Prior to the visit:
Scheduling
It is important to understand where in your schedule you are booking telemedicine visits. Are they going to be in-between regular appointments, or do you have a certain time frame blocked off in your schedule just for telemedicine appointments? How will your patients book telemedicine appointments? Make sure that you include the booked time in the existing scheduling system you use. Share any appointment details and information on how to join in for the appointment with the patient ahead of time.
Patient Education
In this part of the workflow include activities such as educating patient on telemedicine and what they should expect from their visit. It could be as simple as forwarding a “patient flyer” detailing the steps to join virtual appointments before their first telemedicine appointment. Check if they have any one of the supported devices for the virtual appointment, as well as if they understand the steps, they need to take to connect with you. Patients might have different levels of comfort with technology and some things that may seem straight forward and easy to you might not be easy for them. Ask questions like “Do you understand how to access the link in the text and join for the appointment?”; “Do you have a device that has access to the internet?” ;“Do you have stable internet connection at home/place you are planning to use when attending the appointment?”
Regulatory Compliance
Make sure you understand the telemedicine policies and regulations governing patient under private or public payer systems. If patients are across state lines, additional considerations with respect to state laws need to be made. Practitioners may only provide care in the states they are licensed to practice. In addition, ensure that telemedicine is covered in the liability insurance of the practitioners that will be performing the virtual appointments.
During the visit:
Connecting and troubleshooting potential issues
To begin telemedicine appointment, connect with the patient and make sure that they can see and hear you. Have a plan of action in case either side experiences technical difficulties with their devices or internet connectivity. Do you have necessary information to troubleshoot the issues? Will you switch to a phone call or will you reschedule?
Conduct the appointment
Start the appointment by validating patient information and making sure that the patient is comfortable with the set up. Interact with the patient and take notes that you will use to update their EHR records and to create a follow up care plan.
After the visit – The Follow-Up:
Codes and Billing
Be familiar with the CPT codes that are used for telehealth interaction to provide complete information for the billing processing.
Patient Follow-Up
Share any follow up care plans, issuing prescriptions, regimen to follow, or information on the condition with the patient.
Reference for this section: Telehealth Implementation Playbook, American Medical Association
Getting reimbursed for telemedicine appointments
The reimbursement policies governing telemedicine visits vary based on the type of the insurance the patient has and the state regulations. Due to COVID-19, many existing guidelines have been changed and coverage expanded.
Centers for Medicare & Medicaid Services (CMS) has been regularly making changes to their guidelines to reduce the need of patient visits or hospital stays post procedures with the goal to minimize COVID-19 infections. In addition, they introduced parity for Telehealth services allowing using the same POS code for Telehealth and in-person visits. They also included remote patient monitoring, remote supervision, hospice care and nursing homes in their scope.
Guidelines vary from state to state. Some states allow only the specific patient setting for telemedicine appointments (like home, schools, or schools-based health center), while some have specific reimbursement criteria covering only specific types of providers. In addition, states have different parity laws, which can significantly impact the costs and reimbursements. This is why it is crucial to understand applicable laws and procedures in the states you are practicing telemedicine.
Private insurance covers the largest segment of health insurance coverage. The adoption of telehealth in private insurance plans was relatively low until COVID-19 but has been significantly increased since.
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