RefeRence Guide foR Physicians

What is telemedicine?
Telemedicine is the use of electronic information, imaging and communication technologies to provide and support health care services. Telemedicine includes consultative, diagnostic and treatment services between specialty and primary care physicians and their patients. Medicare and several other third-party payors now provide reimbursement for telemedicine services in order to connect providers and patients, enabling access to advanced equipment and specialists to make better diagnostic, management and treatment decisions for the patient without the need to leave their community. Healthcare providers can share test results, radiologic images and other information about the patient. Using live, high quality video and audio, providers can analyze the tests, and talk directly to the patient and his or her local provider. Regional Telemedicine Network (RTN) is a non-profit organization formed, To enable efficient communication and collaboration between healthcare providers and patients, and productive cooperation among various community healthcare assets when geographic distance is a barrier.

Why telemedicine?

Telemedicine has been growing rapidly for 40 years because it offers key benefits: 1. improved access: Telemedicine is currently being used throughout the U.S. to bring health care services to patients in distant locations, improving access for patients, and allowing physicians and health care facilities to expand their reach. In the case of community-based physicians, telemedicine has the potential to keep more patients in the local community to obtain specialty services through their own practices. This presents an enhanced business opportunity for physicians in the local community, many of whom have experienced a drain of routine medical services to urban medical centers. 2. cost efficiencies: Telemedicine has been shown to reduce the overall cost of health care and increase efficiency through better management of chronic diseases, shared staffing, reduced travel time, and fewer and/or shorter hospital stays. 3. Patient demand: Consumers are becoming familiar with telemedicine. The Internet has become a resource for many patients wanting to know more about their health concerns and overall wellness, and seek immediate, fast information. Telemedicine technologies can have great impact on patient satisfaction because they can spend less time traveling and more time with their families. 4. new source of Revenue: Telemedicine offers the opportunity to provide care for your patients while generating additional revenue for these visits. Details on billing and reimbursement for telemedicine services are provided in the telemedicine reimbursement document.

When can i use telemedicine?

RTN is available for use in a variety of different clinical environments, with a wide range of specialties. Key usage environments for telemedicine include: Physician offices, for patient visits and consultation with specialty providers Emergency Departments, for rapid assessment and collaboration between ED providers and specialty physicians Other Hospital departments, for potential sharing of services and other collaborative opportunities that will benefit from live video and audio interaction RTN connectivity will be available 24 hours a day, 7 days a week, with technical support available Monday-Friday from 8 a.m. to 4:30 p.m., excluding holidays. Any telemedicine visits taking place outside of these technical support hours will be considered off-hours and subject to technical support availability.

hoW do i use telemedicine?

RTN will provide telemedicine equipment and connections through secure networks that meet or exceed the current industry, government and regulatory standards. RTN and its health care providers will ensure that only appropriate individuals have access and participate in the telemedicine sessions. RTN will link specialty healthcare providers to clinics and smaller, regional hospitals in rural areas. The links will use dedicated high-speed lines or secure Internet connections for telecommunication, videoconferencing and data transfer. Telemedicine appointments require the provider to perform an exam of the patient who is many miles away. In order to accomplish this task, an individual with a clinical background (e.g., medical assistant, LPN, RN, etc) trained in the use of the equipment must be available at the rural (originating) site to present the patient and perform any hands-on activities to successfully complete the exam. For example, examination of the lungs requires placement of a stethoscope to auscultate breath sounds, or a neurological diagnostic exam may require testing a patients reflexes. In certain cases (i.e. some dermatology or mental health appointments) a presenter with a clinical background is not necessary, because the presenter may only need to operate the digital video camera.

What Patients aRe candidates foR telemedicine?

The decision to use the telemedicine visit as a means to provide health care services ultimately rests with the health care provider. The patients clinical condition should be suited for live visual and audio presentation and within the technical capabilities of the equipment. Joining the cutting-edge group of physicians utilizing the RTNs equipment and connectivity is easy. RTN provides physician practices and hospitals equipment, hands-on training, technical support and expertise for telemedicine. For more information or to add telemedicine to your practice, contact Philip Wolford, RTN Telemedicine Coordinator, at 814/452-5766.

TELEMEDICINE REIMbuRsEMENT
TELEMEDICINE REIMbuRsEMENT
Regional Telemedicine Network (RTN), realizes the impact that reimbursement and regulatory issues have on successful development and sustainability of telemedicine programs. As with all technology, increased utilization will enhance cost effectiveness and benefit patients and providers. Regardless of reimbursement and regulatory issues for Telemedicine, multi-purpose use of RTNs distant technologies for healthcare administration and medical education in the healthcare environment has proven a cost effective method of accomplishing day-to-day business. Medicare, Medicaid and private payer telemedicine reimbursement will be outlined below.

TELEMEDICINE REIMbuRsEMENT

Medicare

The Center for Medicare and Medicaid Services (CMS) administers Medicare programs in the United States. Medicare policy regarding payment of services is located in several documents. Information from these documents, national legislation, intermediary decisions and other sources has been used to provide this broad overview of Medicare coverage healthcare services delivered via telecommunications technology.

MEDICaRE CovERagE of TELEMEDICINE sERvICEs

Medicare reimbursement for telemedicine services is divided into three areas: 1. Remote patient face-to-face services seen via live video conferencing 2. Non face-to-face services that can be conducted either through live video conferencing or via store and forward telecommunication services 3. Home telemedicine services In addition, national and local coverage determinations may alter or expand the services that are eligible for reimbursement. 1. Remote Patient face-To-face, Interactive services CMS defines telemedicine services to include those services that require a face-to-face meeting with the patient. Reimbursement is dependent upon the type of services provided, geographic location, type of institution delivering the services and type of health provider. Location of facility The service must be provided to an eligible Medicare beneficiary in an eligible facility (originating site) located outside of a metropolitan area (i.e. a non-metropolitan statistical area (MSA)). However, there is no limitation on the location of the health professional delivering the medical service (referring site). Eligible facilities Only the following facilities are eligible to be an originating site under the rules of the program: The office of a physician or practitioner A hospital A critical access hospital A rural health clinic A federally qualified health center

Eligible Medical services Services that are eligible for reimbursement include consultation, office visits, individual psychotherapy and pharmacologic management delivered via a telecommunications system. The official CMS policy reads as follows: The use of a telecommunications system may substitute for a face-to-face, hands on encounter for consultation, office visits, individual psychotherapy and pharmacologic management. These services and corresponding current procedure terminology (CPT) codes are listed below. Consultations (CPT codes 99241 - 99275). Office or other outpatient visits (CPT codes 99201 - 99215). Individual psychotherapy (CPT codes 90804 - 90809). Pharmacologic management (CPT code 90862). Psychiatric diagnostic interview examination (CPT code 90801) (Effective March 1, 2003). End stage renal disease related services (HCPCS codes G0308, G0309,G0311, G0312, G0314, G0315, G0317, and G0318). (Effective January 1, 2005). Individual Medical Nutrition Therapy (HCPCS codes G0270, 97802, and 97803) (Effective January 1, 2006)

Eligible Providers Only the following health professionals may claim reimbursement for remote telemedicine services: Physician Nurse practitioner Physician assistant Nurse midwife Clinical nurse specialist Clinical psychologist* Clinical social worker* Registered dietitian or nutrition professional

* Clinical psychologists and clinical social workers cannot bill for psychotherapy services that include medical evaluation and management services under Medicare. These practitioners may not bill or receive payment for the following CPT codes: 90805, 90807, and 90809. Reimbursement amounts Reimbursement to the health professional delivering the medical service at the referring site is the same as the current fee schedule amount for the service provided. Claims for reimbursement should be submitted using the appropriate CPT code for the professional service provided and the telemedicine modifier GT via interactive audio and video telecommunications system. Separately, the rural facility at which the patient is located (the originating site), is eligible to receive a facility fee using HCPCS code Q3014. Medicare payment may be made when the patient is located in a rural area (i.e. the facility is located in a non-metroplitan statistical area (MSA)).

Claims submission Claims for professional consultations, office visits, individual psychotherapy, and pharmacologic management provided via a telecommunications system are submitted to the carrier that processes claims for the performing physician/practitioners service area. Referring (specialty) site Physicians/practitioners submit the appropriate CPT procedure code for covered professional telemedicine services along with the GT modifier (via interactive audio and video telecommunications system). By coding and billing the GT modifier with a covered telemedicine procedure code, the distant site physician/practitioner certifies that the beneficiary was present at an eligible rural originating site (see eligible facilities) when the telemedicine service was furnished. originating site To claim the facility payment, physicians/practitioners will bill HCPCS code Q3014, telemedicine originating site facility fee; short description telemedicine facility fee. The type of service for the telemedicine originating site facility fee is 9, other items and services. For carrier processed claims, the office place of service (code 11) is the only payable setting for code Q3014. There is no participation payment differential for code Q3014 and it is not priced off of the Medicare Physician Fee Schedule Database file. Deductible and coinsurance rules apply to Q3014. By submitting HCPCS code Q3014, the biller certifies that the originating site is located in either a rural HPSA or a non-MSA county. 2. Remote Non face-to-face services Services delivered using telecommunications technology but not requiring the patient to be present during their implementation are covered the same as services delivered when on-site at the medical facility. A service may be considered to be a physicians service where the physician either examines the patient in person or is able to visualize some aspect of the patients condition without the interposition of a third persons judgment. Direct visualization would be possible by means of x-rays, electrocardiogram and electroencephalogram tapes, tissue samples, etc. For example, the interpretation by a physician of an actual electrocardiogram or electroencephalogram reading that has been transmitted via telephone (i.e., electronically rather than by means of a verbal description) is a covered service. These remote services are NOT considered telemedicine by CMS. Rather, they are considered the same as services delivered on-site and are to be coded and will be paid in the same way. There are no geographic or facility limitations on these services. The largest single specialty providing remote services under this policy is radiology. However, the use of telecommunications in delivering pathology, cardiology, physician team conferences and other services are also covered. Special CPT Codes are used for the remote assessment of pacemakers as well as the collection and assessment of data from cardiac event recorders. Complete Medicare Telemedicine regulations: www.cms.hhs.gov/Transmittals/Downloads/R1798B3.pdf

Private Payers Each payer independently determines if they will reimburse for telemedicine services with the exception of those providing coverage in states that have legislatively mandated third party payers to reimburse for telemedicine. Coverage will vary from state or region and can be verified with the individual payer. Specific billing codes that signify a telemedicine encounter may or may not be required. RTN has begun a telemedicine advocacy effort with regional payors and will offer guidance to providers. Healthcare economic and reimbursement information provided by Regional Telemedicine Network (RTN) is gathered from third-party sources and is subject to change without notice as a result of complex and frequently changing laws, regulations, rules and policies. This information is presented for illustrative purposes and does not constitute legal or healthcare reimbursement advice. RTN encourages providers to submit accurate and appropriate claims for services. It is always the providers responsibility to determine medical necessity, the proper site for delivery of any services and to submit appropriate codes, charges and modifiers for services that are rendered. RTN recommends that providers consult with their payers, reimbursement specialists and/or legal counsel regarding coding, coverage and reimbursement matters. for additional Information visit: Saint Vincent Health System www.saintvincenthealth.com American Telemedicine Association www.atmeda.org Telemedicine Information Exchange http://tie.telemed.org/ Office for the Advancement of Telehealth www.hrsa.gov/telehealth/publications.htm