TELEHEALTH ASSISTANCE FOR PROVIDERS

We’ve seen a huge increase in questions and assistance related to implementing telehealth, and to the new emergency and temporary billing, Medicare, Medicaid, and HIPAA regulations. The SCTRC has put together this compendium of resources with much help from our colleagues. Resources specific to Telehealth and COVID-19 Policy and Reimbursement are included.

   This symbol indicates a specific resource related to the COVID-19 situation.

We will update this information regularly. Please review the information below and if you still do not find the information you need, please send us your questions directly or call us at 1.855.664.3450.

Please remember that information provided by the SCTRC is intended for general information purposes only and is not intended or implied to be a substitute for professional legal and billing advice. We recommend discussing billing and legal decisions with your organization’s compliance officer to ensure agreement or consulting with an attorney regarding any legal issue.

(Last Updated: 04.01.2020)

INTRODUCTION TO TELEHEALTH

If you are a new Provider of  telehealth, this is the place to start to learn more about terminology, types of telehealth, and the different modalities.  These resources are ‘bite-sized chunks’ of information designed specifically for those providers new to telehealth.

Live Q & A Sessions| Upcoming Virtual Events

  • Telehealth 101 Webinar Recording |  Video
    • Archived recording of a past Telehealth 101 webinar presenting the easy basics of telehealth and telemedicine
  • Overview of Telehealth | Course Module
    • Free introductory course module perfect to sharpen your understanding of telehealth!

Additional Suggestions

  • Best practices include starting with one program to develop the process and ensure highly skilled and comfortable to all staff. Identify the initial program and purchase other equipment including peripherals only as needed.
  • Make sure you have appropriately licensed health care providers at the originating sites and distant site locations. You may be able to utilize APRN’s, NP, and PAs as providers at the distance site depending on your state laws.
  • As you build your programs, consider that not all health care services should be performed from a distance. Determine the needs of the patient and what is needed to examine the patient. Provide the level of expertise that is needed at the site with the patient to ensure an adequate exam can be performed. Some patients will need to be examined in person rather than over interactive video.
  • To build familiarity with this style of communication, encourage administrative meetings internally and externally with collaborative and prospective partners via video conferencing tools (i.e., Zoom, Cisco Meeting, GoToMeeting, etc.).

PATIENT RESOURCES

What to Expect From a Telehealth Visit (for Patients) | Video

    • Share this video with your patients before your telehealth visit to help them understand telehealth, ways telehealth can be used, types of tools, and what to expect during the visit. It also coaches patients on how to prepare for their visit including having medical history and also how to eliminate distractions. (Credit:  Pacific Basin Telehealth Resource Center, a member of the National Consortium of Telehealth Resource Centers)
  • How Patients Can Use Telehealth | Handout
    • This Patient handout answers some frequently asked questions about telehealth/telemedicine.
      (Credit: National Consortium of Telehealth Resource Centers, supported by grant number G22RH30361 from the Office for the Advancement of Telehealth, Federal Office of Rural Health Policy, Health Resources and Services Administration, Department of Health and Human Services.)
  • Explaining Virtual Healthcare to Your Patient | Handout
    Quick handout for your patients to explain Virtual Healthcare aka Telehealth and how it can be beneficial for them. (Credit: National Consortium of Telehealth Resource Centers, supported by grant number G22RH30361 from the Office for the Advancement of Telehealth, Federal Office of Rural Health Policy, Health Resources and Services Administration, Department of Health and Human Services.)

Technology Help for Your Patients | Website

    • Patients who are new to using technology for their healthcare may need some quick help.  “Telemedicine Visit Toolkit for Patients” which includes videos and help sheets explain how to use FaceTime, Google Hangouts, etc. for online health care. These resources are available for providers to share with patients as needed. (Credit: UAMS’ PatientsLearn.org)

TECHNOLOGY

This section provides an introduction as well as resources to help you choose which technology is right for your program.
  • Telemedicine & Telehealth Service Provider Directory  |  Resource
    • This comprehensive database includes equipment and software providers who specialize in telehealth. Developed by the Southwest Telehealth Resource Center, a member of the National Consortium of Telehealth Resource Centers.
  • National Telehealth Technology Assessment Resource Center | Website
    • This whole website is dedicated to providing resources to help you choose the telehealth equipment, software, and peripherals that are right for your program. The Technology Assessment 101 Toolkit, for example, is especially useful if you are new to choosing telehealth or technology vendors. The National Telehealth Technology Assessment Resource Center is a member of the National Consortium of Telehealth Resource Centers.

Technology-Telemedicine Help for Providers | Website

    • Quick tools to help Providers learn how to use and setup specific, remote communication technologies for consults. Guidance for FaceTime | Google Hangouts | Skype are included. NOTE: Some resources are specific to UAMS Providers. These resources include UAMS EPIC | UAMS CISCO Meeting | and UAMS eLink Portal. Our thanks to our colleagues at the UAMS Institute for Digital Health & Innovation (LearnOnDemand.org and PatientsLearn.org) for curating, developing, and sharing these resources.

Technology Help for Your Patients | Website

    • Many patients who are new to using technology for their healthcare may need some quick help.  UAMS’ PatientsLearn.org hosts some videos and documents that help explain how to use and how to setup remote communication applications such as FaceTime, Google Hangouts, etc. for their online health care. Feel free to share these resources from the UAMS Institute for Digital Health & Innovation as needed.

Additional Suggestions

  • It is critical to have sufficient bandwidth to transmit audio and video data for telemedicine applications. We recommend no less than 2Mbps upload and 2Mbps download speed per telemedicine unit per call for optimum quality. For comparison, HealthIT.gov recommends larger practices (5-25 physicians) should have a bandwidth plan of 25 Mbps. It is important to note that some organizations have found that telemedicine consults can be successful at 1.5 Mbps upload/download per unit per call. (Source: HealthIT.gov, 2013)

CONDUCTING VIRTUAL CONSULTS

Resources to help you conduct your telemedicine consults with your patients
  • Telehealth Consult Checklist  |  Video
    • Demonstration of a patient/provider consult with a tele-presenter. Includes a best practices for the pre-consult setup, during the consult, and post-consult.
  • Telepresenting Basics  |  Course Module
    • This module is meant to provide you with some general guidelines to perform before, during and after a Telemedicine event from both the Originating and Distant Site. Keep in mind that most Telemedicine events are unique and this module is intended to provide you with a sample of what an event could look like
  • Learning Webside Manner/Telehealth Etiquette for Providers | Video Series
    • This series, developed by Old Dominion University and hosted on LearnTelehealth.org, includes videos, which occasionally may seem over-the-top, are based on very real, actual scenarios. Demonstrations include Medical Consults, Behavioral Consult, Group Provider Consults, Providers On Call, and more.
  • Telehealth Best Practices  |  Video
    • Describes setting up the patient and consult rooms to consider lighting, surroundings, and patient interactions. Developed by the University of Hawai’i.
  • Quick Guide to Telemedicine in Practice | Website
    • Developed by the American Medical Association
  • Model Policy for the Appropriate Use of Telemedicine Technologies in the Practice of Medicine | Document
    • Developed by the Federation of State Medical Boards

FEDERAL POLICY & BILLING

Resources to help you understand the current Federal and Medicare policies as they relate to COVID-19

Telehealth & COVID-19 | National Consortium of Telehealth Resource Centers (NCTRC) Archived Webinar

    • Recording of the webinar hosted by the NCTRC. This webinar includes telemedicine and policy information guidance that especially pertains to the current conditions, as of March 19, 2020

COVID-19 Telehealth Toolkit | NCTRC Document

  • If you are new to telehealth or an ‘old-hand’, good reference document with information about telehealth, current policy related to COVID-19, and other useful resources during this emergency situation.

COVID-19 Summary by the CCHP | Document

    • This summary was developed by the Center for Connected Health Policy, the policy-focused TRC, and a member of the National Consortium of Telehealth Resource Centers.

H.R. 6074 Bill | Reference Document

Medicare Billing Information during COVID-19

    • CMS General Telemedicine Booklet | Document
      The Centers for Medicare & Medicaid Services (CMS) have broadened access to Medicare telehealth services so that beneficiaries can receive a wider range of services from their doctors without having to travel to a healthcare facility. This booklet explains how these changes affect Medicare policy. This document also contains electronic links to reliable sources of information regarding telehealth. Most of the information is directed towards providers who may want to establish a permanent telemedicine program.
    • Medicare Learning Network Telehealth Services Booklet (2020) | Document
      Intended for Medicare Fee-For-Service Providers, this booklet discusses Medicare policy, who can be bill for telemedicine services, and includes billing guidance. It includes guidance on the expanded telehealth benefits applicable during the COVID-19 outbreak.
    • Medicare Telemedicine Healthcare Provider Fact Sheet | Document
      Additional information from CMS about the temporary and emergency benefits based on recent legislation and executive orders. This document summarizes and includes “key takeaways” such as “Starting March 6, 2020 and for the duration of the COVID-19 Public Health Emergency, Medicare will make payment for professional services furnished to beneficiaries in all areas of the country in all settings.”  This document also describes regulations and codes about “Virtual Check Ins” and “e-Visits“. (Refer to the CMS Fact Sheet for more information.)
    • Medicare MLN Matters Special Edition re: Fee-for-Service Response to the Public Health Emergency on the Coronavirus | Document
      Updated to cover the use of modifiers on telehealth claims and to explain tha tthe DR condition code is not needed on telehealth claims under the waiver.

Privacy & Security : HIPAA

    • According to the CMS (Medicare) announcement, the Office of Civil Rights (OCR) “will exercise enforcement discretion and waive penalties for HIPAA violations.” Important to note, however, not every state has waived HIPAA requirements so please review your state’s  policies.  (Source: NCTRC, “Telehealth and COVID-19” Webinar, March 19, 2020)
    • For more OCR guidance, visit this OCR page on the HHS.gov website.

Drug Enforcement Administration Policy

    • The Drug Enforcement Administration (DEA) has released guidance regarding issuing prescriptions for controlled substances via telemedicine. Read more about the DEA’s current policy here.

BILLING

Special Coding Advice During COVID-19 Public Health Emergency (Updated 4/4/2020) | Document

    • From the American Medical Association, this reference document includes coding advice for a variety of scenarious including patients being screened for COVID-19 or having COVID-19, as well as non-COVID-19 related cases.

National Uniform Billing Committee Announcement for COVID-19 Billing | Document

    • The NUBC suggested guidance for the appropriate flagging of COVID-19 related care and institutional claims for COVID-19 diagnosis or treatment
  • Billing Guide for Telehealth Encounters (January 2020) | Document
    Developed by the Center for Connected Health Policy, this is an introductory and very useful resource for understanding how to bill for fee-for-service encounters. Perfect if you are new to Telehealth billing.
  • Which providers are eligible to bill for Medicare reimbursement for telehealth services?
    • According to Medicare regulations, and most recently outlined in this CMS Fact Sheet, distant site practitioners who can furnish and expect reimbursement for covered telehealth services (also subject to each state’s laws) can include physicians, nurse practitioners, physician assistants, nurse midwives, certified nurse anesthetists, clinical psychologists, clinical social workers, registered dietitians, and nutrition professionals. (Source: CMS.gov, Center for Connected Health Policy)
    • Note: Billing policies and fees for FQHCs and RHCs differ. Confirm with your Medicare assistance center (MAC) for further clarification.

STATE POLICY & BILLING

These resources help to explain the current policies as they relate to COVID-19 for the SCTRC region including Arkansas, Mississippi, and Tennessee.

Telehealth and Telemedicine regulations can vary by state on such topics as Store & Forward and Informed Consent. The Center for Connected Health Policy provides a summary of the State Laws & Reimbursement Policy for your state.

It is important to note that Medicaid and private payer information varies by state and may also be impacted by your state Medical Board regulations. We strongly encourage you and your billing staff to familiarize yourself with all protocols for the services you elect to provide.

ARKANSAS

Arkansas Medicaid-Telemedicine Requirements for Physicians during the COVID-19 Public Health Emergency, DMS-01(03/18/2020) | Medicaid Document

    • Memorandum in reference to Telemedicine Requirements for Physicians during the COVID-19 Public Health Emergency

Arkansas Medicaid Memorandum, DMS-03 (03/23/2020)| Document
Use of Telemedicine to Provide Occupational, Physical and Speech Therapy during COVID-19 Outbreak

Arkansas Executive Order to Encourage Treatment and Communication by Technology | Executive Order, Document

MISSISSIPPI

Mississippi Medicaid Emergency Telehealth Policy | Document

Mississippi Medicaid Updates including Telemedicine Documents | Website

Medicaid and CHIP Coverage related to COVID-19 | CMS Document

Mississippi Telehealth Association (MTA) Policy Updates Related to COVID-19 | Website

TENNESSEE

TennCare (Tennessee Medicaid) Information About Coronavirus | Website

    • Consolidated web page for coronavirus updates for Tennessee healthcare providers

Updated Behavioral Health Telehealth Services for TennCare Enrollees (03.25.2020) | Medicaid Memorandum

    • Replaces the original memo dated 03.18.2020

Novel COVID-19 Testing and Telehealth Services for TennCare Enrollees (03.17.2020) | Medicaid Memorandum

    • Guidance from each health plan as it relates to telehealth and telephonic
      services for TennCare enrollees.

State of Tennessee Executive Order No. 15 (03.19.2020) | Executive Order, document

    • Several provisions including consideration for physician’s licensed in other states. Refer to the order and additional government guidance for full details.

Additional Helpful Sites

Telehealth Policy Updates Related to COVID-19 provided by Mississippi Telehealth Association | Website

COVID-19 Related State Actions (updates ongoing) | Website

    • Another great resource from the Center for Connected Health Policy, a nationally-focused telehealth resource center. This page tracks actions for all of the states and is updated regularly.

 

Don’t see your state listed? Please visit the National Consortium of Telehealth Resource Centers website to find the TRC for your state. Or, contact us and we will be happy to connect you with your TRC.

RESEARCH

  • Telehealth/Telemedicine Research Library. | Website/Database
    Current and robust resource for publications and resources related to telehealth and telemedicine. This database is developed and hosted by the Northeast Telehealth Resource Center, a member of the National Consortium of Telehealth Resource Center.

SPECIALTIES

Long-Term Care Nursing Homes Telehealth and Telemedicine Tool Kit. | Document

    • From CMS, this telehealth toolkit includes resources specifically for nursing homes.

ADDITIONAL RESOURCES

There are several VERY GOOD resources related to Telehealth and COVID-19.
Here are a few we highly recommend:

Frequently Asked Questions | Mid-Atlantic Telehealth Resource Center

    • Robust FAQ including information about Remote Patient Monitoring, Behavioral Health, Education, and more.

COVID-19 and Telehealth ResourcesPacific Basin Telehealth Resource Center

    • Another good resource for quick start guides and screening tools.

COVID-19 Pandemic Telehealth ToolkitNortheast Telehealth Resource Center

    • Thorough webliography of publications and articles including Epidemiology, Epidemic Planning Resources, Model Programs for Infectious Disease, Models for Home-Based Services, and more.

FREQUENTLY ASKED QUESTIONS

As a Provider, should I use Apple FaceTime, Google Hangouts, Skype, etc.?

    • Some applications are considered “non-public remote communication” and are approved during this temporary emergency according to HHS.gov. Applications that are approved include Apple FaceTime, Google Hangouts, Skype, and Zoom. But there are more, so check out the full list on HHS.gov.  Keep in mind, however, that you may not want to use your personal accounts or cell phone for these types of consults. Also, remember to advise your patient on how they can protect their Priviate Health Information (PHI) by using compliant applications and being in private areas for consults.Furthermore, applications like Facebook Live, TikTok, Snapchat, and the like are considered “public applications” and these are not approved for telemedicine consults. (Refer to the HHS.gov HIPAA and COVID-19 FAQs on HIPAA and Telehealth for more specifics. Information as of 03.27.2020)
  • Who are the Telehealth Resource Centers and what is the National Consortium?
    • Telehealth Resource Centers (TRCs) provide free resources for telehealth program development and sustainability. The TRCs receive funding from the U.S. Department of Health and Human Services’ Health Resources and Services Administration (HRSA) Office for the Advancement of Telehealth, which is part of the Federal Office of Rural Health Policy. There are 14 TRCs located across the country – two have a National focus on policy and technology and the others have a regional focus. All of the TRCs collaborate so you have a vast network of support for your program initiatives. To find out which Regional TRC supports your area, visit: https://www.telehealthresourcecenter.org/who-your-trc/Together, the Telehealth Resource Centers comprise the National Consortium of Telehealth Resource Centers (NCTRC). We work collective to develop resources including webinars, toolkits, events, sample telehealth-related job descriptions, forms, etc. To see what else is available or to register for upcoming events, visit: telehealthresourcecenter.org.

    Are there any factors we should consider when choosing a room to do telemedicine consults, from the provider or patient perspective?

    • Yes. It is important to consider the location, your clinic workflow, room size, purpose, privacy, lighting, and possible distractions for patient and provider.  This video, Telehealth Best Practices (developed by University of Hawai’i) discusses these options in detail.  Also, see the previous section pertaining to Conducting Virtual Consults for more demonstrations of proper and distraction free consult rooms.