The pMD Blog

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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.

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At pMD, we are passionate about creating technology that not only improves patient care but stays up-to-date with the ever-changing needs and requirements of our practices. We realize the way in which providers practice medicine is changing, and we need to be able to support them in successfully navigating these changes. One newer feature of pMD is video calling, which enables provider-to-provider and provider-to-patient communication and brings telemedicine to our customers. While countless specialties benefit from telemedicine encounters, I’d like to highlight our friends in long term care (LTC) and how telemedicine can alleviate some of the stressors they are facing.

After working with my fair share of providers in LTC, one concern I heard repeatedly was about keeping their patients from being readmitted to the Emergency Department (ED). Of course, this is a concern because they want their patients to improve, but also because CMS is now penalizing LTC facilities when a patient who had been discharged is readmitted to the ED within 30 days. These penalties are hefty, and often have a tremendous impact on facilities where a large part of the population is covered by Medicare. Last year alone, 11,000 Skilled Nursing Facilities (SNFs) were penalized by Medicare. So why are these readmissions happening? Well, imagine this: your grandfather was discharged after a 2-week stay at an SNF. A couple of days later he complains of shortness of breath, but it’s a Sunday, and his doctor’s office is closed. Without a way to contact a member of his care team, you are left with little choice but to head back to the hospital. What if you have the ability to triage his symptoms over video conferencing? This could prevent readmissions by contacting a provider on his care team to determine whether or not a trip to the ED is necessary or if he can wait until the office is open on Monday.

Another challenge is providing care for a population that has a variety of conditions and comorbidities. The majority of providers I speak with are excellent primary care providers and feel passionate about their work. However, they are not specialists in fields such as nephrology or cardiology. For many of these patients, they come in with not just one condition, but a laundry list of problems, where outcomes would be improved if under the care of not only a primary care provider but also specialists who can monitor and treat more complex diagnoses. In order to get a care team on the same page for treatment, and thus improving outcomes, telemedicine provides an easy way to connect providers from all backgrounds and ensure the treatment plan sets the patient up for long-term success.

Lastly, the field of medicine is seeing a shortage of geriatric providers. According to the American Geriatric Society, there will be a 45% increase in demand for geriatricians between the years of 2013 and 2025. Many people are living longer due to advances in medicine and, therefore, the elderly population is growing faster than is scalable. Many providers select other specialties, either because they are unaware of this niche or because the thought of caring for geriatric patients with many comorbidities can be daunting. Telemedicine can help in this area, especially in rural areas, as providers can still see and care for these patients, even if they are not at their bedside. This technology improves provider bandwidth and allows them to manage a larger patient census remotely.

Telemedicine can improve provider quality metrics by making providers more readily available during off-hours, reducing readmissions and ED visits. This availability allows patients to have their symptoms triaged in real-time, and also allows providers to more easily collaborate regarding patient care. Lastly, because LTC providers are often dealing with a growing elderly population, telemedicine broadens their reach and enables them to see more patients, without having to travel. While there are likely other use cases I haven’t yet covered, it’s clear that telemedicine will be a valuable tool for LTC providers.

To 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.



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.


Recipe for Success


pMD recently implemented a big performance boost that brings enhanced video chat performance to its iOS and Android apps, facilitating lower latency and higher resolution video calls. What does that mean for you? Clearer, faster video communication!

Video chatting is becoming a more common type of communication between providers and their patients. It’s a convenient way for physicians to consult with patients about non-urgent issues and an effective way to connect specialists with dispersed patient populations and rural communities. Not to mention, certain types of telemedicine video consultations are billable services. 

With more and more of the Millennial generation requesting telehealth over office visits, the demand will only increase with this growing demographic. But even in older patient populations, reducing the amount of travel from home to the doctor’s office can make a world of difference. A HIPAA-compliant video conferencing platform like pMD’s allows care teams to collaborate more efficiently to provide the best patient experience possible with little-to-no operating costs.

Gone are the days of choppy or unflattering frozen stills of your face. Say hello to telehealth from your local corner cafe, on your morning walk with the dog, while finishing up paperwork in the office, or from the comfort of your living room couch. Whether you’re the provider or the patient, pMD’s free video chat allows you the freedom to connect face-to-face at your convenience. Communication in health care should never be a hurdle to providing or receiving the best possible care.

Find out more about pMD's suite of products, which includes our MIPS registry, charge capture, secure messaging, clinical communication, and care navigation software and services, please contact pMD.