Telemedicine

[callmeanesthesia]

Seems like facetime with your iphone is the only way to easily be able to do video and audio? Our group is trying to figure out the easiest most efficient way to be able to do both video and audio but its proved challenging. CMS is reimbursing 13 bucks for audio only...

doxy.me

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[SSdoc33]

Seems like facetime with your iphone is the only way to easily be able to do video and audio? Our group is trying to figure out the easiest most efficient way to be able to do both video and audio but its proved challenging. CMS is reimbursing 13 bucks for audio only...

are you sure? that sounds like the telephone codes, the 9944x, rather than the typical e/m 9920x or 9921x.

 

[10KHertz]

Many insurances are waiving “synchronous “ video telemedicine requirements. You may just use a telephone conversation with or without “asynchronous “ video.

That is, you can just use the phone for 90day for SOME carriers. You have to look up their individual policies...

 

[deleted472101]

How to Use Telehealth

www.mssny.org

 

[PMR2008]

Many insurances are waiving “synchronous “ video telemedicine requirements. You may just use a telephone conversation with or without “asynchronous “ video.

That is, you can just use the phone for 90day for SOME carriers. You have to up their individual policies...

Any link or proof you can share? thanks

 

[hyperalgesia]

Many insurances are waiving “synchronous “ video telemedicine requirements. You may just use a telephone conversation with or without “asynchronous “ video.

That is, you can just use the phone for 90day for SOME carriers. You have to up their individual policies...

Good. At least for a few months, health care decisions should be made by docs and patients.

 

[jewwithguitar]

For those currently using or planning to use Audio + Video Telehealth, what elements of physical exam do you plan on documenting? Easy things seem to be General Appearance, Orientation, Mood, ROM, Gait, functional strength tests (i.e. walking on toes and heels)? Looking for any other suggestions to maximize PE components. Clearly not ideal, but I think this is the right thing to do from a risk/benefit perspective for the individual patient and our communities. Thanks in advance. Stay safe everyone!

 

[Ducttape]

you can skype. there are a few other platforms that are okay.
tiktoc is not one of them.

 

[NeuroGuyIP]

you can skype. there are a few other platforms that are okay.
tiktoc is not one of them.

Is anyone doing telemedicine video consults for new patients or just return patients? I work for a health system that has placed a moratorium on procedures as well as most ancillary services like imaging and PT until 5/1. Just wondering how you guys would approach new patient evals based on the above.

 

[10KHertz]

Any link or proof you can share? thanks

You should be getting emails from your insurance carriers regarding their state specific policies. It’s tedious but you should review each telemedicine policy. This may be the new norm in the future...

Sounds like the Fed is setting a timeline to reopen businesses once the curve abates. 2-3 weeks.

Take super vitamin D (5000 units) if you feel sick...

 

[CalH22a]

What’s the difference between the GT modifier and 95 modifier?

 

[10KHertz]

What’s the difference between the GT modifier and 95 modifier?

There is no pattern. Some carriers use 95 some use GT. Medicare and most insurances uses 95, One local carrier uses GT. Again randomness laid out in their policies for outpatient sites (02)

 

[lobelsteve]

Updates from CMS (and Georgia).

 

[geauxg8rs]

Updates from CMS (and Georgia).

This is a good update, if you get more can you post? Thanks

 

[HouseofPain]

I’m in TN and using OrthoLive ($200/month). Super easy had a nurse walkthough a 93y today for a visit without issues. The DEA is allowing prescription of schedule II by telemedicine (COVID-19 Information Page). We are able to send them electronically with 2FA. You can bill just as an office visit although will not be able to bill more than 99203 for new patient (have to have vitals for level 4). Billing level 4 for follow up is easy even without a physical exam. Yesterday was my last procedure day and we are not doing any clinic visits except for post surgery follow up for the next 4 weeks so this has been a godsend for us as well as patients. Also should check with each carrier as they all have different dates when they will stop paying for telemed visits.

 

[Ligament]

I’m in TN and using OrthoLive ($200/month). Super easy had a nurse walkthough a 93y today for a visit without issues. The DEA is allowing prescription of schedule II by telemedicine (COVID-19 Information Page). We are able to send them electronically with 2FA. You can bill just as an office visit although will not be able to bill more than 99203 for new patient (have to have vitals for level 4). Billing level 4 for follow up is easy even without a physical exam. Yesterday was my last procedure day and we are not doing any clinic visits except for post surgery follow up for the next 4 weeks so this has been a godsend for us as well as patients. Also should check with each carrier as they all have different dates when they will stop paying for telemed visits.

What makes ortholive worth $200/mo when doxy.me is free? You are having your nurse do the telemedicine visit? How do you bill for an RN to do it?

 

[HouseofPain]

What makes ortholive worth $200/mo when doxy.me is free? You are having your nurse do the telemedicine visit? How do you bill for an RN to do it?

I don’t know what all of the features are with doxy. This was chosen as a group. It does interconnect with our scheduling and billing software however so I think that was the main reason. Basically the nurse just sets up an appointment through Ortholive for the patient via phone. The patient then gets a text/email with link to download app. Once they download the app and get their profile set up they are able to access their appointment at the appropriate time. I get notifications once they are logged in and ready to be seen and do everything off my iPhone/iPad. It’s interface is like a virtual office. You have different scheduling options, etc. Very user friendly for the patient.

 

[Ducttape]

or facetime or skype...

 

[10KHertz]

or facetime or skype...

I can’t use my daughters Tick Tock app?

 

[Ducttape]

nope.

Use of public-facing remote communication products, such as TikTok, Facebook Live, Twitch, or a chat room like Slack, which OCR has identified in the Notification as unacceptable forms of remote communication for telehealth because they are designed to be open to the public or allow wide or indiscriminate access to the communication.

https://www.hhs.gov/sites/default/files/telehealth-faqs-508.pdf

 

[SommeRiver]

Doesn't Grindr have a video chat option?

 

[BobBarker]

Doxy.me is nearly perfect. Best $35 ever spent. Keep those E&Ms going.

 

[jewwithguitar]

Doxy.me is nearly perfect. Best $35 ever spent. Keep those E&Ms going.

what features of the paid version have you utilized that make it superior to the free option?

 

[BobBarker]

Send the link via text. Old people
dont like clicking on links in email. Better patient catchment as a result. We do t have emails on file for the majority of patients either. Also the text is much more in your face. People are trained to ignore emails.

 

[Dr. Ice]

Send the link via text. Old people
dont like clicking on links in email. Better patient catchment as a result. We do t have emails on file for the majority of patients either. Also the text is much more in your face. People are trained to ignore emails.

Are you having connection issues. That seems to be our and others major issue with telehealth. The servers are flooded and so connection is poor and slow with dropped calls. Of course we are using free software. Are you experiencing the same issue with paid software?

 

[BobBarker]

No issues

 

[DOctorJay]

sometimes it puts a red banner at the top saying there's a server issue but it still works. if patient can't do it I convert to FaceTime.

no reason you or your receptionist can't text someone your link as well.

 

[PMR’s chill]

I'm looking to hire a medical assistant to go to skilled nursing facilities to assist me so I can transition to tele-medicine encounters for the time being. If I hire them on an part-time independent contractor basis and get malpractice insurance for them will I be covered to have them assist me? Any advice on what else I would need for coverage or advice for implementing this would be greatly appreciated.

Thank you,

 

[Taus]

sometimes it puts a red banner at the top saying there's a server issue but it still works. if patient can't do it I convert to FaceTime.

no reason you or your receptionist can't text someone your link as well.

Is there a way to block your phone number on FaceTime?

 

[HouseofPain]

Is there a way to block your phone number on FaceTime?

Someone posted this in one of groups I’m in I have not tried it though


#telemedicine FaceTime hack.

For those of you having trouble with telemedicine platform or patients having difficulty with it I have figred out a way to change your caller ID to allow you to face time your patients (not sure if it works on androids and patient would have to have an iphone or ipad) It's a bit complicated so let me know if u have trouble following.

First decide what email address u want to use. Consider something like [email protected]. Turn on automatic reply to say something like “
****PLEASE NOTE this inbox does not accept e-mails and any responses will not be monitored. Please call our office at ————or access our patient portal with any questions. If you are experiencing a medical emergency, please call ‪911‬*****

On your phone/ipad:
- go to settings - click on the top where it should have your apple ID
- click on Name, Phone Numbers, Email
- 2nd line down - reachable at - click on edit (in blue)
- click on the red stop icon
- there will be a pop up warning that says "Choose another address to use..."
- click on continue
-might need to enter iphone passcode
-enter the new email address
-this will send a verfication code to that email address

-check your email for the verification code

-back to your phone/ipad - enter the verification code - wait for confirmation

- then back to settings
-scroll down to Facetime icone
-click on use your Apple ID for facetime
-pop up - Apple ID sign in requested - enter your email address and YOUR NORMAL APPLE ID PASSWORD

-scroll down to Caller ID - check only the email address (not your phone number)

Try calling someone to make sre it works - your callerID should now be the email address.

If a patient tries to email that address they will get that automatic message

 

[DOctorJay]

Ai posted the above hack Taus

Also I use my work iPad so I don’t think any phone number is associated with it


Sent from my iPhone using SDN

 

[Doctodd]

I guess my patient population is different. Are you guys so paranoid about giving out your cell phones to a few patients? Then use your receptionist or MA's cell phone for facetime. Maybe get a burner phone.

 

[Taus]

Ai posted the above hack Taus

Also I use my work iPad so I don’t think any phone number is associated with it


Sent from my iPhone using SDN

Worked like a charm!

 

[Ducttape]

or easier yet, set up a simple dummy email account to use, rather than borrowing your MAs and possibly messing up her sleep.

for example, go to Outlook.com, set up [email protected] account.

 

[paindoctor2014]

So if I am understanding correctly:

Phone only: use G2012( do we add 95 multiplier?)
Video: use normal EM codes (add 95 multiplier)

 

[SSdoc33]

So if I am understanding correctly:

Phone only: use G2012( do we add 95 multiplier?)
Video: use normal EM codes (add 95 multiplier)

that is not my understanding. i was told you can bill normal e/m codes with telephone only right now. the G codes pay bupkis

 

[Doctodd]

For those of you providing Telehealth services from your home, Medicare is requesting that the Provider call the hotline listed in the attached correspondence to register their home as a place of service. Please note it is the provider that must call.
Please note that if you choose to perform services from your home (such as telehealth), CMS has indicated that you will need to register your home address with Medicare enrollment. Please review item #3 in the following link for explanation:


https://www.cms.gov/files/document/provider-enrollment-relief-faqs-covid-19.pdf



"CMS has established toll-free hotlines at each of the Medicare Administrative Contractors (MACs) to allow physicians and non-physician practitioners to initiate temporary Medicare billing privileges. The hotlines should also be used if providers/suppliers have questions regarding the other provider enrollment flexibilities afforded by the 1135 waiver. The hotlines can also be used for physicians and non-physician practitioners to report a change in practice location."

 

[Ferrismonk]

For those of you providing Telehealth services from your home, Medicare is requesting that the Provider call the hotline listed in the attached correspondence to register their home as a place of service. Please note it is the provider that must call.
Please note that if you choose to perform services from your home (such as telehealth), CMS has indicated that you will need to register your home address with Medicare enrollment. Please review item #3 in the following link for explanation:


https://www.cms.gov/files/document/provider-enrollment-relief-faqs-covid-19.pdf



"CMS has established toll-free hotlines at each of the Medicare Administrative Contractors (MACs) to allow physicians and non-physician practitioners to initiate temporary Medicare billing privileges. The hotlines should also be used if providers/suppliers have questions regarding the other provider enrollment flexibilities afforded by the 1135 waiver. The hotlines can also be used for physicians and non-physician practitioners to report a change in practice location."

I would avoid this personally. Rather drive to the office than have my home address given to insurance companies and possibly patients.

 

[painfree23]

So if I am understanding correctly:

Phone only: use G2012( do we add 95 multiplier?)
Video: use normal EM codes (add 95 multiplier)

Yes..do u need the modifier though?

 

[Doctodd]

I would avoid this personally. Rather drive to the office than have my home address given to insurance companies and possibly patients.

i will not be doing any calls from home

 

[painfree23]

i will not be doing any calls from home

Why not?

 

[Doctodd]

first off im not bringing work home....2nd i dont have emr at home and im not bringing paper charts. Lastly my care doesnt change on a telemedicine visit based on my location so i dont see the point except what was mentioned above

 

[SommeRiver]

Doxy.me

Send invite via text or email.

Very easy.

 

[Nonphysiologic]

Ok so what’s the final billing verdict here on a follow up patient who just needs refills?


1. Phone only = G2012
2. Audio AND video = normal E/M with 95 modifier?


Sent from my iPhone using SDN

 

[SommeRiver]

We're billing straight 99213 or 99214.

 

[DOctorJay]

I'm documenting 99213 or 99214 as typical billing code to be used and letting the coders/billers earn their keep on this one

 

[cowboydoc]

Ok so what’s the final billing verdict here on a follow up patient who just needs refills?


1. Phone only = G2012
2. Audio AND video = normal E/M with 95 modifier?


Sent from my iPhone using SDN

Some language specific to my system regarding EMR, etc, but this may help.

 

[mickey1t]

Thinking beyond what is currently going on, does anyone think they may make telemedicine a regular part of their practice going forward?

 

[cowboydoc]

Thinking beyond what is currently going on, does anyone think they may make telemedicine a regular part of their practice going forward?

I am highly interested in incorporating telehealth visits for my LOLs that take 1-2 tramadol or norco per day and having them come to clinic twice a year.

 

[SSdoc33]

I'm documenting 99213 or 99214 as typical billing code to be used and letting the coders/billers earn their keep on this one

i have been told that we have to bill using time spent. that means 25 minutes for a 99214. it is tough for me to talk to a patient for 25 minutes. i suspect i am getting some bad info from my billers. any thoughts?