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

2. 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.

3. Essentia Health 5 State - Footprint

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

5. Administrative Pre-Work: Reimbursement Analysis
CMS Telehealth Reimbursement Eligibility Analyzer URL –

6. 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

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

8. 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)

9. 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

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

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

12. 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

13. 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

14. Telehealth Nurse Presenter Proficiency Checklist

15. 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

16. 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

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

18. 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

19. 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

20. Questions?... Maureen.Ideker@essentiahealth.org
Maureen Ideker, RN Independent Consultant - gpTRAC
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