Get Paid for Telemedicine Phone Encounters

The health industry is trending toward telemedicine as an alternative option for office visits. You’re probably already providing telemedicine services that are already billable (such as Nursing phone care), so why not take advantage of that?

PCC recommends that you treat every phone note as though it could be a billable service, unless it’s a scheduling call, or clearly a follow-up to an appointment that occurred within the past 7 days.

You may want to consider preparing your patients’ families before you begin submitting telemedicine claims for phone calls. Having a clear policy explaining what types of calls may become billable, and setting a date on which you will begin charging for those services will help to smooth the transition.

It Will Pay Off In the Long Run: Submit billing claims to all of your insurance carriers, even if you know they won’t pay… because eventually they will, and it will be too late to retroactively bill at that point. Also, if CPTs aren’t used by enough providers, the codes will be eliminated.

Check with your insurance providers to see what their policy and contracts are at this point, but still submit claims, for future payment.

An Administrator Configures PCC EHR and Partner

In order to get paid for telemedicine services provided over the phone, you will need to update the Phone Note Protocol in PCC EHR, and add new Visit Reasons and Procedure Codes in Partner.

Revise the Phone Note Protocol

If you are not already tracking call duration and diagnosis within your phone notes, you will need to add these components to your existing Phone Note Protocol.

Open the Component Builder

Navigate to the Protocol Configuration tool, and select the Component Builder.


Create Duration Component

Add a new custom entry field for “Duration of Call (exact minutes)” to your Component Builder.



Duration vs Start/Stop: If you prefer, create two fields to track the Start Time and Stop Time of the call, rather than one Duration field. You just need a way to track the total minutes spent on the call.

Create Diagnosis Component

Add another custom entry field for “Diagnosis Treated in Call”.

Edit the Phone Note Protocol

Return to the Protocol Configuration and open the Protocol Builder to edit your existing Phone Note Protocol.


Add Your New Components to the Phone Note Protocol

Add your new duration and diagnosis components to the Phone Note Protocol.


Create a Telemedicine Procedure Group

Having a specific procedure group for telemedicine will allow you to separate out telemedicine services for reporting purposes.

You will use this procedure group to set up new procedure codes and visit reasons.

Run the Table Editor (ted) and Select Procedure Groups

Run ted from the Partner Configuration window or by typing ted at a command prompt. From the list of tables, select #18, Procedure Groups.

Type “Add”

From the procedure group list, press A on your keyboard to add a new procedure group.

Enter Procedure Group Information

Give the new procedure group a name and an abbreviation, determine the order it should appear on screen, and indicate “Yes” to display totals for the new group in PCC reports.

Save the New Procedure Group

Press F1Save and Quit to save your new procedure group.

For more help in setting up new procedure groups, contact your PCC Client Advocate.

Create Telemedicine Procedures

You will need to set up a new procedure for each CPT code you will be using to bill for telemedicine services.

Run the Table Editor (ted) and Select Procedures

Run ted from the Partner Configuration window or by typing ted at a command prompt. From the list of tables, select #6, Procedures.

Type “Add”

From the procedure list, press A on your keyboard to add a new procedure.

Enter Procedure Information

Give the new procedure a name, select your new telemedicine procedure group, enter the associated CPT code (and copy to each line) and set the price for the service (and copy to each line).

What Should We Charge?: The average PCC client charges 176% of Medicare reimbursement, using the RVU pricing approach.

Save the New Procedure

Press F1Save and Quit to save your new procedure.

For more help in setting up new procedures, contact your PCC Client Advocate.

Optional: Create Telemedicine Visit Reasons

If you plan to customize your charge screen to make billing for phone care easier, you will need to set up a new telemedicine visit reason.

Appointment Book User: If your practice uses Appointment Book, visit reasons are configured in PCC EHR. Read about Appointment Book configuration here.

Run the Table Editor (ted) and Select Reasons for a Visit

Run ted from the Partner Configuration window or by typing ted at a command prompt. From the list of tables, select #7, Reasons for a Visit.

Type “Add”

From the visit reason list, press A on your keyboard to add a new visit reason.

Enter Visit Reason Information

Give the new visit reason a name. For each provider listed, determine the default number of minutes to assign for scheduling purposes (if applicable).

Save the New Visit Reason

Press F1Save and Quit to save your new visit reason.

For more help in setting up new visit reasons, contact your PCC Client Advocate.

Optional: Customize Charge Screen for Phone Care Encounters

You can customize the default list of diagnoses and/or procedures that appear the screen during checkout.

Use the Charge Screen Editor (csedit) in Partner to associate procedures to your new visit reason.

For more detailed instructions, read Customizable Charge Screens, or contact your PCC Client Advocate.

The Provider Writes the Phone Note

Treat every call as though it may be billable. Document the phone encounter with enough detail to cover telemedicine requirements.

Use the Subject field to reflect the main topic of the encounter. Include enough clinical information in the phone note to make a diagnosis.

Make note of all questions asked during the call, and all clinical information given. Include any reassurances offered. Include all topics covered during the conversation.

Biller Performs Billing Analysis

Each day, someone can analyze the phone notes from 7 days prior, to see if they can be billed.

You must wait 7 days after each phone call, because any call that was followed up by a visit within the next 7 days (or next available visit) for a related complaint will not be billable.

Periodically Review the Messaging Queue

Sort the Messaging queue by the Date column, and focus only on the phone notes from at least 7 days ago.

Review Patient Chart

Open each phone note and check the Appointment History to see if the patient had any related appointments within 7 days of the call (either before or after).

If Applicable, Review Visit Chart Note

If the patient was seen within 7 days on either side of the appointment date, you can check to see if the visit was related to the phone call. If not, the phone call may still be billable.

Billing Staff Uses Partner to Bill for Qualifying Services

Use the Checkout screen in Partner (checkout), to bill any telemedicine services that meet the billing requirements outlined above.

Run (checkout) in Partner

Run checkout from the Daily Operations window in Partner, or by typing checkout at a command prompt.

Find the Correct Patient

Press F2Find Patient to pull up the record of the patient whose telemedicine encounter you are billing.

Perform the Search

Enter the patient’s name and press F1Perform Search.

Create a New Encounter

From the patient’s encounter list, press F4Create Encounter.

Add Billing Details

Within the new encounter, change the Visit Date to reflect the actual date the phone call took place. Select the Visit Reason, Physician, Diagnosis and Procedure Name for the service.

Continue to the Next Step

Press F1Next Step to save your charge and go to the next screen.

Post and Print the Charge

Press F1Post and Print to post your charge and view the checkout summary.

Telemedicine Billing Codes by Carrier

CPT Codes

E&M codes for an established patient, unrelated to services in last 7 days nor leading to procedure or next available appointment:

Services Provided by Phone
Physician or Qualified Provider:

  • 99441 (5-10 mins)
  • 99442 (11-20 mins)
  • 99443 (21-30 mins)

Nurse or Other Qualified Non-Physician Healthcare Professional:

  • 98966 (5-10 mins)
  • 98967 (11-20 mins)
  • 98968 (21-30 mins)

Online Evaluation

  • 99444 – Report once for 7 day episode of care; personal response to online inquiry; permanent storage

Modifiers

  • GQ – rendered via asynchronous telecommunications system (email, video sent and watched later)
  • GT – rendered via interactive audio/video telecom system (such as FaceTime)

New in 2017

  • Star symbol used to identify telemedicine-eligible codes
  • Appendix P – CPTs that may be used for synchronous telemedicine
  • Modifier 95 – synchronous telemedicine service rendered via a real-time interactive audio/video telecom system (internal note – how is this different than the GT modifier?)
  • Place of service – 02 = Telehealth

HPCS

  • T1014 – Telehealth transmission, per minute, professional services bill separately
  • Q3014 – Telehealth originating site facility fee (if you are providing a place for patients to connect to remote providers)

Medicare

  • Several Behavioral Health services approved for telehealth in 2013

Medicaid

  • Up to individual states
  • Last modified: October 12, 2017