Telehealth Updates for PT Private Practices

David Straight March 19, 2020 Telehealth

Telehealth Information from Various Resources (Make Sure to Add Additional Resources in the Comments)

Have your patients support telehealth policy change. Ask them to contact their Senator or Congressperson through this link from the APTA:
https://www.votervoice.net/APTA/campaigns/73113/respond

Start Here

PPS Impact Magazine – Tips & Tricks to Start Telehealth Tomorrow. A nice summary of how to use telehealth by Mark Milligan, PT, DPT. Starts on page 24.
Click here for the issue.
Payment and regulatory resources from the APTA
Click here
I recommend you read this document which was posted by the Private Practice Section of the American Physical Therapy Association.
Click here. It provides current information on evisits and telehealth as of March 19th, 2020
Then, I suggest you join the TelehealthPTs Facebook Group. Lots of good info – look in the Files section of the Group.
Click here for the Facebook Group and request to join it.

Let us know if you need a telehealth page on your website.

5-26-20

Software Services Clients are Using to Assist with Telehealth/E-visits

Zoom.us – live video software
EnGuard Telehealth – New HIPAA Compliant, Webmail-based Video Conferencing and File Exchange Service (call for more info)
Vsee.com – this company has been around for a long time/HIPAA Video and waiting room
Doxy.me – simple, free, secure telemedicine solution
Phzio.com – live video call service
Fiizio.com – an app that you can give to patients. Enables cash transactions
Digitalintakes.com – to set up secure, HIPAA compliant intake forms
Vsee.com – secure video
Valdhealth.com – online programs
BetterPT.com – they have a telehealth option

Additional Web Resources

WebPT blog post about billing and using G codes
APTA FAQ about Evisits
For Billing Questions about Telehealth and E-visits, I recommend Rick Gawenda at GawendaSeminars.com

3-20-20

Are Physical Therapy Essential? Memorandum from the Department of Homeland Security via the PT Private Practice Section

We are writing to share a memorandum from the US Department of Homeland Security issued on the list of essential infrastructure workers (see page 5 of the memorandum). It may be argued that it is our duty to continue to care for our patients’ physical therapy needs during this time of crisis.

The guidance from the memorandum states that:

If you work in a critical infrastructure industry, as defined by the Department of Homeland Security, such as healthcare services and pharmaceutical and food supply, you have a special responsibility to maintain your normal work schedule.

If your clinic is able to practice within the recommended CDC guidelines and follow your local government mandates, consider that community-based physical therapists assist in keeping people healthy. According to Dr. Matos, an expert in biologic surety and the management of select agent programs at federal facilities:

“Physical therapists are essential in flattening the curve of the COVID-19 pandemic. They play a key role in keeping people they can help out of the doctor’s offices and ERs. This will not only free up the medical teams to treat those impacted by COVID-19 but also limit the exposure of those seeking the care of the physical therapist.”

Additional Links, Experts, and Resources

What are your state policies regarding evisits/telemedicine?
Here’s a good website with more details. Click here.
TelehealthPT.com
Telehealth resource from Rob Vining, PT, a leader in telehealth – telehealthpt.com
Facebook Group is here.
Example Language for Those Offering Telehealth:
Here’s an example telehealth webpage we’ve put together and is available for our clients: https://pillsburypt.com/telehealth

PPS APTA Resources

The Private Practice Section of the American Physical Therapy Association has a page dedicated to telehealth. Lots of good resources and more to come I’m sure.
Click here to visit that page.
Major Update for California PTs – Department of Managed Health Care:
“..health plans must take steps to allow people to obtain health care via telehealth when medically appropriate to do so.”
Click here to read the release.

From CMS RE: Telehealth

Clinicians who may not independently bill for evaluation and management visits (for example – physical therapists, occupational therapists, speech language pathologists, clinical psychologists) can also provide these e-visits and bill the following codes:

G2061: Qualified non-physician healthcare professional online assessment and management, for an established patient, for up to seven days, cumulative time during the 7 days; 5–10 minutes
G2062: Qualified non-physician healthcare professional online assessment and management service, for an established patient, for up to seven days, cumulative time during the 7 days; 11–20 minutes
G2063: Qualified non-physician qualified healthcare professional assessment and management service, for an established patient, for up to seven days, cumulative time during the 7 days; 21 or more minutes.

3-19-20

From the American Physical Therapy Association
Here’s a link to some good resources.
Click here for additional information.
PT News from APTA about COVID-19 and Telehealth

Update: APTA to host a live webinar on “Medicare “E-visits” March 19 at 8:00 pm, ET and a Facebook Live event on Friday, March 20 at 2:00 pm, ET.

From a the California Physical Therapy Association:

Telehealth: Billing and Coding Considerations

Medicare

Billing physical therapy services that have been provided through telehealth is an emerging challenge. Due to the 1135 waiver authority and Coronavirus Preparedness and Response Supplemental Appropriations Act, the Centers for Medicare and Medicaid Services (CMS) is expanding access to Medicare telehealth services so that beneficiaries can receive a wider range of services from their providers without having to travel to a healthcare facility.

For the first time, PTs will be allowed to bill Medicare for telehealth visits under codes associated with online assessment and management services, HCPCS codes:

G2061: Qualified non-physician healthcare professional online assessment, for an established patient, for up to seven days, cumulative time during the 7 days; 5–10 minutes;
G2062: Qualified non-physician healthcare professional online assessment, for an established patient, for up to seven days, cumulative time during the 7 days; 11-20 minutes;
G2063: Qualified non-physician healthcare professional online assessment, for an established patient, for up to seven days, cumulative time during the 7 days; 21 or more minutes).

Providers must use place-of-service code “02” and “GT” modifier. The payment rates are significantly lower than the traditional payment for an in-person visit under the CPT 97000 code series.

To determine the reimbursement rates for G2061-G2063, visit the CMS Physician Fee Schedule lookup tool. Medicare coinsurance and deductible apply to the services.

To qualify as an e-visit, three basic qualifications must be met:

The billing practice must have an established relationship with the patient, meaning the provider must have an existing provider-patient relationship;
The patient must initiate the inquiry for an e-visit and verbally consent to check-in services;
The communications must be limited to a seven-day period through an “online patient portal.” (see the definition below)

Although the patient must initiate the service, CMS allows “practitioners to educate beneficiaries on the availability of the telehealth service prior to patient initiation.” For example, if a patient cancels treatment because they can’t come to the clinic or are concerned about leaving home, then the PT may advise the patient that she or her can “virtually” contact the therapists as needed.

Medicaid

As of this writing, Medicaid does not pay for telehealth in California. Governor Newsom has requested a Federal Government Waiverto expand telehealth options under Medicaid. Stay tuned…

Third-Party Payers

Payment for telehealth depends on your contract with your payer. There is no list of third-party payers that pay for telerehab. Also confirm with each payer whether the originating site can be a private home or office, if services must be real-time or can be asynchronous, and any other limitations to your use of telehealth.

For third-party billing, there are “telehealth” CPT codes. But before reporting CPT codes you traditionally use for clinical visits or billing for telephone services (98966-98969), check with your payer. Many of the physical medicine and rehabilitation codes (97000 series) specify “direct 1-on-1 patient contact,” which by strict definition would exclude telehealth unless you and your payer have agreed to include these services. A payer also may require an addendum attached to the bill that identifies the service as being provided via telehealth, along with an explanation of the charges, so be prepared to outline the reasoning for using telehealth.

You also should check with your payer about using place-of-service code “02” when billing for telehealth services to specify the entity where service(s) were rendered. Regardless of the payer or policy, if you provide and bill for services using telehealth, make sure that you are practicing legally and ethically, and are adhering to state and federal practice guidelines and payer contract agreements.

3-18-20

Here’s a webinar that Chad Madden did with Tom Dalonzo-Baker about how you can use his techniques to treat over video.

Click here to watch it on their blog.

Telehealth – A HIPAA Compliant Telehealth App for Physical Therapist by Fiizio.com

Here’s a webinar I did with the owner, a couple weeks ago.

If you are interested in providing telehealth services to your patients, here’s a new company and app that will allow you to accomplish this.
You can reach the owner, Eran Tagor by email at eran@fiizio.com .

The website is https://www.fiizio.com

For an example web page that we put together that explains the process, you can go to https://bandgpt.com/telehealth

March 17, 2020

Some good FAQ about Telehealth from BreakthroughPTmarketing.com

Is Telehealth billable right now, or is it out-of-pocket for the patient?

Yes you can bill under asynchronous telehealth. However, medicare/caid will not reimburse, only private insurance. Some states have parity laws in place to ensure it. Please check this link for each state’s specifics: https://evisit.com/state-telemedicine-policy/ Out-of-pocket is always an option as well.

If it’s out-of-pocket for the patient, how does a Medicare patient sign an ABN if they aren’t with you?

Telerehab is only the vessel used to interact with the patient. The ABN would be between the patient and practitioner (or practitioner’s clinic).

If it is billable, do you bill a normal office visit (3-4 units, 97110/97530/97116/97112) with a modifier, or are there separate codes to use?

Great question. This was asked at APTA CSM and we are still seeking verification for the proper information to provide. What I am confident in saying is this: If you are only prescribing for at-home completion and the practitioner is not monitoring/communicating with the patient actively, it is not considered a timed visit. If you are performing rehab with the patient due to not being able to see them in-office, and are actively monitoring to review each set and provide feedback to the patient before the next set, you should be able to bill as normal with modifier. (This will need to be verified with your billing org)

How effective are you finding telehealth, given how hands-on PT is?

Very, but you do need the initial assessment to be in person in order to properly prescribe a rehab protocol. Very difficult to assess without the use of hands. This is one of the primary reasons patients cannot access telerehab without first being prescribed a protocol by their practitioner.

Do you worry about teaching people this and then them not returning because “they can do it on their own?”

No, telerehab only provides a different method to work with your patients, it does not replace the practitioner. Comments that I have gotten surround patients actually become more engaged in the rehab process. This benefits the therapist by not having to spend time convincing the patient to complete self-care. The compliance metrics within telerehab provide the patient (and clinician) with valuable insight into how they are impacting their own well-being and as a result, they complete things so they can get better.

Telehealth Definitions from the Private Practice Section of the APTA and AmericanTeleMed.org

The Private Practice Section provided some good guidance in their March 19th memo. I recommend you read this first by clicking here.

Evisit:
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.”

Online Patient Portal:
An online patient portal is defined by the HHS Office of National Coordinator for Health Information Technology (ONC), as a secure online website that gives patients convenient, 24-hour access to personal health information from anywhere with an internet connection. A patient portal requires a secure username and password to allow patients to securely message their provider

Telehealth:
Telehealth is the distribution of health-related services and information via electronic information and telecommunication technologies. It allows long-distance patient and clinician contact, care, advice, reminders, education, intervention, monitoring, and remote admissions. Wikipedia

Telemedicine:
Telemedicine is the use of medical information exchanged from one site to another via electronic communications to improve a patient’s clinical health status. Telemedicine includes a growing variety of applications and services using two-way video, email, smart phones, wireless tools and other forms of telecommunications technology. Learn more.

Telerehabilitation:
Telerehabilitation refers to the delivery of rehabilitation services via information and communication technologies. Clinically, this term encompasses a range of rehabilitation and habilitation services that include assessment, monitoring, prevention, intervention, supervision, education, consultation, and counseling. Learn more.

Synchronous:
Interactive video connections that transmit information in both directions during the same time period. Learn more.

Asynchronous:
Term describing store and forward transmission of medical images and/or data because the data transfer takes place over a period of time, and typically in separate time frames. The transmission typically does not take place simultaneously. This is the opposite of synchronous. Learn more.

Distant or Hub site:
Site at which the physician or other licensed practitioner delivering the service is located at the time the service is provided via telecommunications system. Learn more.