WRS has expedited the release of new Telehealth functionality to assist providers in conducting remote patient encounters during the COVID-19 Pandemic. We are pleased to offer this functionality to all current clients at no cost until June 30, 2020.

Please complete the Telemedicine Signup Form to enable the functionality below in your practice immediately.

Sign Up for Telehealth Service

Note: In order to use this functionality, your practice must be enrolled in Telehealth functionality. It will be offered free-of-cost until June 30, 2020. Complete the Telehealth Signup Form for setup.

Collection of patient email address is at the center telehealth workflow. It’s essential to check and/or enter the patient’s email when scheduling an appointment. More information on patient email collection can be found in eLearning – Single email tied to multiple patients user guide.

Check Hardware & Software Setup

Be sure to setup the device (PC, MAC, iPad or Cell Phone) that you plan to use for the telehealth visit. All setup requirements and testing suggestions are detailed in the following videos and PDF documents.

It is strongly suggested that a front desk representative is equipped with a noise-cancelling headset with microphone. This allows the front desk user to join the telehealth session in advance of the encounter (30- minutes prior) and privately assist patients with Telehealth setup, Self Check-in and collection of intake data. This should happen 30-minutes before the actual encounter with the provider.

New Telehealth (System Default) Appointment Type

A new Telehealth (System Default) Appointment Type is now available in your practice. You will see this under Administration>Scheduler Setup>Practice Appointment Type

Schedule a Telehealth Appointment

IMPORTANT NOTE: Success with the Telehealth Workflow requires use of the Telehealth (System Default) Appointment Type. Use of any other appointment type will prevent the complete Telehealth workflow.

All previously created (non-default) custom “Telehealth” appointment types should be renamed to avoid user confusion. All appointments made with these custom types should be adjusted to use the Telehealth (System Default) Appointment Type

(1) To make a Telehealth Appointment just use your existing Appointment Scheduling workflow.

(2) Simply select “Telehealth” under the dropdown Appointment Type Box.

Review Patient Email & Self-Check-In Workflow

One you have scheduled a patient using the new Telehealth Appointment Type, the patient will receive a Telehealth Appointment Confirmation Email and Appointment Reminder Emails. These emails include links to PDFs and videos that explain the use of the Patient Self Check-In process (desktop and iPad only):

Patient Self Check-In

This emails also contain a link for Patient Self Check-In. Upon clicking the Patient Online Check In Module link, the patient will be asked to enter Last Name and DOB. If they match a patient in today’s schedule, they will be taken to a series of automated Check-In screens. This is called the Patient Check-In Module.

During Self Check-in, patients confirm demographic and contact info, enter a preferred pharmacy, pay a co-pay due and check-in from their desktop PC/Mac. The process includes approximately 6 screens and should take them only a few minutes.

Once the patient has completed Check-In their appointment status in WRS under Todays Appointments will automatically be updated to WRS to Step 2- Check-In.

You can then move them to Step 3 Move to Exam Room and begin the telehealth video portion of the visit by clicking on the telehealth link (below)

Launching a Telehealth Video Session

Once the patient has been Moved to Exam Room in WRS, simply mouse over the patient name and press the Launch Telehealth button on the Patient Information Box. This will take you to the patient’s telehealth video room in your browser window.

Note that each patient will have a different video room. The link will consist of meet.wrshealth.com and a unique set of 6 digits for each patient:
meet.wrshealth.com/a23b5c

Revenue Cycle Management for Telehealth Visits

Updated Revenue Cycle Management Guidelines for Telehealth and Telemedicine Under COVID-19 Public Health Emergency (PHE) Waivers

Medicare Part B

CMS issued an Interim Final Rule (IFC) that was published in the April 6, 2020 Federal Register. The Interim Final Rule introduces a new crop of temporary regulatory waivers and new rules to equip the American Health Care System with maximum flexibility in responding to the Coronavirus
(COVID-19) which was declared a public health emergency (PHE) and overall pandemic. All of these articles, updates, and different issue dates from the middle of March through April 6th have led to a great deal of confusion.

Here is an updated guide for “Non-Traditional Telehealth Services” for “Dates of Service” on or after March 1, 2020 and for the duration of the emergency period.

Telehealth means that the service is an audio/video encounter between the provider and the patient while Telemedicine means that an audio only (phone call) encounter took place between the provider and the patient.

Practitioner Locations: Medicare has temporarily waived the requirements that providers must be licensed in the state that they are providing services in during the PHE. However, state requirements may still apply. Telehealth and Telemedicine services can take place over state
lines, if the services do not violate state laws. Medicare is allowing practitioners to render telehealth services from their home without reporting their home address on their Medicare enrollment, while continuing to bill from their currently enrolled location (their office) during the PHE, as stated on the CMS website under PHE Waivers.

TELEHEALTH

In order to bill the approved Telehealth CPT codes which, include E&M codes, along with a list of 80 expanded codes for the PHE, the encounter must be conducted via an audio/video application. Please note: WRS Health has an integrated Telehealth Module within the EHR.

Coding: You can find the list of approved telehealth CPT codes under the PHE. Any of the CPT codes in the list issued by CMS can be provided using an audio/video method. This includes E&M codes such as home visits, ED visits, and inpatient visits, to name a few. CMS has indicated in the Interim Final Rule (page 135), that E&M services performed via telehealth can use either MDM or time to determine their levels.

Place of Service: In traditional telehealth the patient goes to an “Originating site” which is paid a facility fee. However, during the PHE, the “Originating site” is not being used. With the PHE exceptions, the provider and the patient are directly connecting, and CMS has determined the provider should not be paid the lower facility rate, which does not include payment for practice expense, for visits that are usually performed in the office. As a result, the instructions during the PHE are to use the location where the in-person encounter would normally be furnished. This means telehealth care that replaces:

Modifiers: Most telehealth visits during the PHE will be appended with the 95 modifier to tell the carrier that this visit was performed using a telemedicine audio/video encounter as opposed to an in-person encounter. If your payers reject a telehealth claim and the 95 modifier is not appropriate, ask about modifier GT. The goal is to append the appropriate modifier to inform the Medicare Part B that the service was not an in-person encounter. Here are the common modifiers used for telehealth:

• 95 (Synchronous Telemedicine Service Rendered Via a Real-Time Interactive Audio and Video Telecommunications System) (See Appendix P in the CPT® 2020 Professional Edition, American Medical Association, p. 896)
• GQ (via asynchronous telecommunications system) (See HCPCS Level II Expert® 2020 Edition, p. 472)
• GT (via interactive audio and video telecommunication systems) use for billing under Critical Access Hospital (CAH) (See HCPCS Level II Expert® 2020 Edition, p. 473)
• G0 (Telehealth Services for Diagnosis, Evaluation, Or Treatment, Of Symptoms of An Acute Stroke) (See HCPCS Level II Expert® 2020 Edition, p. 465)

TELEMEDICINE

Telemedicine is audio only. Since Telemedicine codes are never used for face-to-face encounters, no modifier or special places of service are needed. The provider should use the place of service where they usually provide the service. For example, if they are at home when taking the call, but they usually take the calls in the office, the POS is 11. CMS has also created the ability to provide telephone audio only services under telemedicine as part of the PHE. These services are not supported under the list of telehealth CPT codes and have specific CPT codes assigned to them.

The first telemedicine code that Medicare created is G2012 which is for a Virtual Check-In (VCI) and it is for a 5-10-minute telephone call. Virtual Check-Ins must be initiated by the patient, but the PHE has made it such that the patient can initiate it during the actual call. G2012 is for established patients and the PHE expanded it to New and Established patients.