1. Thank You For Joining Us! Tuesday 11/11/2014 Women’s Physician Telemedicine Event

2. Thank You To Our Sponsors! Tuesday 11/11/2014 Women’s Physician Telemedicine Event

3. Thank You To Our Sponsors! Tuesday 11/11/2014 Women’s Physician Telemedicine Event

4. Thank You To Our Sponsors! Tuesday 11/11/2014 Women’s Physician Telemedicine Event

5. Thank You To Our Sponsors! Tuesday 11/11/2014 Women’s Physician Telemedicine Event

6. Thank You To Our Sponsors! Tuesday 11/11/2014 Women’s Physician Telemedicine Event Marnique Sparago and Carol Hakemian-Felt

7. TELEMEDICINE AND HOW TO GET PAID USING IT Eduardo Porras CPC, CPMA AHIMA Certified ICD-10 Instructor Tuesday 11/11/2014 Women’s Physician Telemedicine Event

8. 8 Telemedicine and How to Get Paid Using It 8 Benefits 8 6.5 % Increase in medical costs projected in 2015 -PricewaterhouseCoopers Health Research Institute 70% Of doctor’s visits can be handled via telephone or video conference -The American Medical Association 97% Telemedicine patients treated upon first dial-in attempt -The American Medical Association -

9. 9 Telemedicine and How to Get Paid Using It Agenda 9 What is Telemedicine? Provider Documentation Regulatory Compliance

10. WHAT IS TELEMEDICINE?

11. What is Telemedicine? Telemedicine is a health care delivery method that links a patient and a provider who are not at the same location and is identical to a traditional healthcare visit except for the mode of delivery Via real time video or by Sending clinical information or picture images to a provider for evaluation, consult or treatment via store and forward 11 Telemedicine and How to Get Paid Using It

12. Telemedicine Technologies Live Video – Real-time patient provider evaluations, provider-to-provider discussions Store & Forward – technologies electronically transmit patient information between primary care providers and medical specialists. Information could include digital images, X-rays, video clips and photos. Remote Patient Monitoring – Collection of medical data from patients in one location and electronically transmit to health care providers in a different location, either real-time or store and forward 12 Telemedicine and How to Get Paid Using It

13. PROVIDER TELEMEDICINE ROLES AND TECHNOLOGY

14. Telehealth Technologies: Remote Patient Monitoring 14 Telemedicine and How to Get Paid Using It Hospital emergency depts and intensive care units, and skilled nursing facilities At-home management of patients with chronic conditions

15. Telehealth Technologies: Live Video Teleconsultation 15 Telemedicine and How to Get Paid Using It Variety of high- speed digital telecom Outpatient or Inpatient specialty consultation

16. Telehealth Technologies: Store & Forward 16 Telemedicine and How to Get Paid Using It Often low bandwidth, still images, can store video clips Best used in Dermatology, Ophthalmology, Radiology

17. Two Patterns of Telehealth 17 Telemedicine and How to Get Paid Using It 17 Store-and-Forward Mode of Delivery Interactive Mode of Delivery Referring Provider Consulting Provider Presenting Provider (Patient is Here) Consulting Provider Referring Provider Digital images, sounds, previously recorded video Live Interaction with patient using camera, video, or audio conference equipment

18. Referring Provider Type (sending site) Performs face to face evaluation of patient Determines need for further consultation with another healthcare provider Develops media presentation (store and forward) including complete information of evaluation 18 Telemedicine and How to Get Paid Using It

19. Presenting Provider (Where the Patient is Physically Located) Face to Face visit Introduces a patient to consulting provider during an interactive telemedicine session This provider type is not required and would only be billable during a live interactive session 19 Telemedicine and How to Get Paid Using It Procedure Code GT Required Telemedicine Modifier APPROPRIATE COVERED PROCEDURE CODE FOR PROVIDER TYPE

20. Distant Site (Consulting) Provider Evaluates the patient and/or medical data/images using telemedicine mode of delivery upon recommendation of the referring provider 20 Telemedicine and How to Get Paid Using It Procedure Code Required Telemedicine Modifier APPROPRIATE COVERED PROCEDURE CODE FOR PROVIDER TYPE GT (Interactive Method) GQ (Store-and-Forward Method)

21. MEDICARE TELEMEDICINE POLICIES

22. Medicare Requirements Live Video is the only form reimbursed and originating site is located in: – A rural Health Professional Shortage Area (HPSA); – A county outside of a Metropolitan Statistical Area; or – Or in a federal telemedicine demonstration project (Alaska & Hawaii) 22 Telemedicine and How to Get Paid Using It

23. Medicare Requirements The type of facility the “originating site” can be, are: – Physician or practitioner offices – Hospitals – Federal Qualified Health Centers and Rural Health Clinics – Hospital-based or CAH-based Renal Dialysis Centers – Skilled Nursing Facilities Community Mental Health Centers 23 Telemedicine and How to Get Paid Using It

24. Medicare Requirements Provider/Practitioners who may receive reimbursement: – Physicians – Nurse Practitioners – Physician Assistants – Nurse Midwives – Clinical Nurse Specialists – Clinical Psychologists – Clinical Social Workers 24 Telemedicine and How to Get Paid Using It

25. Rural Counties in Florida 25 Telemedicine and How to Get Paid Using It

26. Reimbursable services in Medicare: Tele-consultations-emergency or initial inpatient Office evaluations Follow-up inpatient in hospitals or SNFs Subsequent hospital care: 1 telehealth visit/3 days SNF subsequent care: 1 telehealth visit/30 days Individual psychotherapy & group behavioral assessment and intervention Individual and Group diabetes self-management and training and medical nutrition therapy Smoking cessation 26 Telemedicine and How to Get Paid Using It

27. Reimbursable Medicare Codes 27 Telemedicine and How to Get Paid Using It

28. Reimbursable Medicare Codes 28 Telemedicine and How to Get Paid Using It

29. Medicare Telehealth Payments Specific codes with modifier GT Payments to both distant site provider, and originating site facility 29

30. MEDICAID TELEMEDICINE POLICIES

31. Medicaid Programs CMS reimbursement policy – State may reimburse for telehealth under Medicaid so as long as the service satisfies federal requirements of efficiency, economy, and quality of care 31 Telemedicine and How to Get Paid Using It

32. Common Medicaid Reimbursement Policies 44 states reimburse for some live video 10 states reimburse for remote patient monitoring Only 7 states have partial store & forward reimbursement 17 states reimburse for transmission/facility fee Reimbursement policies vary for all states! 32 Telemedicine and How to Get Paid Using It

33. AHCA – Florida Medicaid For the purposes of reimbursement FL Medicaid follows CMS guidelines regarding the definition of telemedicine Only physicians can provide and receive reimbursement for telemedicine services Originating site does not receive reimbursement unless the provider at the site performs a separately identifiable service for the recipient on the same day as the telemedicine service The only codes reimbursed for telemedicine purposes are the consultation codes 99241 through 99255 No mention of rural location requirement 33 Telemedicine and How to Get Paid Using It

34. COMMERCIAL CARRIER GUIDELINES

35. 35 Telemedicine and How to Get Paid Using It Private Payers Private payers today are embracing – and reimbursing – a broad range of telemedicine services as a way to squeeze savings out of the current system

36. PROVIDER DOCUMENTATION

37. Provider Documentation Follow same requirements as face to face to meet CPT standards for coding – remember SOAP notes Always remember that the information you send/receive becomes part of the patient’s medical record As with all medical records, it is important to clarify the encounter so that coders aren’t making judgment calls Do not assume! 37Telemedicine and How to Get Paid Using It

38. Guidelines to Remember New Patient – A new patient is one who has not received any professional services from the provider or another provider of the same specialty who belongs to the same group practice, within the past three years Established Patient – An established patient is one who has received professional services from the provider or another provider of the same specialty who belongs to the same group practice, within the past three years 38 Telemedicine and How to Get Paid Using It

39. REGULATORY COMPLIANCE

40. 40 Telemedicine and How to Get Paid Using It Authentication Issues regarding privacy and confidentiality in the medical realm are not different in telemedicine HIPAA Rules and Regulations Regulatory Compliance

41. 41 Telemedicine and How to Get Paid Using It HIPAA and Telehealth Telemedicine services have the same duty to safeguard, store and maintain privacy records All transmitted data has to be via “secure” means - this excludes Face Time and Skype applications as commonly used today

42. CLOSING THOUGHTS

43. Thank You If you would like more information on this topic or other ways to increase your reimbursements, contact us directly. Call us: 1-877-AVISENA E-Mail: marketing@avisena.commarketing@avisena.com Visit us at www.avisena.comwww.avisena.com Presenter: Eduardo Porras CPC, CPMA Director of Operations Avisena, Inc Phone 786-621-3879 Eporras@Avisena.com 43 Telemedicine and How to Get Paid Using It