Telemedicine/Telehealth Articles and Resources

According to the Center for Connected Health Policy (CCHP), "States alternate between using the term “telemedicine” or “telehealth”. In some states both terms are explicitly defined in law and/or policy and regulations. In some cases, “telehealth” is used to reflect a broader definition, while “telemedicine” is used mainly to define the delivery of medical services."

Regardless of which definition you prefer, this field has experienced nearly exponential growth over the last several years.

News and Important Information

Even if a code is identified as a telemedicine service by either the CPT codebook (Appendix P), or on the Medicare telehealth list, that doesn't mean that another service might be able to be rendered via telehealth. Much of that depends on individual payer policies.***Also, be sure you are aware of individual state laws regarding these services.


List of Telehealth Services: CMS.gov  (01/2022)

Article:  Changes in RPM for 2021! Now,  Wait for it... New RTM Codes for 2022 (11/2021)

AMA Telehealth policy, coding & payment

Resources

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Select the title to see a summary and a link to the full article.  some articles require a subscription to view.

Four Ways Your Organization Can Benefit from Gathering and Reporting Social Determinants of Health Data

by  Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

Providers who actively engage in collecting and reporting social determinants of health (SDoH) open avenues of identifying and treating their patients' population health trends. Pairing chronic conditions that are difficult to control with identified SDoH circumstances such as transportation or electricity insecurity, can help identify those patients who may wish to be healthier, but who are dealing with circumstances that prevent compliance, such as transportation or access to electricity, for instance.

Seven Major Changes Proposed by CMS in the 2023 Proposed Rule

by  Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

As the COVID-19-related public health emergency (PHE) seems to be dying down, CMS publishes the 2023 Medicare Proposed Rule that outlines more than a dozen major changes to existing programs, including some that relate to telemedicine after the PHE is declared officially over. Of the many changes, seven (7) really stand out and make us think about how the end of the PHE may affect services such as telemedicine or new E/M encounter types.

How CMS Determines Which Telehealth Services are Risk Adjustable

by  Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

Medicare Advantage Organizations (MAOs) have gone back and forth on whether or not to use data collected from telehealth, virtual Care, and telephone (audio-only) encounters with Medicare beneficiaries for risk adjustment reporting, but the following published documents from CMS cleared that up once and for all by providing an answer to a question specifically related to this question.

Calendar Year 2023 Medicare Physician Fee Schedule Proposed Rule

by  Amanda Ballif

The Centers for Medicare and Medicaid Services (CMS) is soliciting public comments on proposed changes for Medicare payments under the Physician Fee Schedule (PFS) and other Medicare Part B issues effective on January 1, 2023 and thereafter. The Calendar Year (CY) 2023 PFS proposed rule is one of several proposed rules aimed at increasing equity in health care.

The Beginning of the End of COVID-19-Related Emergency Blanket Waivers

by  Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

It appears that the end of the 1135 waivers related to the COVID-19 public health emergency (PHE) has begun. According to CMS, the residents of skilled nursing facilities, long-term care facilities, and inpatient hospice centers have struggled due to the effects of some of the 1135 waivers. CMS is focusing primarily on removing the 1135 blanket waivers that pertain to certain aspects of care, training, and maintenance of these facilities to ensure the weakest of our citizens are guaranteed adequate care.

New Audio-Only Telehealth Guidance to Meet HIPAA Rules

by  U.S. Department of Health & Human Services

Covered entities (healthcare providers and health plans) can use remote communications, called telehealth, to provide services to patients as long as they follow certain guidelines. Because certain populations may have difficulty using audio-video telehealth, HHS is now issuing this guidance on audio-only telehealth. This guidance will help ensure that individuals can continue to benefit from audio-only telehealth by clarifying how covered entities can provide telehealth services and improve public confidence that covered entities are protecting the privacy and security of patients' health information.

2022-06-16-MLNC - ICD-10-CM Diagnosis Codes: Fiscal Year 2023

by  CMS - MLNConnects

News - Comprehensive Error Rate Testing Program Report: Sample Reduced for Reporting Year 2023 - Men’s Health: Talk to Your Patients About Preventive Services - Compliance - Implanted Spinal Neurostimulators: Document Medical Records - Claims, Pricers, & Codes - ICD-10-CM Diagnosis Codes: Fiscal...

Telehealth: The Current PHE Status and What to Expect

by  Terry Fletcher, CPC CCC CEMC CCS CCS-P CMC CMSCS CMCS ACS-CA SCP-CA QMGC QMCRC

Coming soon is the possible end of the PHE. Will it be extended? How does the Consolidated Appropriations Act of 2022 impact the PHE, and where does telehealth fit into all of this? The COVID-19 public health emergency (PHE) is slated to end this week on Thursday, April...

Monitoring Changes to Telehealth in 2022

by  Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

SUMMARY: Did you realize telehealth services increased by 11,000% between 2019-2020? Once again the newest CPT and HCPCS updates address telehealth changes for 2022 with new modifiers and guidelines for reporting. With such an increase in usage, the OIG has also identified significant fraud.

Audit News Exacerbates Healthcare Crisis

by  Ronald Hirsch, MD FACP CHCQM CHRI

No good news is not good news. Last week brought some news that may have significant financial consequences for many providers. The Health Resources and Services Administration (HRSA) program that funded care for uninsured patients with COVID-19 will run out of money and stop accepting claims on March...

Changes in RPM for 2021! Now, Wait for it... New RTM Codes for 2022

by  Christine Woolstenhulme, QMC QCC CMCS CPC CMRS

Remote physiologic monitoring and clinical data monitoring is a relatively new concept thriving and growing as an essential component for telehealth services. According to global consumer trends, a company called Dynata reported, "Among the 39% of people who consulted a healthcare professional, two-thirds used telemedicine, many of them for the first time ...

Final Rule on Communications Technology and 2021 Physicians Fee Schedule

by  Christine Woolstenhulme, QMC QCC CMCS CPC CMRS

To create a healthcare system that will benefit providers as well as Medicare beneficiaries there have been several new rules issued that begin on or after January 01, 2021. CMS released the final policy and payment provisions on December 01, 2020, which includes the physician fee schedule (PFS) for 2021. ...

CMS Expands Telehealth Again

by  Wyn Staheli, Director of Content - innoviHealth

On October 14, 2020, CMS announced further changes to expand telehealth coverage. Eleven (11) new codes have been added to their list of covered services bringing the current total to 144 services. The new services include some neurostimulator analysis and programming services as well as some cardiac and pulmonary rehabilitation services.

Are Diagnoses from Telehealth Services Eligible for Risk Adjustment?

by  Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

On April 10th, CMS released a memo with the subject line, “Applicability of diagnoses from telehealth services for risk adjustment,” suggesting there may be some telehealth services that might not qualify for risk adjustment. However, in the memo CMS states: “Diagnoses resulting from telehealth services can meet the risk adjustment face-to-face ...

Additional Telehealth Changes Announced by CMS

by  Wyn Staheli, Director of Content - innoviHealth

On April 30, 2020, CMS announced additional sweeping changes to meet the challenges of providing adequate healthcare during this pandemic. These changes expand the March 31st changes. The article covers some of the key changes. See the official announcement in the references below.

Dismal OIG Report on Telemedicine

by  Wyn Staheli, Director of Content - innoviHealth

Providers need to understand the rules for reporting telemedicine services. A recent OIG report shows that this is not the case. What problems are being found in documentation claims? As providers are expanding their telehealth offerings, now is the time to understand the potential pitfalls since disallowed amounts will be taken back.

COVID-19 Chiropractic Resources

by  Wyn Staheli, Director of Content - innoviHealth

COVID-19 Chiropractic Resources contains current, updated information regarding COVID-19. Included are lists of webinars, articles, websites and links pertaining to the ongoing changes.

More Telehealth Changes Announced by CMS

by  Wyn Staheli, Director of Content - innoviHealth

On March 31, 2020, CMS announced further changes to their telehealth program in response to this unprecedented public health emergency (PHE). See this article for further information as well as references & links to CMS information

COVID-19: Cybercrime, Telehealth, and Coding

by  Wyn Staheli, Director of Content - innoviHealth

Your inbox is probably like mine with all sorts of announcements about COVID-19. Here are just a few reminders of things we felt should be passed along. We have heard of several cases of cybercrime related to this outbreak. For example, there was a coronavirus map which loads malware onto your ...

Billing for Telemedicine in Chiropractic

by  Evan M. Gwilliam, DC MBA CPC CCPC CPC-I QCC MCS-P CPMA CMHP AAPC Fellow

Many large private payers recognize the potential cost savings and improved health outcomes that telemedicine can help achieve, therefore they are often willing to cover it. While there are several considerations, there could be certain circumstances where telemedicine might apply to chiropractic care.
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Reporting Telemedicine Services by Aimee Wilcox 

by  Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

Telehealth Policies for Medicare and Commercial Payers 

Telehealth Policies for Medicare and Commercial Payers

Coding and Billing Updates for Telemedicine Services 

by  Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

Coding and Billing Updates for Telemedicine Services ...

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