Telehealth is table stakes in a coronavirus world. Federal rules have relaxed such that anyone can get started, and now more than ever, patients are willing and ready to talk to their doctors from afar.
However, that puts pressure on providers to learn the basics of telemedicine for COVID-19 without much time, if any, to assess options, compare vendors and learn technologies. But in this evolving environment, adapt you must.
In the absence of a year-long runway to plan and implement virtual care, here’s a quick starter guide from Wolters Kluwer Health’s 5MinuteConsult.
Pick Your Platform
Telemedicine can include any platform that delivers care at a distance, from videoconferencing to phones if video isn’t available. Thanks to lifted restrictions from the Centers for Medicare & Medicaid Services, private chatting tools like FaceTime or Skype are also OK.
As the American Academy of Family Physicians (AAFP) says in its telemedicine best practices guide, getting started may simply require a laptop, smartphone or tablet. Still, malpractice considerations may apply, so check with your insurer to see whether you’re covered.
Follow Telemedicine Standards of Care
Providers can conduct virtual visits with any patient, whether they’re new or established.
As with in-person visits, providers can still take a full patient history via telemedicine. Physical exams can be done, too, with certain limitations as well as help from patients:
- Physician-conducted visual exams can assess the eyes, rashes and lesions, joints and the oropharynx.
- Physician-guided patient exams can assess lymphadenopathy, joint range of motion and special testing such as limited cranial nerve exams, palpation of masses and gait.
Ultimately, some patients may still need a physical exam, but only if the benefits outweigh the risks of excess testing, overprescribing and potential COVID-19 exposure.
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Document the Encounter
As with in-person care, the standard evaluation and management (E/M) procedures still apply, the AAFP notes. That includes the chief complaint, history of present illness, review of symptoms, past/family/social history, exam (if applicable) and medical decision-making.
Additionally, telehealth encounters require documentation of the technology, patient identity confirmation (name and date of birth), location of the provider and patient consent.
Example: “After connecting through patient-initiated televideo (or telephone) connection, the patient was verified with two unique identifiers. Patient (or legal representative) was informed that this was a telemedicine visit and that the exam was being conducted confidentially over secure line to my location. Patient acknowledged consent, understanding of billing, privacy and security of telemedicine visit, and gave permission to obtain a history and exam as needed. The patient agrees to participate.”
Submit the Right Billing Codes
Right now, video visits share the same billing structure and codes as in-person encounters, either by components or by time. Phone-based visits can use 99441 (E/M of five to 10 minutes), 99442 (E/M of 11 to 20 minutes) or 99443 (E/M of 21 to 30 minutes).
Providers can also conduct Medicare annual wellness visits using telemedicine, since the physical components are waived for virtual encounters.
Telemedicine for COVID-19: More Resources to Explore
As practices quickly get their telehealth programs up and running, many organizations have made it easier with a library of free telemedicine best practices. For more information, explore these resources:
- Medicare Telehealth FAQs (Centers for Medicare & Medicaid Services)
- Using Telehealth During the COVID-19 Pandemic (American Academy of Family Physicians)
- Quick Guide to Telemedicine in Practice (American Medical Association)
Most importantly, remember that it’s a frightening time for patients and providers alike. Even as care gets digitized and ever more physically distant, keep compassion and humility at the core of your practice. Now more than ever, the world needs more of it.