Telehealth in PALTC

COVID-19 and Telehealth Information:

• HHS Telehealth Info

• What will the next year look like for telehealth? 'Well above pre-pandemic levels'

• CDC COCA Call: COVID-19 & Telehealth Implementation: Stories from the Field.

• New Informed Consent Resources for Telehealth from AHRQ

  As the COVID-19 pandemic has forced healthcare providers to limit in-person visits, telehealth has expanded rapidly. In response to the need to obtain informed consent from patients for virtual visits, AHRQ has created a sample telehealth consent form that is easy to understand and guidance for clinicians on how to obtain informed consent for telehealth. Access more information about AHRQ’s telehealth consent form and other health literacy resources.
• Updated 6/16/2020 From CDC: Using Telehealth to Expand Access to Essential Health Services during the COVID-19 Pandemic
• CMS Addresses Society Concerns–Makes Sweeping Changes/Additions to Telehealth Services
• From CMS: Long-Term Care Nursing Homes Telehealth and Telemedicine Tool Kit
• From CMS: (Updated 3-17-2020) MEDICARE TELEMEDICINE HEALTH CARE PROVIDER FACT SHEET
• From CMS: Highlighted telehealth benefits in the Medicare program for use by patients and providers. Expanded use of virtual care are important tools for keeping beneficiaries healthy, while helping to contain the community spread; see the fact sheet on coverage and payment related to COVID-19.

• Society Guidance for Submitting Clean Claims for Telehealth Services During COVID-19 in the Nursing Home Setting (UPDATED 04/09/2020 to reflect new COVID-19 Telehealth Waivers:

1. Originating site (where the patient is located) is furnished in any emergency area during any portion of any emergency period 
   Q3014 Originating Fee is a valid 2020 HCPCS code for Telehealth originating site facility fee or just “Telehealth facility fee” for short.
   • Long description:
     Telehealth originating site facility fee
   • Short description:
     Telehealth facility fee 
     Click here for more information on the code.
2. The patient has been seen by the same or other qualified provider in the same practice (as determined by tax ID)
3. Distal site consult is conducted by a qualified provider (physician or practitioner)
4. Distal site provider billing and coding requirements:
   1. Use appropriate CPT E&M nursing facility code (99304-99310, 99315/16)
   2. Use appropriate Place of Service (POS) Code: 31 SNF; 32 NF
   3. Use modifier 95
   4. Conduct telehealth visits “as appropriate”
5. ICD-10-CM Official COVID-19 Coding Guidelines

1. Please note that you will generally need two codes to describe the scenario until October 1 when new codes will come out. 
   1. Pneumonia: Code for the PNA J12.89 then B97.29; other coronavirus as the cause of diseases classified elsewhere
   2. Acute Bronchitis: J20.8 Acute Bronchitis due to other specified organisms, and B97.29; other coronavirus as the cause of diseases classified elsewhere
   3. Lower respiratory infection (or acute respiratory infection): J22 unspecified acute lower respiratory infection, and B97.29; other coronavirus as the cause of diseases classified elsewhere
   4. ARDS: J80, Acute respiratory distress syndrome, and B97.29; other coronavirus as the cause of diseases classified elsewhere
   5. Concern about exposure to COVID-19 but determined to not have been exposed: Z03.818, encounter for observation for suspected exposure to other biological agents ruled out
   6. Actual exposure to someone with confirmed COVID-19: Z20.828, contact with and (suspected) exposure to other viral communicable diseases
2. If the patient is not known to have COVID-19, and presents with cough, fever, or shortness of breath, just assign the code for that symptom:
   1. R05 Cough
   2. R06.02 Shortness of breath
   3. R50.9 Fever, unspecified
3. ICD-10-CM Official Coding Guidelines

Below are some resources on telehealth in the PALTC setting:

• Quick Guide to Set Up Telemedicine in Your Practice 
• Notification of Enforcement Discretion for telehealth remote communications during the COVID-19 nationwide public health emergency
• A Practical Guide to Telehealth-Implementing Telehealth in PALTC Settings from West Health
• AMDA Position Paper on Telemedicine
• Navigating PALTC: Telemedicine
• AMDA On-The-Go Episode on Telemedicine
• JAMDA article: Standards for the Use of Telemedicine for Evaluation and Management of Resident Change of Condition in the Nursing Home
• Telemedicine Moves From Niche to New Normal
• Billing for Telehealth Encounters-An Introductory Guide on Fee-For Service
• AMDA letter sent to CMS Admistrator Seema Verma on March 13. 
• WEBINAR: Establishing, Billing, and Coding Telehealth Services during the COVID-19 Pandemic

CMS Telehealth Resources:

• CMS State Medicaid & CHIP Telehealth Toolkit
• Telehealth Services Medicare Learning Network Booklet
• Medicare Claims Processing Manual, Chapter 12, Section 190
• Medicare Telehealth Payment Eligibility Analyzer
• List of Covered Telehealth Services Webpage 
• CMS Paid Practitioners for Telehealth Services That Did Not Meet Medicare Requirements OIG Report