Telemedicine

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Yo GabbaPentin

Yo GabbaPentin

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  1. Attending Physician
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Are any of you doing much telemedicine? For example procedure follow ups. Is it possible to schedule procedures without hands on physical exam? My practice is in the middle of no where and we have people coming from hours away.
 
I probably do two a day. Typically follow ups for patients who travel > 1 hour, and for patients that likely only need a small med change if anything. Only Aetna has declared they won’t cover it anymore, and that was just a couple weeks ago.
 
A handful every week. Perfect for documentation after mbb-#1, or after mbb#2 to get RFA approved, etc.
 
So how do you all document facet loading on physical exam to get the RFA or MBB #2 approved?
 
You guys are having patients do follow up visits after MBB's to go over their pain logs?
 
bill all mbb follow ups. or, you can take save a step and just flush some cash down the toilet. these arent your rules. but if you are forced to play by them, get your $ worth. you are doing the work, you should be paid for it
 
paindoc503 said:
You guys are having patients do follow up visits after MBB's to go over their pain logs?
Click to expand...

Why would you work for free? Insurers require ridiculous amounts of clinically irrelevant information that wastes my time. So I absolutely am going to get my 1.63 RVU. The patient can blame their insurance company.
 
agree to getting moneys worth, but there is a potential financial advantage of not seeing them in follow up...

if you are booked out a ways, having patients not have to come in may actually keep open up slots for new patients, which would generate not only higher wRVU than the follow up appointment but would bring in patients for procedures.
 
just hypothetically, you get a level 3 fu visit out of that - a 99213.

would a 99214 to discuss a 62323 pay more?


or a 99204?
while a 99204 might take a little more time, you could then get, out of that 99204, possibly a 64493/64494 x2 and 64635/64636.
 
My telemeds are typically completed within two minutes and I am on to the next one. So 3 in 10 minutes is normal.
 
Ducttape said:
just hypothetically, you get a level 3 fu visit out of that - a 99213.

would a 99214 to discuss a 62323 pay more?


or a 99204?
while a 99204 might take a little more time, you could then get, out of that 99204, possibly a 64493/64494 x2 and 64635/64636.
Click to expand...
If you’re already having your MA or nurse do the work of copying the pain diary into the chart and placing the order for the next procedure, then all that’s left is for you to personally talk to the patient. Very quick conversation if it was successful.
 
i hate to ask the question but
is this actually good patient care? does the patient get anything out of this?
it takes 10 seconds to approve an MBB log and place a new order.
 
paindoc503 said:
i hate to ask the question but
is this actually good patient care? does the patient get anything out of this?
it takes 10 seconds to approve an MBB log and place a new order.
Click to expand...
ask that question to medicare

a single MBB would be enough. in fact zero mbbs would be better, although there are some cretins who would abuse the system.
 
BobBarker said:
My telemeds are typically completed within two minutes and I am on to the next one. So 3 in 10 minutes is normal.
Click to expand...
is this a phone call or a video visit? does office staff set this up for you? does your scheduler call them later on to set up the next MBB/RFA?
 
paindoc503 said:
i hate to ask the question but
is this actually good patient care? does the patient get anything out of this?
it takes 10 seconds to approve an MBB log and place a new order.
Click to expand...
patients get access to a procedure that has a high probability to reducing a significant portion of their pain, so yes.

the office visit part is part and parcel to the procedure, so however it gets done is appropriate. i like to get it done without the visit so it can get scheduled sooner, but it is entirely appropriate to see each and every patient
 
have anybody heard about telemedicine being continued next year?
Currently they are updated till the end of of next year.
 
the DEA came out with a message saying that they will allow video visits to be completed.

dea.PNG


Federal Register :: Request Access

www.federalregister.gov www.federalregister.gov
 
In Alaska they routinely do pre-procedure evals via video.
 
not worth it if its video calls. if its a 1-2 minute conversation via telephone, thats fine. but i dont need to wait for grandma to figure out a zoom call, or the wifi to stop working, or for the cat to bust up my appt....
 
Dawkter said:
I did hear the codes might be changing. Is anyone using the telephone based codes 99441, 99442, or 99443?
Click to expand...

This is only for the Rx of controlled substances under the jurisdiction of DEA, this has nothing to do with billing visits

(b) During the period May 12, 2023, through December 31, 2025, a Drug Enforcement Administration (DEA)-registered practitioner is authorized to prescribe schedule II-V controlled substances via telemedicine, as defined in 21 CFR 1300.04(i), to a patient without having conducted an in-person medical evaluation of the patient if all of the conditions listed in paragraph (c) of this section are met.
 
yes this is a ruling stating that the DEA and HHS are allowing telemedicine visits for controlled substances.

it was put in place to continue telemedicine opioid treatment if congress does not act to continue telemedicine, there is no ruling to say that telemedicine cannot continue or regarding billing.
 
Expanding telemedicine also expanded the amount of fraud, waste, and abuse of CMS resources

So I doubt it
 
bedrock said:
Also improved care access for patients in rural areas or with mobility issues.
Click to expand...
Rural patients still have access to telemedicine services, though. They had access with the old rules.
 
Agast said:
Rural patients still have access to telemedicine services, though. They had access with the old rules.
Click to expand...
Where are you getting that info from? It seems that that would hold true only for mental health issues.

telehealth.hhs.gov

Telehealth policy updates

Learn about recent Federal legislation and policies related to telehealth.
telehealth.hhs.gov telehealth.hhs.gov

Rural health​

Telehealth can increase access to health care in rural communities. To support access to care, telehealth policies allow:

  • FQHCs and RHCs can serve as Medicare distant site providers for non-behavioral/mental telehealth services through March 31, 2025. For an encounter furnished using interactive, real-time, audio and video telecommunications technology or for certain audio-only interactions in cases where the patient is not capable of, or does not consent to, the use of video technology services, payment to RHCs and FQHCs are subject to the national average payment rates for comparable services under the physician fee schedule (PFS) through December 31, 2025.
  • Non-behavioral/mental telehealth services in Medicare can be delivered using audio-only communication platforms through March 31, 2025. Interactive telecommunications system may also permanently include two-way, real-time audio-only communication technology for any telehealth service furnished to a patient in their home if the distant site physician or practitioner is technically capable of using an interactive telecommunications, but the patient is not capable of, or does not consent to, the use of video technology.
  • FQHCs and RHCs can permanently serve as a Medicare distant site provider for behavioral/mental telehealth services.
  • Medicare patients can permanently receive telehealth services for behavioral/mental health care in their home.
  • There are no geographic restrictions for originating site for Medicare behavioral/mental telehealth services on a permanent basis.
  • Behavioral/mental telehealth services in Medicare can permanently be delivered using audio-only communication platforms.
 
Pain Applicant1 said:
Where are you getting that info from? It seems that that would hold true only for mental health issues.

telehealth.hhs.gov

Telehealth policy updates

Learn about recent Federal legislation and policies related to telehealth.
telehealth.hhs.gov telehealth.hhs.gov

Rural health​

Telehealth can increase access to health care in rural communities. To support access to care, telehealth policies allow:

  • FQHCs and RHCs can serve as Medicare distant site providers for non-behavioral/mental telehealth services through March 31, 2025. For an encounter furnished using interactive, real-time, audio and video telecommunications technology or for certain audio-only interactions in cases where the patient is not capable of, or does not consent to, the use of video technology services, payment to RHCs and FQHCs are subject to the national average payment rates for comparable services under the physician fee schedule (PFS) through December 31, 2025.
  • Non-behavioral/mental telehealth services in Medicare can be delivered using audio-only communication platforms through March 31, 2025. Interactive telecommunications system may also permanently include two-way, real-time audio-only communication technology for any telehealth service furnished to a patient in their home if the distant site physician or practitioner is technically capable of using an interactive telecommunications, but the patient is not capable of, or does not consent to, the use of video technology.
  • FQHCs and RHCs can permanently serve as a Medicare distant site provider for behavioral/mental telehealth services.
  • Medicare patients can permanently receive telehealth services for behavioral/mental health care in their home.
  • There are no geographic restrictions for originating site for Medicare behavioral/mental telehealth services on a permanent basis.
  • Behavioral/mental telehealth services in Medicare can permanently be delivered using audio-only communication platforms.
Click to expand...
It seems you blew past the first few bullet points

What I’ve heard from doctors who practice rural medicine, is that specialty visits were coordinated by having the patient go to their local doctor’s office and then doing telemedicine on location while the specialist called in from theirs.
 
Agast said:
It seems you blew past the first few bullet points

What I’ve heard from doctors who practice rural medicine, is that specialty visits were coordinated by having the patient go to their local doctor’s office and then doing telemedicine on location while the specialist called in from theirs.
Click to expand...
No, everybody has access to telehealth services right now. Rural or not, it doesn't matter. That's not the question. The issue is what happens after March 31, 2025.

Extensions of telehealth access options​

The Federal government took a range of steps to expedite the adoption and awareness of telehealth. Some of the telehealth flexibilities have been made permanent while others are temporary. Telehealth policies allow:

  • Medicare patients can receive telehealth services for non-behavioral/mental health care in their home through March 31, 2025.
  • There are no geographic restrictions for originating site for Medicare non-behavioral/mental telehealth services through March 31, 2025.
  • Telehealth services can be provided by all eligible Medicare providers through March 31, 2025.
 
What happens after March, without Congress stepping in, is that telemedicine reverts to the way it was practiced before COVID. The Lord giveth and the Lord taketh away. If you consider the current tagline is that COVID is no big deal, there was no reason to expand services during a “plandemic”
 
Pain Applicant1 said:
No, everybody has access to telehealth services right now. Rural or not, it doesn't matter. That's not the question. The issue is what happens after March 30, 2025.

Extensions of telehealth access options​

The Federal government took a range of steps to expedite the adoption and awareness of telehealth. Some of the telehealth flexibilities have been made permanent while others are temporary. Telehealth policies allow:

  • Medicare patients can receive telehealth services for non-behavioral/mental health care in their home through March 31, 2025.
  • There are no geographic restrictions for originating site for Medicare non-behavioral/mental telehealth services through March 31, 2025.
  • Telehealth services can be provided by all eligible Medicare providers through March 31, 2025.
Click to expand...
my understanding is that extension of telehealth for all is included in the current iteration of the funding bill making its way thru congress. the doc pay fix is not. whether it passes is another story
 
Expanding telehealth services is beneficial regardless of covid.

The majority of my patients are now telemed and I don't want that to change, nor do my patients. Some choose to come in. They're lonely, need a hug, need to get out, need eval or procedure, like or need face to face human contact, whatever, that's fine but the vast majority of my pts benefit from telehealth services. I have my pts well managed just the way it is.

From my perspective, too, it's very healthy. I can walk like somewhere between 10 to 20 miles per day on my treadmill and I don't want to give that up. If they do away with telemed, I'll likely retire if my other business does well.

Cut my reimbursement if you want but don't do away with telemed.
 
Pain Applicant1 said:
Expanding telehealth services is beneficial regardless of covid.

The majority of my patients are now telemed and I don't want that to change, nor do my patients. Some choose to come in. They're lonely, need a hug, need to get out, need eval or procedure, like or need face to face human contact, whatever, that's fine but the vast majority of my pts benefit from telehealth services. I have my pts well managed just the way it is.

From my perspective, too, it's very healthy. I can walk like somewhere between 10 to 20 miles per day on my treadmill and I don't want to give that up. If they do away with telemed, I'll likely retire if my other business does well.

Cut my reimbursement if you want but don't do away with telemed.
Click to expand...
im not sure you workout routine is on the top of the policy list.

IMHO, telemedicine has its place (like for your suboxone patients), but in general it leads to poorer medical care, virtually nonexistent physical exams, and worse communication than in person
 
SSdoc33 said:
im not sure you workout routine is on the top of the policy list.

IMHO, telemedicine has its place (like for your suboxone patients), but in general it leads to poorer medical care, virtually nonexistent physical exams, and worse communication than in person
Click to expand...
I know you're joking but it should be. I don't need a study to show that happy docs make better docs.

Let's keep things in perspective. We're celebrating that physician burnout has dropped below 50%. Something is terribly wrong.
 
Pain Applicant1 said:
I know you're joking but it should be. I don't need a study to show that happy docs make better docs.

Let's keep things in perspective. We're celebrating that physician burnout has dropped below 50%. Something is terribly wrong.
Click to expand...
hey, im all for it. if i dont get an hour of exercise a day, i get very moody (hard to believe, i know) and i dont sleep

nothing burns me out more then telehealth
 
SSdoc33 said:
hey, im all for it. if i dont get an hour of exercise a day, i get very moody (hard to believe, i know) and i dont sleep

nothing burns me out more then telehealth
Click to expand...
What if you put all your telehealths together and did the treadmill thing like I do. I know you're a solid runner so you'd probably love it. I honestly feel that I'm getting paid to exercise. That's why I don't want to give it up.
 
There are a lot of things that are way easier due to Covid innovations. Docusign. Zoom. Etc

Telehealth is one. Has helped my increase efficiency with the decreasing reimbursement for office only practice. Basically even $ to precovid.

staff added a new telehealth patient on at 320 today. No mri. Order mri. Done at 335 and out the door. Got paid for the cognitive labor. The 50% of the time it works every time PE not really missed.
 
Looks like the bill passed the house and headed to the senate. Do you have a link to where they included telemedicine extension in the bill?

Thanks
 
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