Great Plains Telehealth Resource & Assistance Center Telemedicine 101 – “Implementation” April 9, 2018 Maureen Ideker RN, BSN, MBA, LNHA Essentia Health Senior Advisor - Telehealth

Objectives Provide details on Administrative Pre-Work recommended for Telehealth program start-up. Consider templates used for Implementation activates for new telehealth programs, sites & services. Provide usable hand-outs of templates.

Essentia Health 5 State - Footprint

Administrative “Pre-Work” Reimbursement Analysis Business infrastructure considerations Contracting Privileging and credentialing

Administrative Pre-Work: Reimbursement Analysis CMS Telehealth Reimbursement Eligibility Analyzer URL – https://datawarehouse.hrsa.gov/tools/analyzers/geo/Telehealth.aspx

Administrative Pre-Work: Reimbursement Analysis cont.… Involved Admin parties Leadership approvals Internal/External providers Eligible providers, sites & services? CPT codes planned Billing method for professional fees – providers bill/assigned billing rights

Administrative Pre-Work: Reimbursement Analysis cont.… Originating/distant sites Documentation plans ABN/Waivers expected verify reimbursement from expected payers, CMS, MA

Administrative Pre-Work: Business Considerations Finance Partners involved Leadership Approval New service line, locations, accounting unit Rev./Expense estimate – ROI CPT codes, billing method RHC, PBB clinic status concerns Supplies Compensation (Ok to go forward to Contracting)

Administrative Pre-Work: Contracting Compliance Services performed will comply with federal, state, local rules & regs. (HIPAA, Medicare COPs, OSHA, Joint Commission, MDH, Licensures. Med staff bylaws, QI policies) Quality Assurance Evaluation annually to include patient outcomes Data at a minimum any adverse events & formal patient concerns regarding providers of telehealth. Peer review process

Administrative Pre-Work: Privileging/Credentialing Additional form in providers packet List sites for service – payer enrollment Enrolled locations – including remote with addresses

Implementation Templates (Handouts) Implementation Checklist Agenda – Implementation Retreat Proficiency Checklist - Nursing Scope of Service Work Flow Process Map

Checklist for Implementation (Hand-out) 50 Items Administrative pre-work Equipment/Broadband Education on Equipment Scope of Service Workflow - Analysis Documentation Scheduling – open, build template QI

Implementation Retreat Agenda (Hand-out) Pre-Work status QI – File Mtc./Joint Commission Survey Patient Safety Statistics Scope of Services Workflow Business – scheduling Equipment Training

Telehealth Nurse Presenter Proficiency Checklist

Scope of Service (Hand-out) Opportunity Statement Describe services offered List provider full names, credentials Finance – coding/billing Predict volumes Scheduling – open/block Quality metrics – patient outcomes Go-Live date

Work Flow Process Map (Hand-out) Referral Swimlane Safe for telemed? Initials & follow-ups? Chart review required before accepting Scheduling Swimlane 2 appointments (originating/distant) Who contacts patient? Prior authorization steps needed? Registration Swimlane Notification of arrival, ready

Work Flow Process Map cont. Rooming/Nurse Presenter Swimlane Vital signs, PHQ9, AIMS, Screenings Forms (scan or fax) Documentation Charges Guided assessment Patient Safety!!!

Work Flow Process Map cont. Specialist/Provider Swimlane Initiating video connection Documentation (Required elements) Coding Communication-loop process (In-basket, letter, EMR) Check-Out Swimlane AVS Tests, Labs Patient Safety No Tele-Vox

QI – Survey Documents Implementation Retreat Agenda with attachments, final Workflow Process Map, Scope of Service & Meeting Minutes for each service on site. Contract (Final, fully signed, current) List of distant site providers using telehealth for each service Privileging & credentialing, including state licensure(s) verification. Proficiency & Competency Education documents for Telehealth Nurse Presenters. Annual Quality Review Meeting Minutes

Questions?... Maureen.Ideker@essentiahealth.org Maureen Ideker, RN Independent Consultant - gpTRAC (218.371.0596) Maureen.Ideker@essentiahealth.org