Question 1

What is TeleHealth?

Accepted Answer

Telehealth is the ability for your physicians to provide services to patients remotely via electronic information and telecommunication technologies.   It allows long distance patient/clinician contact and care, advice, reminders, education, intervention, monitoring and remote admissions.

Question 2

What Financial Benefits does TeleHealth offer?

Accepted Answer

CMS has proposed three new code sets for services to be covered under specific conditions Virtual Check-Ins, officially titled “Brief Communication Technology-Based Service" Asynchronous Images and Video, officially titled “Remote Evaluation of Pre-Recorded Patient Information” Peer-to-Peer Internet Consults, officially titled “Interprofessional Internet Consultation.

Question 3

Virtual Check-Ins / Brief Communication Technology-Based Service

Accepted Answer

Virtual check-ins are defined by a physician (or other qualified health care professional who can report evaluation and management services) digitally interacting for 5-10 minutes (telephone interactions or audio interactions enhanced with video) with an established patient.

Question 4

How will Asynchronous Visits be Supported?

Accepted Answer

Asynchronous telemedicine is efficient, patient-centered, and aligns with how many service providers deliver non-healthcare and online services today. CMS’ coverage of these services sends a strong message, both to medical boards and commercial health plans, that asynchronous telemedicine is an important and clinically-valid tool through which providers can deliver healthcare services. The new code, HCPCS GRAS1, for “Remote Evaluation of Pre-Recorded Patient Information,” which would reimburse for a provider’s asynchronous review of “recorded video and/or images captured by a patient in order to evaluate the patient’s condition” and determine whether or not an office visit is necessary.  This type of review is also referred to as “store-and-forward” communication technology.

Question 5

About Peer-to-Peer Internet Consults

Accepted Answer

The third category of new virtual care codes is reimbursement for peer-to-peer internet consultations.   Under the new CPT codes 994X6, 994X0, 99446, 99447, 99448, 94449, CMS will pay for:   “Assessment and management services conducted through telephone, internet, or electronic health record consultations furnished when a patient’s treating physician or other qualified healthcare professional requests the opinion and/or treatment advice of a consulting physician or qualified healthcare professional with specific specialty expertise to assist with the diagnosis and/or management of the patient’s problem without the need for the patient’s face-to-face contact with the consulting physician or qualified healthcare professional.”

Question 6

Are there any Limitations?

Accepted Answer

Frequency Limitations - CMS did not propose to impose a frequency limit on the use of virtual check-ins by the same practitioner with the same patient.

Timeframe Limitations - Under the proposed virtual check-in code, CMS would reimburse providers for “5-10 minutes of medical discussion” so long as an E/M was not provided within the previous seven days.

Additionally, in order for the code to apply, the virtual check-in appointment must not lead to an E/M or procedure within 24 hours of the appointment or soonest available appointment.

This is similar to how CMS views coverage of telephone consults, and the AMA has historically advocated for separate coverage and reimbursement for telephone consults.

Other Limitations - None of these codes require the use of interactive audio-video technology, nor do they require the patient be located in a rural area or a specific qualifying originating site.

Moreover, CMS’ proposal to cover asynchronous telemedicine and non-face-to-face services is a major recognition of the validity of asynchronous telemedicine (also known as store-and-forward medical care without the use of interactive audio-video or a face-to-face exam).

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