FAQ on Telehealth

Hey Tek-ninjas, this information comes from the source... hopefully it will be useful to some of you navigating the world of Telehealth. 

Medicare 

Medicare has not extended telepractice to audiologists, SLPs, or physical and occupational therapists, despite the publicity regarding alleviation of penalties regarding noncompliance with telepractice requirements. However, Medicare has expanded use of e-visit G-codes—which are not considered telepractice—to more providers in an effort to ease access issues.

The e-visit codes describe specific online communications that require a clinical decision and must meet specific criteria for appropriate billing.
The Medicare G-codes for e-visits are G2061-G2063 and include very specific parameters to determine whether an e-visit can be included on a Medicare Part B (outpatient) claim for payment.

• 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 

To correctly report G2061-G2063, the online assessment and management services must be:

• initiated by an established/existing patient,
• conducted through a patient portal, 
• medically necessary (requires clinical decision-making and is not for administrative or scheduling purposes), and 
• documented and stored to reflect the clinical decision-making and amount of cumulative time spent providing e-visit services to each patient. 

Clinicians may report an e-visit code only once per seven consecutive days.

Medicaid

Each State Medicaid program is issuing guidance on their decision to allow telehealth. For example, Ohio Medicaid recently release an update to their Administrative rule that allows telehealth to SLPs. If a state allows this, the following billing codes are applicable –

Commercial Insurance

Commercial Insurance Plans typically follow suit with Medicare (CMS). We continue to monitor each commercial insurance plan as they publish guidance and will keep you updated when the information is applicable.

HIPAA Guidance for Telehealth

The Office for Civil Rights (OCR) at the Department of Health and Human Services (HHS) is responsible for enforcing certain regulations issued under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), as amended by the Health Information Technology for Economic and Clinical Health (HITECH) Act, to protect the privacy and security of protected health information, namely the HIPAA Privacy, Security and Breach Notification Rules (the HIPAA Rules).

• During the COVID-19 national emergency, which also constitutes a nationwide public health emergency, covered health care providers subject to the HIPAA Rules may seek to communicate with patients, and provide telehealth services, through remote communications technologies. Some of these technologies, and the manner in which they are used by HIPAA covered health care providers, may not fully comply with the requirements of the HIPAA Rules.
• OCR will exercise its enforcement discretion and will not impose penalties for noncompliance with the regulatory requirements under the HIPAA Rules against covered health care providers in connection with the good faith provision of telehealth during the COVID-19 nationwide public health emergency. This notification is effective immediately. 
• A covered health care provider that wants to use audio or video communication technology to provide telehealth to patients during the COVID-19 nationwide public health emergency can use any non-public facing remote communication product that is available to communicate with patients. 
• OCR is exercising its enforcement discretion to not impose penalties for noncompliance with the HIPAA Rules in connection with the good faith provision of telehealth using such non-public facing audio or video communication products during the COVID-19 nationwide public health emergency. 
• This exercise of discretion applies to telehealth provided for any reason, regardless of whether the telehealth service is related to the diagnosis and treatment of health conditions related to COVID-19. 
• For example, a covered health care provider in the exercise of their professional judgement may request to examine a patient exhibiting COVID- 19 symptoms, using a video chat application connecting the provider’s or patient’s phone or desktop computer in order to assess a greater number of patients while limiting the risk of infection of other persons who would be exposed from an in-person consultation. Likewise, a covered health care provider may provide similar telehealth services in the exercise of their professional judgment to assess or treat any other medical condition, even if not related to COVID-19, such as a sprained ankle, dental consultation or psychological evaluation, or other conditions. Under this Notice, covered health care providers may use popular applications that allow for video chats, including Apple FaceTime, Facebook Messenger video chat, Google Hangouts video, or Skype, to provide telehealth without risk that OCR might seek to impose a penalty for noncompliance with the HIPAA Rules related to the good faith provision of telehealth during the COVID-19 nationwide public health emergency. Providers are encouraged to notify patients that these third-party applications potentially introduce privacy risks, and providers should enable all available encryption and privacy modes when using such applications. 
• Under this Notice, however, Facebook Live, Twitch, TikTok, and similar video communication applications are public facing, and should not be used in the provision of telehealth by covered health care providers. 
• Covered health care providers that seek additional privacy protections for telehealth while using video communication products should provide such services through technology vendors that are HIPAA compliant and will enter into HIPAA business associate agreements (BAAs) in connection with the provision of their video communication products. The list below includes some vendors that represent that they provide HIPAA-compliant video communication products and that they will enter into a HIPAA BAA. 
• Skype for Business / Microsoft Teams 
• Updox 
• VSee 
• Zoom for Healthcare 
• Doxy.me 
• Google G Suite Hangouts Meet

Clean those hands!!