Special COVID-19 Webinar: Navigating COVID-19 Challenges with Telehealth

Webinar Q and A
Pdf Summary
The document is a comprehensive Q&A session involving HCCI, West Health Institute, and Northwell, focusing on the use of telehealth during the COVID-19 pandemic. Key points addressed include:<br /><br />### In-Home Visits vs. Telehealth<br />Given Northwell's location in downstate NY, highly affected by COVID-19, the practice has shifted to primarily telehealth. Face-to-Face (F2F) visits are reserved for cases where they would significantly alter clinical management. Telehealth is expected to complement F2F visits post-pandemic.<br /><br />### Billing and Codes<br />CPT 99358 for prolonged non-F2F services must directly relate to a F2F or telehealth visit and require at least 31 minutes of documented time. They must not coincide with Chronic Care Management within the same month.<br /><br />### Telehealth Visit Preparation<br />Providers mentally prepare for telehealth visits by mimicking F2F protocols using the EMR as a guide. No checklists are provided to patients to avoid burdening them.<br /><br />### Special Telehealth Considerations for Alzheimer’s/Dementia Patients<br />Telehealth for advanced dementia patients often involves caregivers facilitating the visit, including maneuvering the camera. This approach aims to make both patients and caregivers comfortable, although it presents unique challenges compared to patients who can directly participate.<br /><br />### Billing for Technology-Based Services<br />Virtual Check-ins, E-visits, and remote patient monitoring are not classified as telehealth by CMS. They are billed with the service location (e.g., POS 11), without a telehealth modifier. <br /><br />### Telehealth Platforms and Policies<br />Northwell explored various telehealth platforms that are flexible and secure. Their policy integrates telehealth as part of clinical care, ensuring patient information security during and after visits.<br /><br />### Technology Troubleshooting for Geriatric Patients<br />iPads and smartphones are generally more user-friendly for patients, particularly those with mobility issues. Text message invitations are preferred for ease of use.<br /><br />### E/M Codes and Two-Way Communication<br />Two-way audio and video communication is mandatory for all home and domiciliary E/M codes under Medicare, with specific exemptions for certain audio-only services.<br /><br />### Specialist Use of Telehealth<br />Many specialists, including psychiatrists and psychologists, have adopted telehealth, especially in hard-hit areas like downstate NY, significantly benefiting homebound patients.<br /><br />The session highlights the integration of telehealth into routine practice, the importance of proper billing, the nuances of geriatric care, and the flexibility needed in technology and policy to ensure patient care continuity during the pandemic.
Keywords
Telehealth
COVID-19
In-Home Visits
Billing Codes
Alzheimer’s
Dementia
Telehealth Platforms
Geriatric Patients
E/M Codes
Specialist Use