below.
2. What are the different ways Telehealth can be applied?
   See below.

Requirements to implement telehealth?

1. What licensing and credentialing requirements should we consider?
   For now, waived by BCBS and medicare.
2. How should we obtain patient consent?
3. Which health care providers are able to provide telehealth services under Medicare Part B program?
   Per BCBS “This applies to physicians and their extenders who currently receive Blue Cross reimbursement on the Preferred Medical Doctor (PMD), Physician Extender, Select and Select Extender fee schedules. Urgent care is also included; however, at this time, we are not including other provider types.”
   Nurses cannot bill.
4. What are Virtual Check-Ins? How do they differ from telehealth and when would I use them?
   See the table below.

For BlueCross BlueShield of Alabama

• For now, phone calls will suffice. Do not need video calls.
• Maximum coding allowed 99213
• These actions will be effective until April 16, 2020, for now
• More info at the BCBS site

For Medicare

• “Effective for services starting March 6, 2020 and for the duration of the COVID-19 Public Health Emergency, Medicare will make payment for Medicare telehealth services furnished to patients in broader circumstances.”
• “The provider must use interactive audio and video telecommunications system that permits real-time communication between the distant site and the patient at home.”
• More info at the Medicare site
• Summary table from the Medicare website

Training requirements to start on telehealth?

It depends on the software. They are usually easy to use. We also need to document the visit to your EMR, which should be business as usual.

Getting paid for telehealth?

See Above

For BCBS: “Providers should bill new or established patient evaluation and management codes up to a level 3 (CPT codes 99201, 99202, 99203, 99211, 99212 or 99213). Standard documentation applies and additional billing guidelines will be posted on ProviderAccess. Claims should be filed with the place of service 02 (telehealth). A modifier is not required.”

Preferred technology platforms?

For BCBS phone calls will suffice for a telehealth visit.

For medicare where video call is needed, there are several options available.

• Through your own EMR. For example, Allscripts has Followmyhealth. They are usually expensive with high upfront costs.
• Doxy.me
• Updox
• AMC Health
• swyMed
• Teladoc
• Mend

Scheduling and performing these visits?

Coming soon!

1. Do I need to designate a physical space?
2. Should we designate time specifically for telehealth visits or mix them in with in-person visit scheduling?
3. How should we advertise this to patients?
4. Should we prioritize any specific patient groups for virtual visits?
5. How many of my providers should be ready to perform telehealth?
6. What if demand exceeds our practice’s supply? Are there any overflow options?
7. Do I need special equipment like monitors, cameras, headphones or special lighting?
8. Is my Internet speed fast enough to provide telehealth?
9. How can I make the most of the visit?
10. What are the limitations of the visit? What can/can’t I do during them (e.g., vital signs)?
11. Will my patients know how to participate in telehealth visits?

What equipment is needed?

1. Will they need to set up an account or remember a password?
   Smartphone option: with the most telemedicine apps like Doxy.me they do not need to have this. The patient should, however, know how to use their smartphones and work with text messaging.
   Desktop option: Alternatively, they should know how to sign in on their desktops.
2. Will they be required to provide a credit card?
   For most apps no.
3. Should they try to have a family member or caregiver present? What about a 3-way (or more) video call?
   It helps a lot with elderly patients and patients that cannot operate smartphones and desktops.

Documentation in the EHR?

Need to document full EMR note like the one done for the face-to-face visits (minus the Vitals and Physical Examination).

1. Do I need special codes or a special template?
   See above
2. If I cannot meet all the requirements of a CPT code during a visit, how should I document and bill for the visit?
   Just the simple virtual check-in per Medicaid which is usually G2012