TeleHealth

Telehealth – Virtual Check In and E-Visits: Know the Differences?

Coronavirus (COVID-19) Alert

As a nation we are facing a new chapter in treating patients and we must look at alternative ways healthcare can be delivered to best serve communities during this evolving time. With the safety and health of patients at the highest priority, as of March 1, 2020 providers can submit claims for telemedicine visits by billing your standard E&M CPT codes for New and Established patients. Providers will also receive reimbursement as if the patient were present in your office by using many platforms of interactive video.

In these unprecedented times there have been changes in requirements to provide services to patients. The Center for Medicare and Medicaid services (CMS) continues to issue guidance, below are some screenshots from their website of highlights we here at eMedApps recommend you pay close attention to.

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Type of Service What is the Service? HCPCS/CPT Code Patient Relationship w/Provider
MEDICARE TELEHEALTH VISITS A visit with a provider that uses telecommunication systems between a provider and a patient Common telehealth services include:

For new* or established patients

*To the extent the 1135 waiver requires an established relationship, HHS will conduct audits to ensure that such a prior relationship existed for clients submitted during this public health emergency

Data Credit – CMS.gov

 

KEY TAKEAWAYS:

  • Effective for services starting March 6, 2020 and for the duration of the COVID-19 Public Health Emergency, Medicare will make payment for Medicare telehealth services furnished to patients in broader circumstances.
  • These visits are considered the same as in-person visits and are paid at the same rate as regular, in-person visits.
  • The Medicare coinsurance and deductible would generally apply to these services. However, the HHS Office of Inspector General (OIG) is providing flexibility for healthcare providers to reduce or waive cost-sharing for telehealth visits paid by federal healthcare programs.

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Type of Service What is the Service? HCPCS/CPT Code Patient Relationship w/Provider
VIRTUAL CHECK-INS A brief  (5-10 minutes) Check in with your practitioner via telephone or other telecommunication device to decide whether an office visit or other service is needed. A remote evaluation of recorded video/or images submitted by an established patient
  • HCPCS code G2012
  • HCPCS code G2010
For established patients

Data Credit – CMS.gov

KEY TAKEAWAYS:

  • Virtual check-in services can only be reported when the billing practice has an established relationship with the patient.
  • HCPCS code G2012: Brief communication technology-based service, e.g. virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related e/m service provided within the previous 7 days nor leading to an e/m service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion.
  • HCPCS code G2010: Remote evaluation of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related e/m service provided within the previous 7 days nor leading to an e/m service or procedure within the next 24 hours or soonest available appointment.

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Type of Service What is the Service? HCPCS/CPT Code Patient Relationship w/Provider
E-VISITS A communication between a patient and their provider through online patient portal
  • 99421
  • 99422
  • 99423
  • G2061
  • G2061
  • G2063
For established patients

  Data Credit – CMS.gov

KEY TAKEAWAYS:

  • These services can only be reported when the billing practice has an established relationship with the patient.
  • Patients communicate with their doctors without going to the doctor’s office by using online patient portals.
  • Individual services need to be initiated by the patient; however, practitioners may educate beneficiaries on the availability of the service prior to patient initiation.
  • The services may be billed using CPT codes 99421-99423 and HCPCS codes G2061-G206, as applicable.

Bullet Points Credit: CMS Website

For the full tool kit please visit here

https://www.cms.gov/outreach-education/partner-resources/coronavirus-covid-19-partner-toolkit

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About the Author:

Betsy Anderson
Betsy is a NextGen Certified Professional who has been with eMedApps over 9 years. She is an EPM implementation specialist with a strong revenue cycle management background. She has helped multiple organizations with her powerful analytical skills to identify process issues and implement improvements among a complex payer and specialty mix.