Telehealth is the provision of health care services to a patient who is not physically present with the provider. Sounds simple, right? But telehealth holds more meaning and nuance, encompassing a variety of technology options for delivery of services. Telehealth reduces barriers of time, cost, and inconvenience for both providers and patients. Use of telehealth also minimizes the spread of infections and the related fears about in-person visits. This guide intends to assist independent practitioners in understanding telehealth and implementing virtual care.
Telehealth Definitions and Glossary of Terms
- Telehealth: The term encompasses a broad definition of remote healthcare that includes more than just clinical services. One federal definition defines telehealth as “the use of electronic information and telecommunication technologies to support long-distance clinical health care, patient and professional health-related education, public health, and health administration.” This includes videoconferencing, transmission of still images, patient portals, remote monitoring of blood pressure, continuing medical education, and nursing call centers.
- Telemedicine: Telemedicine is part of telehealth, but more narrowly refers to clinical services. Telemedicine involves interactive, electronic health communications with clinicians who are diagnosing or treating a patient’s health. Examples of telemedicine include videoconferencing with patients, transmitting X-rays to radiologists, and presenting a patient to a remote specialist for consultation.
- Distant Site: This is the location where the provider delivering the service is located when the service is provided via telecommunications.
- Originating Site: An originating site is where the patient gets medical services through a telecommunications system.
- Synchronous: In this method of telehealth, both the patient and care provider are present at the same time, with a two-way audiovisual link between them that allows for real-time interaction. An example is videoconferencing.
- Asynchronous (Store and Forward): With asynchronous telemedicine, a patient’s health information is sent to a provider, usually a specialist, for review at a later time. An example is the transmission of X-rays to a radiologist for review.
Benefits of Telehealth
The benefits of telehealth for both patients and providers are numerous and include the following:
- Lower risk of spreading infection: The COVID-19 public health emergency highlights the critical role telehealth can play in preventing further spread of the coronavirus while still providing medical care to patients. A recent survey found two-thirds of respondents said that COVID-19 increased their willingness to try telehealth.
- 24/7 availability of care: You can expand beyond your usual office hours with telehealth. Platforms like Carie not only connect you to your patients outside of the office, but allow you to designate another provider to conduct telemedicine visits with your patients at any time of day.
- Reduced patient travel burden: Patients often have lengthy commutes to manage just to visit your clinic. Telehealth helps minimize the amount of travel needed, eliminating a common barrier for many patients’ receipt of medical care.
- Overcome clinician shortages: Much of the country faces a shortage of providers, especially in rural and underserved areas. Telehealth connects patients to providers and health care they otherwise would not have readily accessible.
- Increased continuity of care: Telehealth solutions allow you to offer more convenient options for follow-up, curb patient no-shows for in-person appointments, and provide better chronic care management for conditions such as diabetes.
- Higher patient satisfaction: With telehealth, patients tend to have shorter wait times for appointments, which raises satisfaction levels. The ease of using a virtual visit application versus the inconvenience and hassle of a traditional doctor visit also improves patient satisfaction overall.
Telehealth Technologies and Applications
When deciding to offer telehealth services to your patients, you have several service delivery models and technology choices available.
- Live Videoconferencing (Synchronous): This telehealth modality most closely mimics traditional clinical visits. Using audiovisual telecommunications technology, the provider and patient engage in a live, two-way interaction. One option for synchronous telehealth is Carie, a cloud-based, HIPAA-secure platform that quickly and easily connects you (or a physician designated by you) to a patient for a remote visit.
- Store and Forward (Asynchronous): In this telehealth model, an electronic communications system transmits a patient’s recorded health history to a remote practitioner, usually a specialist, who then uses the information either to evaluate the case or to render a service. This occurs outside of a real-time or live interaction.
- Remote Patient Monitoring (RPM): Wearable devices facilitate remote patient monitoring, which is the use of electronic tools to record a patient’s health and medical data in one location and then electronically transmit to a provider, who is physically located elsewhere and usually reviews the data at a later time. This allows for ongoing monitoring of a patient’s condition without the need for an in-person visit.
- Mobile Health (mHealth): Like the name implies, mobile health concerns health-related activities supported by mobile communication devices such as smartphones, tablets, and PDAs. Examples include targeted text messages that promote healthy behavior and wide-scale public health alerts about disease outbreaks.
Reimbursement for Telehealth Services
Commercial insurance plans, state Medicaid offices, and Medicare have different requirements when it comes to covered services, eligible providers and locations, reimbursement rates, and billing requirements. For the duration of the COVID-19 public health emergency, most payers are allowing expanded use of telehealth services. You will need to stay up-to-date on continually shifting reimbursement rules.
For telehealth reimbursement, documentation is critical. Include details in the patient’s medical record about the type of technology used, patient’s consent to telehealth services, duration of visit, etc.
To receive timely reimbursement of your services, be sure your claims are coded correctly and include all information required by the particular payer. Keep in mind that different payers will reimburse for different services, but CPT codes are commonly used for telemedicine services. Many payers, including Medicare and Medicaid, typically require use of specific place of service (POS) codes and CPT code modifiers on claims to indicate that the services being billed were performed through use of telehealth.
Compliance Concerns: Legal, Ethical, and Regulatory
Before implementing telehealth services, you should familiarize yourself with applicable state and federal laws and regulations. Address compliance concerns such as the following:
- Are there prescribing limitations, such as a state requirement for in-person visits before prescribing?
- Does your medical liability insurance carrier cover telehealth?
- What are the relevant patient consent requirements for telehealth services?
- How will you meet the privacy and security requirements required under the Health Insurance Portability and Accountability Act (HIPAA)?
- What restrictions are in place by your state’s Medicaid agency?
Policy and Protocol Development
When developing your telehealth policies and virtual care protocols, you should refer to existing resources available. A few reliable sources include:
- Make sure to refer to your specialty board association which offers a number of practice guidelines to tailor your implementation and practice of telehealth services.
With just a few clicks, you can begin providing telehealth visits to your patients. Get started today on the Carie platform, a provider-centric virtual care platform based in the cloud, and you’ll soon be on your way to the benefits of telehealth.