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Telehealth Tips, Strategies and Resources

July 29, 2020

Telehealth Tips, Strategies and Resources

Using interactive audio and video telecommunication systems, telehealth services are a substitute for an in-person encounter between a patient and provider. A telehealth visit is not simply answering questions as you might do via phone or patient portal.

Because many of the virtual care and telehealth reimbursement and HIPAA requirements were relaxed during the public health emergency (PHE) caused by the COVID-19 pandemic, patients and providers alike have had more exposure to this service delivery option. Following CMS’s lead, many payors expanded coverage for telehealth services during the PHE by:

  • Lifting the location requirements (e.g., originating site) for the patient
  • Removing the established relationship provision between provider and patient (e.g., services to new patient visits)
  • Relaxing the restrictions on the type of technology (e.g., platforms) that could be used to deliver the services
  • Reimbursing for telehealth services without synchronous video connections (e.g., audio only)
  • Adding services (e.g., additional CPT codes) to the list of eligible telehealth services
  • Allowing additional provider types to provide telehealth services

Regardless of how the service is delivered, who is delivering the service, where the participants are located physically and what services are actually being delivered, below are some recommended practices, tips, suggestions and resources for practices delivering telehealth services.

1. Confirm professional liability coverage is in place for delivering telehealth services.

2. Know the regulations. 

  • Stay current on the federal, state, payor and licensing regulations regarding telehealth services in your area [Link]
  • Patient consent for telehealth may be mandated by state or payor requirements [Link]
  • Consider including the following:
    • Give the patient the option to decline to receive services via telehealth, and they may withdraw from receiving virtual care at any time
      Note: Include risks and benefits, treatment alternatives and risk and benefit of no treatment
    • Limitations of the service (e.g., certain diagnosis, lab testing, physical exam, emergency situations)
    • Security measures taken to ensure privacy (e.g., using a secured network)
    • Rights of the patient with respect to PHI (e.g., providing access to the visit summary)
    • Patient cost share obligations
    • Instructions in case of technical difficulties
    • Explain potential for needing an in-person visit 
    • Recording of the call (if applicable)
  • Providers should ensure they are meeting the licensing requirements in the applicable states
  • Providers should comply with prescribing laws of applicable states

3. Maintain documentation. 

  • Clear and detailed documentation will be critical for coding, billing and reimbursement, clinical follow-up and risk mitigation. Documentation of a telehealth visit should meet the same standards as an in-person visit. For a comprehensive list of what should be included in your documentation, access LAMMICO's "Documentation for Telehealth" resource. To access this resource, log in as a Member at lammico.com and select to “Go to Practice Solutions Home” from your Member homepage. 

4. Ways to encourage telehealth services:

  • Explain the benefits of telehealth to your patients
  • Update website to include information on telehealth services (e.g., what conditions are covered)
  • Change the out-of-office phone message to include telehealth options
  • Employ social media channels to “market” telehealth services
  • Develop written scripts for office staff and patient education resources [Link]    
  • Develop patient instructions or prep sheet and include:
    • Whether patients be notified that the minutes of their data plan could be exceeded during the televisit
    • How to access assistance with the telehealth platform or application or in using equipment
    • Check-in/registration process
    • Payment obligations and process
    • What to bring to the telehealth appointment:
      • List of medications
      • Name, phone number and address of preferred pharmacy
      • Reason for visit
      • Any relevant clinical information (e.g., glucose levels, BP, height, weight, etc.)
      • Family member
  • Provide patients with guidance on recommended technology: (e.g., internet speed, browser, etc.)
    • Do not use a public network
    • Use a secure and private room
    • Use a quality camera
    • Place the camera at eye level
    • Test the sound – use an external speaker/headphones or microphone if needed, and make sure you are not muted
    • Charge your device 
    • Use wired connection if possible
    • Close all other applications
    • Remind patients that the visit may use data depending on their personal internet or cell phone plan

5. Prepare the practice.

  • Determine what telehealth platform to use and test it in your location
  • Obtain a Business Associate Agreement (BAA) from the telehealth platform vendor 
  • Include your telehealth platform in your HIPAA Security Risk Assessment
    • Create a telehealth policy and procedure for your practice
    • Train staff on the telehealth policy and procedures for your practice
  • Develop scripts for scheduling. Include a triage plan to assess if an encounter is appropriate for telehealth.
  • Develop a process for scheduling, consent, check-in, patient education, check-out, collections and other handoffs during the call
  • Password protect devices used for delivery of services
  • Disable phone and microphones when not in use
  • Prepare to use auxiliary aids should there be a need
  • Consider having a “site coordinator”
  • Have a plan for in-person follow-up exam if needed
  • Practice, practice, practice

6. Telehealth etiquette:

  • Be professional
  • Sign in early and do a tech check
  • Turn off all web application notifications 
  • Verify the patient’s identity
  • Have the medical record readily available before beginning the encounter
  • Introduce yourself and everyone in the room
  • Place camera at eye level
  • Use the self-view window during the call
  • Use headphones and/or speakers to improve communication
  • Speak clearly and deliberately, pause often
  • Narrate actions if you look away from the camera
  • Dress as you would for an in-person visit
  • Select an appropriate location (e.g., consider using an exam room). Consider all of the following, especially if in a remote location:
    • Private and secured
    • Strong, reliable, secure internet connection
    • Quiet or minimal distractions
    • Adequate lighting
  • In the event of an emergency, stay online with the patient until transfer of care can be given to the team assuming care if possible
  • Terminate the connection immediately when the visit is over. Do not leave the connection unattended.

7. Revenue cycle issues:

  • Create a telehealth appointment type in your scheduling system
  • Include telehealth visits in RCM processes (e.g., insurance and benefits verification, financial obligations, pre-auth or pre-cert when applicable)
  • Monitor payor policies
    • Telehealth expansion
    • POS and modifiers
    • Cost share 
      View LAMMICO's "Telehealth Billing and Coding Matrix" and "Upcoming Dates: Reimbursement, Financial Relief, Public Health Emergency and Quality Payment Program" table by logging in as a Member at lammico.com
  • Consider alternative methods for accepting payment

Important Note: Many of the waivers currently in place will end when the public health emergency ends.

Although it is early to say what telehealth services will look like “post-COVID-19,” many believe that virtual care is going to have a more prominent place in our healthcare system moving forward. To assist you with establishing, maintaining and getting reimbursed for telehealth and other virtual services, LAMMICO has a consolidated list of resources to help you and your practice, regardless of where you are in implementation. To access this resource, log in as a Member at lammico.com and select to “Go to Practice Solutions Home” from your Member homepage. 

This content is accurate as of July 29, 2020. 

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