Telemedicine

This page provides a library of communications and resources to help members remain informed, specifically regarding Telemedicine.

To contact members of the Clinical Line Committee, please reference their information here:

 

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To help the practices succeed in using telemedicine, a dedicated telemedicine page was created on the TopLine MD website. This page is an excellent source of information for patients to learn more about telemedicine and how it works.

For practices enrolled in the automated appointment reminder program through Relatient, the confirmation message sent after a patient confirms their appointment has been updated to include a link to the TopLine MD Telemedicine landing page. Only appointments with the specified telemedicine reason codes identified in Intergy will receive this confirmation message. For a list of telemedicine reason codes to use, please click here. For questions, contact toplinemd@femwell.com.

The following health plans have extended their telemedicine billing timeframes to the dates listed below. All other Medicare and Medicaid plans will continue to allow telemedicine services until the state of emergency is lifted.

  • Aetna – September 30, 2020
  • AvMed – September 30, 2020
  • Florida Blue – December 31, 2020 for PCPs only. For specialists, until the state of emergency is lifted.
  • Cigna – December 31, 2020 (Extending cost-share waivers and other administrative benefits through at least October 31, 2020)
  • United – September 30, 2020
  • Humana – December 31, 2020

Contact: Jessica Capote, Femwell Director of Managed Care, at jecapote@femwell.com.

We acknowledge the Coronavirus pandemic is far from over, and within the next few months, practices will move into the cold and influenza season. OB/GYN Providers are encouraged to continue to find ways to creatively enforce social distancing rules while supporting patients during their pregnancies. It is not always in the best interest of patients to be seen in-person for visits that can be consolidated or conducted via telemedicine.

The Society of Maternal Fetal Medicine recently published an instructive paper on how to code for remote patient monitoring programs. This is just one example of how to employ new techniques and tactics to achieve clinical objectives.

OB/GYN Roundtable Discussions 6/29 and 7/1:
Please take advantage of the opportunity to engage with your VitalMD colleagues through the regular OB/GYN roundtable meetings. These meetings are an opportunity to share ideas about how to support each other through this ongoing crisis. Click here to sign up for an upcoming meeting.

Florida Medicaid has expanded telemedicine visits to include Well-Child visits for children older than 24 months through 20 years of age. Managed Care MMA plans have also adopted the expansion of these telemedicine services.

CPT codes for Well-Child visits are as follows:

  • New Patient: 99382-99385
  • Established Patient: 99392-99395

Providers must append the GT modifier for live, two-way communication. The Agency and the Medicaid health plans will reimburse the same rate as if the service was delivered face to face. Please refer to the Florida Medicaid Health Care Alert for more detailed information.

We have been informed by Aetna that some of the telemedicine visits billed with a modifier 95 and GT have been incorrectly underpaid. At this time, there is no action required from the practice as this is not related to the practice billing but rather a configuration error on Aetna’s end that is affecting all practitioners in their network. They are currently working on correcting the issue and will reprocess all affected claims accordingly. Please allow some time for the adjustments to be completed on their end. As soon as we have additional information, we will communicate with all practices.

Should you have any questions, please contact Jessica Capote, Director of Managed Care, at jecapote@femwell.com or Elizabeth Sanchez, Managed Care Manager, at elsanchez@femwell.com.

The COVID-19 crisis has reached a new phase in Florida, and providers will have to find ways to deliver great care in a way that protects patients and staff on an ongoing basis. This summary may help you figure out tactics that might work for your particular practice but is, in no way, meant to be prescriptive. This sheet refers to “telehealth” as a technology-enhanced healthcare framework that includes services such as virtual visits, remote patient monitoring and mobile health care. Click here to access updated Telemedicine Tips for OB/GYNs.

Contact: For more information, you may email Co-Chairs of the Femwell OB/GYN Clinical Line Committee: Nathan Hirsch, MD, nhirsch@femwell.com and Joyce Miller, MD, jmiller@femwell.com.

Thank you to those offices that attended the “Telemedicine: Documentation and Coding Training” webinar. During the webinar, multiple topics were covered, such as: the difference between Telemedicine and Telehealth, understanding the different services being recognized by payers, documentation requirements, etc. If you missed the webinar, below you will find links for the recorded sessions or you can access them through VitalNet, under “Practice Resources, Coding Compliance.”

Click here to find an FAQ document with questions received throughout the sessions. For further questions, email codingcompliance@femwell.com.

Florida Blue is expanding to allow virtual annual wellness visits for new and established patients. The expansion of the additional services for virtual visits will be in effect for the next 90 days. These visits will be reimbursed at the contracted in-office rates.

Additionally, we would like to inform you that we are monitoring telemedicine claim payments and confirmed that most of all the major payers are reimbursing evaluation and management (E/M) visits at the contracted in-office rates. However, we did notice that for Cigna and United Health Care, some claims were paid at the out-of-office rate when billed with place of service (POS) 02. At one point, Cigna and United Health Care indicated that all claims should be billed with place of service 02, but shortly thereafter, the billing guidelines changed to bill with POS 11.

  • If your practice has claims for Cigna with date of service of March 2, 2020 or thereafter billed with POS 02 and received the reduced rate, please rebill by sending a corrected claim with POS 11 to receive the in-office rates.
  • If your practice has claims for United Health Care with date of service March 18, 2020 or thereafter billed with POS 02 and received the reduced rate, please rebill by sending a corrected claim with POS 11 to receive the in-office rates.

Please note, it is important to verify benefits and eligibility before rendering these services. We noticed that some practices are not collecting patient responsibilities. Many patients continue to be responsible for their portion as if they would have come in for an in-person visit.

The latest changes to telemedicine billing were posted on the COVID-19 Updates for Providers landing page under “4/17/2020 Telemedicine Insurance Plan Guidelines” section. It is very important that all practices check this site periodically to obtain the most updated information.

Should you have any questions, please contact Jessica Capote, Director of Managed Care, at jecapote@femwell.com or Elizabeth Sanchez, Managed Care Manager, at elsanchez@femwell.com.

We want to thank you for all of your great work in the face of the enormous COVID-19 challenge. We have all faced big and daunting obstacles as we try to provide the best care for our patients, while simultaneously protecting our staff and patients from this very infectious virus.

It is expected that some of the government-directed social-distancing measures will be relaxed in the coming days or weeks. We feel it is important to remind everybody of some tactics you can implement, and some that you should not implement, in your practice in order to carry on your important work. Please see below along with the attached documents for additional information:

  • There is still no FDA-approved antibody test to confirm COVID-19 immunity. Many are being developed, but none have passed the criterion to imply that a positive antibody test would immunize a person. 
    • Once there is an approved antibody test, VitalMD will work to bring the testing into MediPath to make it available for practices to use in order to make decisions about staff and staff protection.
    • Until a more reliable and proven test is available, you should act as if every patient and staff member is vulnerable to infection.
  • We anticipate that testing for active COVID-19 infections will soon become available with a much faster turn-around time. It will not be practical to use this test every day in the office for staff, but this might be something to offer patients who are at risk.
  • Practices should develop and enforce policies around social distancing, disinfection, use of personal protective equipment and scheduling that offer the best protection for patients and staff.
  • Please take advantage of telemedicine resources on the TopLine MD Updates for Providers page
    • Every insurance carrier has modified their telemedicine coverage and reimbursement policies to encourage providers to use this technology.
    • A workgroup in the OB/GYN clinical line has constructed some guidelines (see attached) to help providers in that discipline use telemedicine more creatively.
    • Medicare and Medicare Advantage Plans have relaxed almost all of their telemedicine policies and are paying providers the same for most telemedicine visits as for in-person visits. This is unlikely to change until all of the social distancing restrictions are relaxed.
    • With the expected partial relaxation of the “shelter-in-place” orders, we anticipate that providers will soon be able to schedule non-urgent procedures.

We will be conducting a series of Clinical Line Round-Table discussions. This will be an opportunity for you to discuss tactics and challenges with colleagues in your same, or similar, clinical discipline in order to creatively find ways to do your best work in the next few months. Please look out for more information on these round-table discussions.

You may refer to more information and resources related to COVID-19 on the TopLine MD Updates for Providers page. As usual, we are available for any questions.

Resources:

COVID-19 Service Line Recommendations
TopLine MD COVID 19 ObGyn Potential Telemedicine Opportunities

Many insurance plans have temporarily updated their telehealth policies due to the COVID-19 situation. Below you will find an outline of the information that was provided by each insurance plan on billing and the type of practitioners that can bill for these services. Please ensure that you read the attached payment policies for each of the insurance plans as there may be certain criteria that must be followed dependent on the plan. Also, it’s important to verify benefits and eligibility to ensure the patient has telehealth as part of their benefit plan.

We have also a consent form for patients who do not have the telehealth benefit in their policy and are willing to pay cash. Please note, this consent is only to be used for cash pay patients. As we continue to gather more information on this matter, we will continue to update this document.

  • Aetna Better Health:
    • Applicable to all practitioners listed below:
      • All physician specialties
    • Medicaid and Florida Healthy Kids products:
      • Bill with appropriate E & M codes with a GT modifier. Please ensure to review the policy attached.
      • Please review the policy under resources listed below.
  • AvMed:
    • Applicable practitioners listed below:
      • Internal Medicine
      • Family Medicine
      • Pediatrics
      • Specialist
      • Physician assistant
      • Nurse practitioner
    • The following codes listed below are the only telehealth services that will be payable for AvMed Commercial and Medicare members.
      • Physicians:
        • Telephone Evaluations: 99441 -99443 (PCPs only) or G2012 (All specialties)
        • Online digital evaluations and management services: 99421-99423
        • Appropriate E & M code with place of service 02 and a 95 modifier
      • Mid-levels:
        • Telephone Evaluations: 98966 -98968 or G2012
        • Online digital evaluations and management services: 98970-98972
    • Please review the policy under resources listed below.
  • United Health Care:
    • Applicable to all practitioners listed below:
      • All physician specialties
      • Physician assistant
      • Nurse practitioner
      • Nurse-midwife they did share the attached handout, which states they will pay for it.
    • Telehealth Billing: (You may use audio-video or audio only)
        • Commercial, Medicare & Medicaid
          • Use appropriate office visit E/M using modifier using modifier 95
        • Place of service: 11, 20, 22, 23
    • Electronic Visit (e-visit):
        • Commercial, Medicare & Medicaid
          • Use appropriate CPT code (99421-99423) no modifier required
        • Place of service: 11, 20, 22, 23
    • Virtual Check-In: (Use audio only)
        • Commercial, Medicare & Medicaid
          • Use appropriate CPT code (G2012, G2010) no modifier required
        • Place of service: 11, 20, 22, 23
        • Issue not related to a medical visits within the previous 7 days and not resulting in a medical visit within the next 24 hours (or soonest appointment available)
    • You can find the updated information on the telehealth policy by clicking on the hyperlink
      https://www.uhcprovider.com/en/resource-library/news/provider-telehealth-policies.html 
  • Humana:
    • Applicable to all practitioners listed below:
      • All physician specialties
    • Commercial & Medicare Plan
  • Florida Blue:
    • Applicable to all practitioners listed below:
      • All physician specialties
    •  Commercial Products
      • E/M Office visit: Bill with appropriate E/M code
      • Annual Wellness visits: Bill with standard annual wellness codes (99381-99397)
        • Mainly utilized by Primary Care Physicians
      • Use place of service 02 and modifier 95 or GT
    • Medicare Products
      • E/M Office visit: Bill with appropriate E/M code
      • Annual Wellness visits: Bill with G0402, G0438 or G0439
        • Mainly utilized by Primary Care Physicians
      •  Use place of Service 11 and modifier 95 or GT
    •  Please review the policy under the resources section listed below and the link
      https://www.floridablue.com/providers/covid-19-information
  • Community Care Plan:
    • Applicable to all practitioners listed below:
      • All physician specialties
    • Medicaid and Florida Healthy Kids products:
      • Bill with appropriate E & M codes with a GT modifier.
    • Please review the policy under the resources section listed below.
  • WellCare
    • Applicable to all practitioners listed below:
      • Internal Medicine
      • Family Medicine
      • Pediatrics
    • Medicaid and Medicare products:
      • Bill with appropriate E & M codes with a GT modifier.
      • Telephone conversations, chart review(s), electronic mail messages, or facsimile transmissions will not be reimbursable
      • Please note: Claims for Medicare members will need to go out with Place of Service 02 and the appropriate modifier.
    • Please review the policy under the resources section listed below.
  • Sunshine Health
    • Applicable to all practitioners listed below:
      • All physician specialties
      • Physician assistant
      • Nurse practitioner
      • Nurse-midwife
    • Commercial, Medicaid and Medicare products:
      • Bill with appropriate E & M codes with a GT modifier.
    • For additional information please review the following link: https://www.sunshinehealth.com/providers/coronavirus-information.html
  • Oscar Health Plan
    • Applicable to all practitioners listed below:
      • All physician specialties
      • Physician assistant
      • Nurse practitioner
      • Nurse-midwife
    • Commercial Exchange plan:
      • Bill with appropriate E & M codes with a GT modifier.
    •  Please review the policy under the resources section listed below.
  • Molina Health Plan
    • Applicable to all practitioners listed below:
      • All physician specialties
      • Physician assistant
      • Nurse practitioner
    • Commercial Exchange, Medicaid and Medicare plan:
      • Bill with appropriate E & M code, GT modifier and place of service 02
    •  Please review the policy under the resources section listed below.

Resources:

For those Primary Care Physicians who care for Medicare Advantage patients, the Federal Centers for Medicare and Medicaid Services (CMS) has put out the following statement which applies to your care of patients in Medicare Advantage plans:

CENTER FOR MEDICARE

DATE: April 10, 2020

TO: All Medicare Advantage, Cost, PACE and Demonstration Organizations

SUBJECT: Applicability of diagnoses from telehealth services for risk adjustment

The 2019 Coronavirus Disease (COVID-19) pandemic has resulted in an urgency to expand the use of virtual care to reduce the risk of spreading the virus; CMS is stating that Medicare Advantage (MA) organizations and other organizations that submit diagnoses for risk adjusted payment are able to submit diagnoses for risk adjustment that are from telehealth visits when those visits meet all criteria for risk adjustment eligibility, which include being from an allowable inpatient, outpatient, or professional service, and from a face-to-face encounter. This use of diagnoses from telehealth services applies both to submissions to the Risk Adjustment Processing System (RAPS), and those submitted to the Encounter Data System (EDS). Diagnoses resulting from telehealth services can meet the risk adjustment face-to-face requirement when the services are provided using an interactive audio and video telecommunications system that permits real-time interactive communication.

While MA organizations and other organizations that submit diagnoses for risk adjusted payment identify which diagnoses meet risk adjustment criteria for their submissions to RAPS, MA organizations (and other organizations as required) report all the services they provide to enrollees to the encounter data system and CMS identifies those diagnoses that meet risk adjustment filtering criteria. In order to report services to the EDS that have been provided via telehealth, use place of service code “02” for telehealth or use the CPT telehealth modifier “95” with any place of service.

Questions can be addressed to RiskAdjustment@cms.hhs.gov, and please specify “Applicability of telehealth services for risk adjustment” in the subject line.

Reference:

https://www.apg.org/wp-content/uploads/2020/04/4.10-Applicability-of-Diagnoses-from-Telehealth-Services-for-Risk-Adjustment.pdf

Should you have any questions, please contact either Leanne Mascaro, Senior Clinical Program Director, at lmascaro@femwell.com or Jessica Capote, Director of Managed Care, at jecapote@femwell.com.

As most practices expand their business to telemedicine, communicating with patients will be essential. The following guide offers recommendations on how to communicate to patients and promote your telemedicine services across all channels: Telemedicine Implementation Guide.

Contact: TopLine MD team at toplinemd@femwell.com.

In support of the telemedicine marketing objectives, various social media posts and door sign templates were created to increase visibility and awareness of your telemedicine services, while driving patients to take action. We encourage you to download the social media posts and door sign templates here. For help promoting your telemedicine business, email the Marketing department at TopLineMD@femwell.com .
In order to provide financial reporting for the Telemedicine services being offered by many of Vital MD’s LLCs, we have created a new Intergy Finance Center named Telemedicine. The nomenclature for the Finance Center code is Txxx (xxx=dataset number).  Thus, if the practice is dataset number 300, the Finance Center will appear in the Charge Posting window as T300- Telemedicine.

Please see attached document for detailed system instructions.

Selecting this Finance Center code (at charge posting level) will enable the practice to capture the services rendered through productivity reports.  Reports that may be run are Practice Financial Activity and Practice Financial Summary Report.

Please feel free to reach out to Ria Trujillo-Camprubi with any questions (mtrujillo@femwell.com ).

Resources:

In response to the Telemedicine Webinar hosted last week, we have created a Frequently Asked Questions (FAQ)  document with answers to questions asked throughout the webinar, including billing, coding, compliance, workflow, best practices and more.

Additionally, the template consent form sent through Corporate Notifications is now available in a branded TopLine MD template. For options on how to receive patients’ consent remotely, please click here .

Additional Telemedicine Resources:

Telemedicine Webinar Recording – password: covid-19

Telemedicine Webinar Recording

Yesterday, Dr. Juan Carlos Millon of the VitalMD Board of Directors hosted a webinar explaining how to provide telemedicine visits during the COVID-19 crisis. If you were unable to attend the live webinar, please click here to watch the recording. The password is: covid-19

Effects on Personal Protective Equipment (PPE)

Due to the surge in global demand for PPE, major distributors (i.e. Henry Schein, McKesson, Medline and Cardinal) are limiting orders to existing customers and not accepting new customers. All distributors are facing these same challenges and are trying as hard as possible to get supplies to their customers. Click here to read about product inventory updates.

 

Donations Requested: Our Primary Care practices are in the frontlines of COVID-19 and in urgent need of PPE. To donate supplies to these Providers, please click here.

We understand that you may feel the need, in an emergency situation, to use a video call to assist you in assessing a patient. Under these circumstances, you should use whatever technology you feel necessary to ensure your patients’ health. You should obtain their permission to do so.

Telemedicine Options

In an effort to ensure you have the available resources to continue care, we have identified two options to conduct telemedicine visits for your patients:

  • eClinicalWorks (eCW) TeleVisits

For eCW customers, you have the option to activate the built-in TeleVisits module within the eCW application that enables Providers to conduct a secure two-way visit with patients. Recorded webinar trainings on how to use TeleVisits can be found on eCW University at my.eclinicalworks.com to register. The TeleVisit feature has a fee of $2.00 per appointment and will be charged to the practice if the patient joins the appointment. If you wish to use eCW telemedicine, please e-mail EHRSupport@femwell.com for activation.  

[Note – If you are not an eCW user, you may inquire with your EMR provider.]

  • Doxy.me

You can download an easy-to-use, HIPAA-compliant application called Doxy.me that offers both a free version and paid version. The paid version offers high definition video and video quality assurance. Both versions offer a BAA that you must sign and submit to Femwell if you choose to use Doxy. We have not had any time to vet this company or fully test its system, and suggest that Providers exercise their own due diligence in evaluating the product. To use Doxy.me, you may visit the site to learn more about the different features for each version. 

Should you have any questions on telemedicine options, please contact Mark Grenitz, MD, Chief Healthcare Information Officer, at mgrenitz@femwell.com.

Insurance Reimbursements

From the insurance perspective, most contracts do not include telemedicine services. However, due to the severity of the Coronavirus issue, insurers have advised they are currently considering a temporary policy to ensure Providers can be reimbursed for virtual care. In the interim, if a patient chooses to pay for these services on a cash pay basis, a consent form should be completed by the patient.  

Most health plans are encouraging the use of virtual care services to limit the potential exposure in Physicians’ offices. Femwell will research VitalMD Physicians’ ability to bill telemedicine services to the health plans, including participating plans, CPT codes and rates, and cash pay options. 

Should you have any questions on insurance reimbursements, please contact Jessica Capote, Director of Managed Care, at jecapote@femwell.com.

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