Telehealth in a Medical Practice…here to stay and how to do it!

Telehealth in private practice two physicians working on computers

Telehealth in a medical practice is here to stay!  One of the biggest recent changes in the healthcare industry is how people access their doctors. One of the consequences of the coronavirus pandemic is the requirement for social distancing. This has made virtual doctor visits not just an added perk but a necessity, and private practices are now scrambling to put virtual visits into place. Although there are many challenges to successfully implementing telehealth, or any other type of electronic communication in a medical practice, there is no need to face these challenges on your own.


A Telehealth Visit in a Medical Practice

The term telehealth (or telemedicine) has a specific meaning:

  • “Telemedicine” means the practice of medicine using electronic communications, information technology or other means between a licensee (a provider) in one location, and a patient in another location with or without an intervening healthcare provider.
  • Generally, telemedicine is not an audio-only, telephone conversation, e-mail/instant messaging conversation, or fax.
  • It typically involves the application of secure videoconferencing to provide or support healthcare delivery by replicating the interaction of a traditional, encounter in person between a provider and a patient.

Telemedicine and telehealth are more than just chatting with a patient over the phone or using a video conference system.

All of the requirements for a regular doctor’s visit still need to be followed during a patient’s virtual visit:

  • The same documentation required for a face-to-face visit is necessary for a telehealth visit.
  • The administrative staff needs to implement a similar workflow as they do for in-office visits, including scheduling, confirming the appointment, and gathering patient demographic information before the appointment time.
  • Patient privacy and the Health Insurance Portability and Accountability Act (HIPAA) regulations still need to be maintained for electronic doctor’s visits.
  • The patient will still receive treatment information and information about necessary prescriptions, follow-up testing, and further referrals to other providers.
  • The billing department will need to determine the proper procedure codes for the telehealth visit to bill insurance carriers and Medicare or Medicaid.


Other Electronic Communication Possibilities

Additionally, remember that there are several other methods to communicate electronically with patients who are uncomfortable with using audio/visual technology or do not have the means to participate in a telehealth visit.  Each of these methods comes with certain requirements for technology, billing, and documentation.

  • Telephone visits
  • Virtual check-ins visits: professional services only (telephone, audio/visual, secure text messaging, email, or via a patient portal)
  • E-Visits: office visits by providers or other professionals who cannot bill for E&M code office visits (via a patient portal for established patients)
  • Remote patient monitoring. (This involves recording patient information at home, such as vital signs, heart rate, blood pressure, weight, and blood sugar.)


How to Implement Telehealth in a Medical Practice?

Software vendors alone can’t provide a full package of every requirement your practice needs to have a compliant telehealth program. You need to meet patient needs while still maintaining patient confidentiality and complying with HIPAA requirements.

Before you begin scheduling telehealth visits, you need to complete the following steps:

  • Identify your goals. What are the goals you have for your practice? Perhaps it’s patient satisfaction, low wait times, revenue, or patient retention. Think of what you want to achieve before you begin to plan your telehealth options.
  • Consult with your staff. You will need everyone’s cooperation for telehealth to work smoothly. Make sure the physicians, medical staff, and administrative team are all on board with you. Consult with your administrative staff to find out what they need for a proper workflow. They can help brainstorm the most efficient way to transfer their workflow to telemedicine.
  • Choose your technology. Your choice is either a software vendor for telehealth or a chat platform such as Skype or Zoom. If you choose a software vendor, look for one that is easy to use, HIPAA compliant, and able to be integrated into your current electronic health record (EHR) system. However, software vendor regulations have been eased for platforms such as Apple FaceTime and Google Hangouts video. We’ll discuss this more later.
  • Training. For telehealth to run efficiently, the proper training and resources for your staff can encourage them to feel motivated and confident to keep the new process running smoothly.  And make sure patients get information in advance on how a telehealth visit will work.
  • Market your serviceWhen you roll out your service, you want to get the word out to patients as quickly as possible. When patients call in, make sure your staff communicates the telehealth options.
  • Be flexibleAsk your patients and your staff for feedback on the new process. Take their comments into consideration and be prepared to be flexible to meet their needs.
  • Documentation. Continue to document telehealth services as precisely as in-office visits. When providing telehealth care to patients, doctors must continue to document medical necessity. Part of doing this involves using accurate diagnosis codes and the correct procedure coding for payors. Your staff needs to keep updated on the codes, as new ones have been introduced for telehealth.  You must also record the amount of time spent with the patient during such a visit. 
  • Consent. Many states require documentation of the patient’s consent for a telehealth/telemedicine visit with a patient covered by Medicaid.  And it is a good idea to explain the risks and benefits to all patients of using a telehealth approach to visits.


What are the Technology Requirements for Telehealth in a Medical Practice?

There are certain technical requirements that you will need to fulfill before you can get started with telehealth in a medical practice:

  • Secure telehealth technology that enables secure electronic communications between the provider in one location and the patient in another.
  • A computer or mobile device with a high-quality microphone and camera. A wired connection is preferable as it is much more reliable than using WiFi.
  • A reliable internet connection preferably with a high access speed.


Regulations have Eased for Telehealth

The federal government and the states have been adjusting the usual regulations on telehealth to respond to the current crisis. These regulations are changing rapidly and may vary at local levels. Be sure to keep up with the current regulations at the local and federal level.

  • Licensure. Some doctors may now be able to treat patients that do not reside in the same state. Many states are relaxing the requirements that a physician must be licensed in the state to provide care to patients residing in the same state.
  • More choices in HIPAA-compliant telemedicine platforms. Commonly used video apps such as Google Hangouts and Apple’s FaceTime are permitted during the duration of the coronavirus public health emergency. However, HIPAA’s Security Rules are still in effect and can be enforced. You must protect patient information when using these apps.
  • Medicare is expanding its coverageRelaxed requirements of patient location are making it easier for patients and physicians to use telemedicine. For instance, a patient may receive telehealth visits while at home, and providers may also be at home during such a visit.  Additionally, reimbursement relaxations are occurring to help broaden the spectrum of care.  For instance, Medicare just announced that hospitals can bill the facility fee portion of a telehealth visit when the patient is at home, as long as the patient is registered as an outpatient of the hospital.  And telephone-only visits can be billed as telemedicine visits if the patient does not have access to a phone or other device with video capability.


Financial Compensation and Insurance Payments

Insurance companies have been rapidly shifting their policies to respond to the health crisis. They are changing their policies in the following ways to promote telehealth options and expand treatment:

  • Medicare, Medicaid, and insurance companies are expanding their coverage for telemedicine to respond to the pandemic. Many are reimbursing providers for telehealth appointments at the same rate as they would be for an in-person doctor’s visit.
  • Existing CPT codes are being approved for telehealth visits, including mental health services.
  • Many insurance carriers are now waiving cost-sharing or copays for telehealth visits.


Patient Education is Required

Don’t neglect the patient side of telehealth medicine. You can communicate with your patients about what they need to do to prepare for a successful e-visit before their appointment.

Keep in mind that some patients may need help with the technological aspect of telehealth visits. You can provide them with a helpful guide before they begin their appointment. This guide may include the following suggestions:

  • Test their phone (or webcam), volume, and microphone before the visit starts.
  • If using an internet connection, and their internet connectivity is spotty, they can plug directly into their modem for more reliable service.
  • Have them close unnecessary programs before starting the telehealth visit. This will cut down on memory, which can improve the quality of a video chat.
  • Remind them they should find a quiet and private space where they can speak freely.
  • Suggest the patient treats the telehealth visit just as they would a physical visit to their doctor’s office.
  • Remind them to dress appropriately, write down questions ahead of time, and focus their full attention on their visit.

Virtual visits can keep your revenue flow going while safely providing your patients with the medical care that they need. But there a lot of steps to take to get your practice up and running virtually. A consulting firm with a broad range of expertise in EHR software applications, HIPAA regulations, benchmarking and optimal performance in a private practice can help you navigate the many challenges required for successful telehealth in a medical practice.

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