understanding how to implement telehealth services ... · 05/05/2020 · specification sheets...

QUALITY PAYMENT PROGRAM

SMALL UNDERSERVED RURAL SUPPORT (QPP SURS) WEBINAR

MAY 26, 3:30 PM ET AND MAY 28, 11:00 AM ET

UNDERSTANDING HOW TO

IMPLEMENT TELEHEALTH

SERVICES: IMPLICATIONS FOR

SOLO AND SMALL GROUP

PRACTICES

UNDERSTANDING HOW TO IMPLEMENT TELEHEALTH SERVICES

HOUSEKEEPING ANNOUNCEMENTS

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If you are listening to this webinar through your phone,

please remember to mute your computer speakers.

You can download the slides from the file pod on your

screen.

For assistance, enter your issue in the chat box.

To ask a question, enter your inquiry in the chat box.

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POLLING QUESTION

What is your role?

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A clinician working in a practice with 15 or fewer clinicians

Non clinical staff from a practice with 15 or fewer clinicians

A clinician working in a practice with more than 15 clinicians

Non clinical staff in a practice with more than 15 clinicians

Quality Payment Program (QPP) contractor

Other person helping practices prepare for MIPS

Other

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POLLING QUESTION

Is your practice using telehealth services to care for patients?

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Yes and we are confident that it is working well

Yes, but we are still working through the best process for our

practice

No, but we would like to know more about how it works

No, we are not interested

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POLLING QUESTION

What are your biggest challenges or concerns with implementing telehealth?

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POLLING QUESTION

What do you think are the biggest advantages to offering telehealth services?

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CMS WELCOME

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Krishna Patel, MPH

Centers for Medicare & Medicaid Services

(CMS)

Center for Clinical Standards and Quality

UNDERSTANDING HOW TO IMPLEMENT TELEHEALTH SERVICES 8

Bruce Spurlock, MDPresident & CEO,Cynosure Health

Samuel “Le” Church, MD, MPH,

CPC,FAAFP, Synergy Health, Hiawassee,

GA

Kathy Wild, BSN, RN, QPP Project Manager, Quality

Insights

Donna Cohen, RN, BSN, CCM, Deputy Director

Population Health QIN-QIO, Alliant Health Solutions

Savannah Kendall, BA, CCMA, Clinical Manager, Synergy

Health, Hiawassee, GA


SETTING THE STAGE▸

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Focus: Understanding and implementing telehealth services, implications for billing

and MIPS participation, and tips on how to best modify your practice workflows.

Strategy: A panel of experts will discuss how to implement telehealth services and

update your practice workflows to care for your patients.

Topic Overview:

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What is telehealth and how to implement telehealth services within your practice

How to modify your practice workflows

Implications of telehealth on billing practices and MIPS participation

Practical tips on how to get started

Free technical assistance!

▸ Using the Chat Box

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FIND YOUR LOCAL TECHNICAL ASSISTANCE ORGANIZATION FOR FREE ASSISTANCE

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Location of Practice Technical Assistance Organization

Contact Information

FL, GA, NC, SC Alliant GMCF [email protected]

IL, IN, KY, MI, MN, OH, WI Altarum [email protected]

ID, WA Comagine Health [email protected]

CT, MA, ME, NH, RI, VT Healthcentric Advisors [email protected]

AZ, CA, HI, NM, VI HSAG [email protected]

DC, MD, NY, VA IPRO [email protected]

AK, MT, NV, OR, UT, WY NRHI NV, OR, UT: [email protected], MT, WY: [email protected]

AL, TN QSource [email protected]

DE, NJ, PA, WV Quality Insights [email protected]

IA, ND, NE, SD Telligen [email protected]

AR, CO, KS, LA, MO, MS, OK, PR, TX

TMF [email protected]

Find your local technical assistance contractor here:

https://qpp.cms.gov/about/small-underserved-rural-practices

mailto:[email protected]













PANELIST INTRODUCTIONS

11UNDERSTANDING HOW TO IMPLEMENT TELEHEALTH SERVICES

Samuel “Le” Church, MD, MPH, CPC, FAAFP and

Savannah Kendell, BA, CCMA, Clinical Manager, Synergy Health, Hiawassee, GA



Donna Cohen, RN, BSN, CCM, Deputy Director Population Health QIN-QIO, Alliant Health

Solutions



Kathy Wild, BSN, RN, QPP Project Manager, Quality Insights

QUESTION:

What exactly is telehealth, is that different from

telemedicine, and if so how?



TELEHEALTH AND TELEMEDICINE

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Telemedicine - term commonly used in the past for providing

medical care virtually

Telehealth is one example of telemedicine

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Not a service or medical specialty—it’s a tool to deliver care

Provision of health care and health education using

telecommunication technologies

Greatly reduces capacity in healthcare settings and reduces

unnecessary exposure

Allows patients self-quarantined at home to be remotely

monitored

Allows quarantined providers to continue to treat patients

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EXPANSION OF TELEHEALTH WITH 1135 WAIVER

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Retroactive effective March 1, 2020 through the end of the emergency declaration

Services can originate from home and be provided to patient who is at home

Expands the types of health care professionals that can furnish distant site

telehealth services including physical therapists, occupational therapists, speech

language pathologists, and others, to receive payment for Medicare telehealth

services.

Allows the use of audio-only equipment to furnish services

For more visit:

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COVID-19 Emergency Declaration Blanket Waivers for Healthcare Providers

(4.21.20)

Physicians and Other Clinicians: CMS Flexibilities to Fight COVID-19 (3.30.20)

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https://www.cms.gov/files/document/summary-covid-19-emergency-declaration-waivers.pdf

https://www.cms.gov/files/document/covid-19-physicians-and-practitioners.pdf


BENEFITS OF TELEHEALTH

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Provides opportunity for patients to stay home and receive healthcare for non-emergency

medical conditions

Many services normally provided in-person can be provided via telehealth. This includes

common office visits, mental health counseling and preventive health screenings. View the full

list of covered services.

Promotes coordinated care

Maintains relationship with patient

Generates revenue and reimbursement while reducing practice overhead

Promotes rapid diagnosis by more immediate access to care and remote monitoring

Reduces cancellations by alleviating transportation issues and extended time away from work

Improves patient satisfaction (decreased ‘wait’ time, lack of interruptions, ability to stay home

when not feeling well

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https://www.cms.gov/Medicare/Medicare-General-Information/Telehealth/Telehealth-Codes


CLINICIAN PERSPECTIVE

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Samuel “Le” Church, MD, MPH, CPC, FAAFPSavannah Kendell, BA, CCMA, Clinical Manager,

Synergy Health, Hiawassee, GA

Before I get started with telehealth,

what do I need to consider?



HIPAA CONSIDERATIONS

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HIPAA violation penalties will be waived when this technology is used as long as

providers exercise good faith.

You must ensure the technology is secure; therefore, applications on public platforms

such as Facebook Live, Twitch and TikTok cannot be used.

Telehealth technology platforms offered by IT and EHR vendors can also be used, but

there may be fees involved.

Encourage patient to be alone or with others who they are comfortable listening in

with the clinician.

Clinicians to “meet” with patients in a private room—exam room is a good location.

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TECHNOLOGY PLATFORMS

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TELEHEALTH WORKFLOW ▸

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Team approach!

PRIOR TO APPOINTMENT:

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Clinician: identify patients amenable to telehealth

Administrative staff:

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Call patients and discuss options

Send patient link to audio/video platform with instructions

Schedule practice session with patient

Send reminder the day before appointment

DAY OF APPOINTMENT:

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Clinical support staff: call patient 30 minutes prior to begin patient work-up and

obtain annual consent

Clinician:

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Open audio/video platform and begin visit/examination when work-up completed

Document visit in EHR as the patient is “seen” (best if two devices are used)

Administrative staff: check-out patient and schedule any follow up appointments

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How will telehealth visits affect

MIPS reporting?



TELEHEALTH AND QUALITY MEASURES

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Approximately 1/3 of the 2020 quality measures include telehealth visits: https://www.cms.gov/Medicare/Medicare-General-Information/Telehealth/Telehealth-Codes

To capture as many visits as possible, select measures that include telehealth visit

codes.

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The majority of telehealth codes begin with 9 and have 5 digits OR

Begin with G and have 4 digits after the G

Specification sheets dictate which quality measures can be counted for MIPS.

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The patient encounter code must be an approved telehealth code (current list has 240

codes) AND

The patient encounter cannot state “WITHOUT Telehealth Modifier GQ, GT, 95, POS

02”

4 frequently reported quality measures that do not include telehealth visits:

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ID 110: Influenza Vaccination

ID 128: BMI Screening and Follow-up

ID 226: Tobacco Use Screening and Cessation Intervention

ID 317: Screening for High BP and Follow-up

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https://www.cms.gov/Medicare/Medicare-General-Information/Telehealth/Telehealth-Codes


IMPROVEMENT ACTIVITIES AND TELEHEALTH▸Improvement Activities:

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Annual Wellness Visit

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Can be provided via telehealth as well as audio only

Self-reported vital signs are acceptable and should be noted as self-reported

HCC coding with the annual wellness visit continues to be acceptable just as it was

with a face to face visit

Chronic Care and Preventative Care Management for Empaneled Patients

Other Activities:

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IA_EPA_2 Use of telehealth services that expand practice access (medium weight)

IA_ERP_3 COVID-19 Clinical Trials (high weight)

IA_EPA_1 Provide 24/7 Access to MIPS Eligible Clinicians or Groups Who Have

Real-Time Access to Patient's Medical Record (high weight)

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BILLING CONSIDERATIONS

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Review coding and billing regulations

applicable during the COVID-19

emergency and be aware that they will

probably change when the emergency

is lifted.

Place of Service -as you would

normally bill (Originally POS-02)

Use Modifier 95 for Telehealth

Services

Payment same as in office visits

No changes in out of pocket cost of the

beneficiary

E/M guidelines apply (bullets v time)

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Increasing payments for audio-only

telephone visits to match payments for

similar office and outpatient visits.

Waiving the video requirement for

certain telephone evaluation and

management services and adding

them to the list of Medicare telehealth

services.

CMS is paying for Medicare telehealth

services provided by rural health clinics

and federally qualified health centers.

Contact your Medicare Administrative

Contractor (MAC)

Review the Medicare Telehealth and

Remote Patient Monitory Coding and

Guidelines Toolkit for more information

on billing and coding

https://neqpp.org/telehealth-rpm-guide/

What if my patients don’t have

access to a computer or smart

phone?



OTHER VIRTUAL OPTIONS ▸

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Virtual Check-in: •

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New and established patients can call, text, e-mail or use the patient portal to ask if

an office visit is necessary

Can send a recorded video and/or image to aid in decision (if applicable)

The medical issue cannot be related to a visit within the previous 7 days or lead to a

visit within the next 24 hours (or first available appointment).

E-Visit: ••

Established patients can contact their clinician using the patient portal

The electronic communication can occur over a period of 7 days and is billed based

on the amount of time spent communicating with the patient

Telephone Visits: •••

Covered by Medicare since April 30, retroactive to March 1

Code 99441 (5-10 min), 99442(11-20 min, and 99443 (21-30min)

If the telephone visit ends with a decision to see the patient within 24 hours or next

available urgent visit appointment, the code is not reported (the encounter is

considered part of the pre-service work of the subsequent E/M service, procedure,

and visit)

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I would like to implement telehealth

services. What are some tips for

success?



TIPS FOR WHERE TO BEGIN▸

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Check with your malpractice insurance carrier to ensure your policy covers

telemedicine before you proceed.

Form a small team with at least one clinical person and one non-clinical person to

lead the decision making.

If you have an electronic health record (EHR), contact your vendor to see if they

offer telehealth functionality.

Look at telehealth as an expansion of your revenue

If considering commercial telehealth technology, research and compare each

platform’s capabilities and costs and analyze how each fits into your business

plan.

Consider asking peers or medical associations for recommendations.

Inquire if the vendor will provide timely technical support when needed.

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TIPS FOR WHERE TO BEGIN▸

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Be specific about a workflow—this will depend on the size of your practice

Create an office policy that includes:

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Telemedicine consent

Triage protocol

A list of medical conditions, complaints and visits that are amenable to

telehealth

A process to identify patients with chronic conditions to ensure there is not a

lapse in their healthcare needs

Guidelines on appointment length (for example: initially schedule 20-30 minutes

per telehealth visit to work out technology issues, then decrease time as

everyone gains experience)

A process for referrals

Contact your Technical Assistance Contractor

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QUESTION:

If I still need help, where can I go?


FREE RESOURCES FOR ASSISTANCE FROM CMS

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QPP website: https://qpp.cms.gov/ -- includes information tailored for the needs of

small practices

Contact the Quality Payment Program at: [email protected] or call 1-866-288-8292

Support and Available resources for Small, Underserved, and Rural Practices:


Small Underserved Rural Support Technical Assistance Organizations (see list on slide

10)

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Contact information is available at: https://qpp.cms.gov/about/small-underserved-

rural-practices

Available websites of each Technical Assistance Organization

Types of help: needs assessments, webinars, technical support, links to peers you

can talk with, assistance getting signed up to report through an approved channel

that meets your practice’s needs

Resource Library


https://qpp.cms.gov/




https://qpp.cms.gov/about/resource-library

FREE RESOURCES FOR ASSISTANCE FROM CMS▸

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QPP Participation Status Tool

2020 QPP Final Rule

National Consortium of Telehealth Resource Centers

Coding Resources

CMS General Provider Telehealth and Telemedicine Tool Kit

CMS Physicians and Other Clinicians: CMS Flexibilities to Fight COVID-19

CMS COVID-19 Waivers

CMS COVID-19 FAQs


https://qpp.cms.gov/participation-lookup

https://www.federalregister.gov/documents/2019/11/15/2019-24086/medicare-program-cy-2020-revisions-to-payment-policies-under-the-physician-fee-schedule-and-other

https://www.telehealthresourcecenter.org/resource-documents/

https://www.cms.gov/files/zip/covid-19-telehealth-services-phe.zip

https://www.cms.gov/files/document/general-telemedicine-toolkit.pdf

https://www.cms.gov/files/document/covid-19-physicians-and-practitioners.pdf

https://www.cms.gov/files/document/summary-covid-19-emergency-declaration-waivers.pdf

https://www.cms.gov/files/document/03092020-covid-19-faqs-508.pdf?inf_contact_key=79530e2a4eea4f25d95665fd4500e31d680f8914173f9191b1c0223e68310bb1

WRAP-UP ACTIVITIES

▸ Links to Q&A documents, transcripts, and recordings of the event are

available here: https://qppsurs.com/

▸ July 2020 LAN Webinar: Topic is TBD

• Tuesday, July 14, 2020, 11:00 a.m. – 12:00 p.m. ET

• Thursday, July 16, 2020 3:30 p.m. – 4:30 p.m. ET

▸ Please provide feedback on this event: Feedback Form


https://qppsurs.com/

https://docs.google.com/forms/d/e/1FAIpQLSe0GREbA5Hls3tm22GLbTy4gD35uU2NSmWEuzmN9NmbCHVufA/viewform

REFERENCES

Slide decks created by event panelists also provided information reflected in this presentation. The input from project panelists is gratefully acknowledged.

Telehealth Implementation and Workflow Tips_Quality Insights

“Seeing” your patients virtually with Telehealth Workflows and Billing Considerations_Alliant Health Solutions

Other documents on the https://qpp.cms.gov/ and https://qpp.cms.gov/about/resource-library website provide additional detail about the MIPS program.

Disclaimer: This presentation was current at the time it was published or uploaded onto the web. Medicare policy changes periodically so links to the source documents have been provided within the document for your reference. This presentation was prepared as a service to the public and is not intended to grant rights or impose obligations. This presentation may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations, and other interpretive materials for a full and accurate statement of their contents.


https://qpp.cms.gov/

https://qpp.cms.gov/about/resource-library

APPENDIX: ACRONYMSAPM – Alternative Payment Model

ACO – Accountable Care Organization

CERT—Certified EHR Technology

FORHP— Federal Office of Rural

Health Policy

E&M—Evaluation and Management

Services

FFS- Fee-for-Service

MIPS – Merit-based Incentives

Payment System

MSPB—Medicare Spending Per

Beneficiary

MVP—MIPS Value Pathways

PDMP— Query of Prescription Drug

Monitoring Program

PCMH— Patient Centered Medical

Home

PCP— Primary Care Provider

PI— Promoting Interoperability

PFS - Physician Fee Schedule

IA – Improvement Activities

EHR – Electronic Health Records

TPCC—Total Per Capita Cost

QCDR—Qualified Clinical Data

Registry

QPP – Quality Payment Program

QRDA – Quality Reporting Data

Architecture

QRUR— Quality and Resource Use

Reports

SURS - Small Underserved Rural

Support

TIN—Tax Identification Number

QI - Quality Improvement

QP - Qualifying APM Participant

VBP- Value-Based Purchasing


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