The pMD Blog

Welcome to the
pMD Blog...

where we cover interesting and relevant news, insights, events, and more related to the health care industry and pMD. Most importantly, this blog is a fun, engaging way to learn about developments in an ever-changing field that is heavily influenced by technology.

2019 Changes to Telehealth Reimbursement



Earlier this year the Centers for Medicare and Medicaid Services (CMS) made the biggest change to telehealth policy in decades. In one abrupt, little-advertised bulletin, it announced that it would begin paying for five entirely new “Category 2” telehealth services on January 1, 2019. In that instant, tens of millions of Medicare beneficiaries became eligible for new remote services. However, nine months later very few of their physicians know about the change, and even fewer have the tools to offer or bill for these services.

Most physicians and practice administrators still think of telehealth as largely unfunded. This is understandable because until 2019 Medicare still only reimbursed provider-to-patient video visits, and only for patients located in rural areas, and only when the patient was physically located at a medical facility such as a clinic or hospital. In effect, CMS only used telehealth to supplement specialist staffing at medical facilities in rural areas. It didn’t want to introduce competition against the traditional office visit.

So until this year, telehealth was progressing mainly in the private sector. Because of successful direct-to-consumer telehealth companies, we associate telehealth with several major benefits: convenience and time savings for patients, increased access to care, work-life balance for physicians, and lower costs. CMS took a big step towards these additional benefits in the public sector with its new Category 2 telehealth funding.

Category 2 Telehealth Services and Charge Codes


Here are the new Category 2 services that can be billed today for Medicare patients:

Interprofessional Internet Consultation
CPT® codes 99446, 99447, 99448, and 99449

This is a physician-to-physician service billed by a consulting specialist. The specialist uses phone or video to give treatment guidance to the referring physician, along with a written report. The specialist never has any contact with the patient. The reimbursement is small, but many specialists already offer phone advice to other physicians without always seeing the patient. Now they can be reimbursed for these calls - it removes a perverse financial incentive for them to always do an in-person consult when that might not be necessary and could be an extra expense and inconvenience for the patient.

Interprofessional Written Internet Consultation
CPT® code 99451

This is similar to the Interprofessional Internet Consultation above, but removes the voice or video requirement. The specialist’s treatment guidance is purely written in this scenario.

Interprofessional Referral Services
CPT® code 99452

This pays the referring physician (typically a primary care physician, family medicine doctor, or hospitalist) for their end of the interprofessional internet consultation described above. The billing is based on time spent preparing materials, reviewing documentation, and speaking with the specialist. It’s nice that both parties can now get reimbursed for something that they were already doing in many cases.

Remote Evaluation of Pre-Recorded Patient Information
HCPCS code G2010

Consumer wearable medical devices got ahead of reimbursement models, leaving physicians to wonder “how am I going to get reimbursed for interpreting this flood of patient-generated data?” Apparently by billing G2010. When a physician gets a medical recording or image directly from a patient, this code pays them to send their interpretation back. No voice or video involved, just text chat. The reimbursement is low, but then again, it’s a simple transaction and it could be high-volume with the right marketing and tools.

Virtual Check-in
HCPCS code G2012

This code pays a physician to talk with an established patient for 5-10 minutes, as long as it’s unrelated to any scheduled in-office visits from the past 7 days and doesn’t lead to an immediate office visit or procedure. Typically this would be used after the patient calls the practice with a complaint or question, and the call gets escalated to a physician. It can be proactive on the part of the practice as well. Many practices traditionally provide this service for free for their established patients - now there’s reimbursement available.

How to Get Reimbursed for Category 2 Telehealth Services


If you’re already meeting the requirements to bill for one of these services, then the remaining challenge is charge capture. Because of the time requirements and the coding complexity, it’s prohibitively time-consuming to capture the billing charges for these services unless you can do the charge capture in the same clinical communication software where the service itself took place.

In order to fully capitalize on these codes, health care organizations should invest in integrated charge capture and clinical communication software. This software can be used for interprofessional and provider-patient text chat, voice, and video. The same software then can guide the physician to bill the appropriate Category 2 charge code based on the type of service (provider-provider or provider-patient), type of communication (text, phone, or video), and the duration of the call. It has to be mobile because who is in front of a computer every time they talk on the phone? And it has to be easy and integrated so that the time spent on charge capture doesn’t exceed the time spent on the actual encounter!

Why miss out on telehealth reimbursement? Contact pMD to find out how our easy-to-use, integrated charge capture and clinical communication software can streamline your telehealth services!

Further Reading
https://www.aappublications.org/news/2019/01/04/coding010419
https://practice.asco.org/sites/default/files/drupalfiles/2018-12/Final-Rule-2019-Resource-FINAL-12-5-18.pdf
https://acpinternist.org/archives/2014/01/coding.htm

 

Find out more about pMD's suite of products, which includes our MIPS registrycharge capturesecure messagingclinical communication, and care navigation software and services, please contact pMD.
5G ACA Account Management ACI Advancing Care Information AHCA AHRQ AI Alternative Payment Model Android API Apple Artificial Intelligence Audit BCRA Best Place to Work Big Data bootcamp BPCI BPTW Bundled Payments Care Communities care coordination Care Navigation Care Team Career Fair CDC Charge Capture Charge Capture App Charge Capture Software Charge Capture Solution Charge Capture Statistics Charge Lag CHIP CIO Clinical Communication clinical data Clinical Data Registry Clinically integrated network CMS cms regulations Communication Company Culture Conferences Connected Health Record culture custom reports Customer Interaction customer success customer support Customers cybersecurity Developer DHHS Dialysis discharge instructions EHR Electronic Charge Capture Encryption epidemic Expansion FDA FHIR Flu fundamentals GI GI Outlook Goals Health Care Health Care Technology Health Care Web health data Health Information Exchange Health Record Healthcare HIE HIPAA hipaa compliant communication hipaa compliant communication platform HIPAA-Compliant HL7 Home dialysis Hospital Census Hospital Communication IA ICD-10 ICD-11 Implementation Improvement Activities Instant capture interoperability iOS iOS 8 iOS7 iPad iPhone iPhone 6 Lead Generation length of stay Long Term Care LTC Machine learning MACRA Medical Billing Medical Errors Medical Software Medicare Mentorship Messaging Messaging with Patients MGMA MIPS MIPS Registry mobile Mobile App Mobile Charge Capture Mobile EHR Mobile Health Mobile Messaging Mobile security Mobile Technology Modern Healthcare Native App Network new feature news NIH OCM onboarding Oncology Care Model opioid crisis Patient Patient App Patient Care Patient Chat Patient Communication patient data Patient Engagement Patient Generated Health Data Patient Handoff Software Patient Information Patient Safety Patient Visits Patient-Centric pmd pMD Team population health Population Health Management PQRS Product Development Productivity Promoting Interoperability QCDR Quality Scoring Recruiting Recruitment Reimbursement Remote Work reports Residents Responsibility ROI Sales Secure Data Secure Messaging Secure Messaging Video Secure Text Messaging Security Audit SF Biz Times SNF SOC 2 success support TCM Teamwork technology telehealth Telemedicine Text Messaging texting training Travel Upgrades VA Value-based care Video Calling Video chat video communication video conferencing Wearable Device wearing many hats Web App Wireless Work From Home