by Marty Kotlar, DC, CPCO, CBCS
President of Target Coding
#1 TeleHealth
Telehealth is the use of an interactive audio and video telecommunications system that permits real-time communication between a provider and a patient. Patients should have a prior established relationship with you, however, during the COVID-19 public health emergency (PHE) it could be a new patient. HHS will not conduct audits to ensure that such a prior relationship existed for claims submitted during this PHE.
Counseling/coordination of care and clinical decision-making become the key components and the deciding factor in choosing the proper telehealth E/M code (e.g., 99212, 99213) to report. Clinical decision-making refers to the complexity of establishing a diagnosis and/or selecting a management option which is determined by considering the amount and/or complexity of medical records, diagnostic tests, and/or other information that must be obtained, reviewed, and analyzed. The number of diagnoses and/or the number of management options that must be considered. And the risk of significant complications, morbidity and/or mortality, as well as comorbidities, associated with the patient’s presenting problem(s), the diagnostic procedure(s), and/or the possible management options.
The Wall Street Journal stated that telehealth services, which have been around for decades, are getting a boost with patients avoiding in-person doctor visits because of the coronavirus pandemic. Many practices from small offices to large health systems are now using telehealth and quickly scaling up their services to meet the demand. Since the start of the PHE, the use of telehealth services has increased by 50% nationwide, according to research by Frost and Sullivan consultants, and virtual interactions could reach nearly 1 billion by the end of this year, according to some analysts. “I think the genie doesn’t go back in the bottle after this is all over,” said Jonathan Baker-McBride, corporate manager of Telehealth, Telecare, and Remote Patient Monitoring at Orlando Health. “We have made 10 years of progress in probably two to three weeks.”
Doctors are realizing, in some ways, telehealth is rewarding. It’s more intimate seeing people in their homes. It’s more of a connection than when you’re in a busy office setting. You can see their worry and angst, their vulnerability. It’s an honest conversation and you can figure out the next steps in their care. Florida BC/BS waived the copay and increased access to virtual visits for its members. Before the pandemic, the insurer typically had 9,000 to 10,000 people use telehealth each month. Through March 2020, the number of users has increased by more than 400%.
Telehealth technology enables the remote diagnoses and evaluation of patients in addition to the ability to remote detection of fluctuations in the condition of the patient so that the specific therapy can be altered accordingly. E-visits are not telehealth. CMS describes e-visits as “non face-to-face patient-initiated digital communications that require a clinical decision that otherwise typically would have been provided in the office.” The code descriptors for the HCPSC codes related to e-visits suggest that the codes are intended to cover short-term (up to seven days) assessments and management activities that are conducted online or via some other digital platform and include any associated clinical decision-making. An e-visit is considered a service furnished remotely using technology but is not considered a telehealth service. An e-visit does not constitute telehealth under Medicare. With commercial payer policies, the answer varies, so check with your payer.
#2 Acupuncture
As of January 1, 2021, Medicare will cover acupuncture for chronic low back pain. Up to 12 visits in 90 days will be covered. An additional 8 visits will be covered if the patient is showing improvement. No more than 20 treatments will be covered annually. Treatment must be discontinued if the patient is not improving or regressing. Physician assistants, nurse practitioners, and auxiliary personnel may furnish acupuncture if they meet all applicable state requirements and have a masters or doctoral-level degree in acupuncture or Oriental Medicine from a school accredited by the Accreditation Commission on Acupuncture and Oriental Medicine (ACAOM) and current, full, active, and unrestricted license to practice acupuncture in a State, Territory, or Commonwealth of the United States, or District of Columbia.
#3 Patient Gets the Insurance Check
It hurts when an insurance company doesn’t pay your bills. It hurts even more when a patient “suddenly disappears” because they got the insurance check and kept your money. Get proactive to ensure you get paid what you deserve.
On the initial visit, make sure the patient is made aware that insurance reimbursement checks and explanation of benefits (EOBs) will be arriving in the mail. Have the patient review and sign your financial policy. Make sure the patient understands the arrangement and agrees to pay any outstanding balances once the insurance company has received all your bills.
Here are a couple of other strategies to ensure payment: 1) Provide the patient with a few self-addressed stamped envelopes. Instruct the patient to mail the checks and EOBs as soon as possible…this is better than telling the patient to bring in the checks on the next visit. 2) Have the patient sign a form that provides credit card authorization just in case the patient “suddenly disappears” – check with your state board to see if you’re allowed to hold a credit card on file.
Would you like to schedule a FREE 15-minute consultation with Dr. Kotlar? Click the link and pick your meeting time. https://go.oncehub.com/DrKotlar
Dr. Marty Kotlar is the President of Target Coding. Over the last 12 years, he has helped hundreds of chiropractors, physical therapists, and acupuncturists with compliance as it relates to billing, coding, documentation, Medicare & HIPAA. Dr. Kotlar is certified in compliance, a certified coding specialist, a contributing author to many coding and compliance journals, and a guest speaker at many state association conventions. He can be reached at 1-800-270-7044, website – www.TargetCoding.com, email – drkotlar@targetcoding.com.
Why is the Discount Challenge prize amount $11,181? Because that is the average “per-occurrence” fine for Medicare inducements. That’s not $11,181 per patient, that’s not per provider, that’s PER VISIT. Stinks, doesn’t it? To us, the prize amount is worth the investment if we can help our profession better understand proper discounting.