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Claudia Téllez

Getting Reimbursed for Telemedicine in Virginia


In order to serve the needs of Virginia’s diverse and distributed population, state leaders have been out in front of the new healthcare delivery options made possible by telemedicine. In 2010, Virginia became just the 10th state to require private payer parity for telehealth visits.

History of telemedicine regulations in Virginia

 

  •  Senate Bill 675, Health insurance; mandated coverage for telemedicine services (2010) – On March 2, the Virginia Legislature unanimously approved a bill (SB 675) that would require private health insurers, health care subscription plans and HMOs to cover for the cost of health care services provided through telemedicine technology.
  • SB 1227 Telemedicine services; provision of health care services. (2015) – Enacted on February 26th, 2015, SB 1227, expanded access to care for minor illnesses by amending Virginia law to clarify that a prescriber licensed in Virginia may prescribe Schedule VI controlled substances via telemedicine, provided the prescriber conforms to the same standard of care expected of an in-person visit.

Private payer reimbursement for telemedicine in Virginia

Virginia can be considered a leader in achieving private payer reimbursement parity for telehealth.  In 2010, they became just the 10th state to mandate reimbursement for this important method of patient care.

Definition
The law defines telemedicine services as, “The use of electronic technology or media, including interactive audio or video, for the purpose of diagnosing or treating a patient or consulting with other health care providers regarding a patient’s diagnosis or treatment.”

Exclusions
Reimbursement is not required for the following:

        • An audio-only telephone conversation
        • An electronic mail message
        • A facsimile transmission

Policies Included
The law applies to all insurance policies, contracts, and plans delivered, issued for delivery, reissued, or extended on and after January 1, 2011, or at any time thereafter when  any term of the policy, contract, or plan is changed or any premium adjustment is made.

It does not apply to short-term travel, accident-only, or limited or specified disease policies or contracts, nor to policies or contracts designed for people eligible for Medicare, or any other similar coverage under state or federal governmental plans.

Parity
Insurers must reimburse treating providers for the diagnosis, consultation, or treatment of the insured delivered through telemedicine “on the same basis” that insurer is responsible for coverage for the provision of the same service through face-to-face contact.

Copayments and Maximums
An insurer may offer a health plan containing a deductible, copayment, or coinsurance requirement for a health care service provided through telemedicine as long as it does not exceed the deductible, copayment, or coinsurance applicable if the same services were provided face-to-face. Insurers may not impose any annual or lifetime dollar maximum on coverage for telemedicine services other one that applies to all items and services covered under the policy.

Patient Site Requirements
A policy can not distinguish between patients in rural or urban locations.

Code of Virginia Physician Regulations
Virginia’s State Medical Board

Telemedicine Definition
For the purpose of regulating physician practices in Virginia “telemedicine services,” as it pertains to the delivery of health care services, means the use of electronic technology or media, including interactive audio or video, for the purpose of diagnosing or treating a patient or consulting with other health care providers regarding a patient’s diagnosis or treatment. “Telemedicine services” does not include an audio-only telephone, electronic mail message, facsimile transmission, or online questionnaire.”

Practitioner-Patient Relationship
Practitioners recognize the obligations, responsibilities, and patient rights associated with establishing and maintaining a practitioner-patient relationship. Where an existing practitioner-patient relationship is not present, a practitioner must take appropriate steps to establish a this relationship. Relationships may be established using telemedicine services provided the standard of care is met.

Identity and Consent
A practitioner is discouraged from rendering medical advice and/or care using telemedicine services without (1) fully verifying and authenticating the location and, to the extent possible, confirming the identity of the requesting patient; (2) disclosing and validating the practitioner’s identity and applicable credential(s); and (3) obtaining appropriate consents from requesting patients after disclosures regarding the delivery models and treatment methods or limitations, including any special informed consents regarding the use of telemedicine services.

Documentation
Evidence documenting appropriate patient informed consent for the use of telemedicine services must be obtained and maintained.

The medical record should include, if applicable, copies of all patient-related electronic communications, including patient-practitioner communication, prescriptions, laboratory and test results, evaluations and consultations, records of past care, and instructions obtained or produced in connection with the utilization of telemedicine services.

Prescriptions
Prescribing medications, in-person or via telemedicine services, is at the professional discretion of the prescribing practitioner.

Frequently Asked Questions (FAQ)

How to Launch a Successful Telehealth Program for DC Metro Area Medical Practices

Telemedicine is all about convenience for any patient but it’s also a powerful tool that transforms patient engagement, while increasing revenue for an independent practice. There are a number of factors to consider when developing a telemedicine program.  Luckily, at MSNVA, we have narrowed down the key ingredients that will help physicians launch a successful telemedicine program with minimum risk.

For example, many of our network physicians and their support staff have brought up the fact that some patients don’t like to schedule follow-up visits to discuss diagnostics and would rather just get a telephone call from their physician.  The main reasons for this are inconvenience of taking time off again, driving time, and cost, which leave the practices out of that revenue.  With DoctorsTelemed, the front-end staff can simply schedule patients for follow-up visits at the time of the first appointment and even collect the co-payment for that future visit in advance.

For primary care physicians with a heavy patient load of Medicare subscribers, the opportunity to provide patients with chronic care management programs while increasing revenue is almost too easy.  Practices should focus on at least two chronic conditions like Diabetes and High Blood Pressure, identify the patients and offer to enroll them in a program using DoctorsTelemed.  Schedule your patients monthly for monthly 20-minute sessions for up to 12 months, the system will automatically bill Medicare for the appropriate codes 99487, 99489 or 99490, which reimburses at an average rate of $40 – $45/session or $480 – $540/patient/year depending on the area where physicians practice.

Another key benefit is keeping specialist consultations in-house, thereby giving patients real-time access to specialty care while retaining more revenue.  Some DoctorsTelemed providers are already implementing this model, by assigning one exam room for the exclusive use of telemedicine.  This model works well in primary care settings and for specialists who do surgeries and need to have pre-operation physical clearance for their patients.

Under Medicare billing rules, for example, the consulting practitioner can bill for the level of service provided.  Physicians/practitioners submit the appropriate Current Procedural Terminology (CPT®) procedure code for covered professional telehealth services along with the ‘GT’ modifier (‘via interactive audio and video telecommunications system’). By coding and billing the GT modifier with a covered telehealth procedure code, the distant site physician/practitioner certifies that the beneficiary was present at an eligible originating site when the telemedicine service was provided. To claim the facility payment, physicians/practitioners bill Healthcare Common Procedure Coding System (HCPCS) code ‘Q3014, telehealth originating site facility fee,’ with the short description ‘telehealth facility fee.’

Hurricane Treatment Guide

Our thoughts continue to be with all of those affected by Hurricane Harvey and Irma.

From now through the end of September 2017, DoctorsTelemed physicians are delivering free telehealth consults to hurricane victims in Texas and Florida, adding needed clinical capacity in these states to make sure those impacted by the hurricane get the care they need. We are also setting up free accounts for physicians whose physical practices have been affected by the hurricane and would like to see patients remotely. For more information, please email here.

Below is a list of services our doctors can treat, along with conditions that may require a visit to the ER.

  • What we can treat:
    • Asthma
    • Cold & Flu
    • Congestion
    • Coughing
    • Medication refills
    • Sore throats
    • Vomiting & Diarrhea
    • Infections following water exposure
    • Other non-emergency issues
  • When to go to the ER
    • You can’t catch your breath
    • Bleeding wounds
    • Broken bones or dislocations
    • Chest pain
    • Loss of consciousness

If you are experiencing a crisis or emergency, call 911 or go to your nearest emergency room. You can also access the free, 24-hour National Suicide Prevention Lifeline at 1–800–273–8255.

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