Increase Practice and Clinic Revenue: Understanding Telehealth Visits

Find out how to Increase small practice and clinic revenue without increasing malpractice insurance coverage while increasing visits.

Transcript

1. Increase Your Practice and Clinic Revenue with Cash Payments and Free Liability: Understanding Telehealth Visits ©2012 AHC. All Rights Reserved http://avidohealthpromo.or 1
2. Remote Clinical Services • Telemedicine • Telehealth • Teleconsultation • Telemonitoring • Teletreatment • Telediagnostics ©2012 AHC. All Rights Reserved http://avidohealthpromo.org 2
3. Physiological Monitoring (Remote Device Management) • Invasive/ Non-Invasive Blood Pressure • Pulse Rate • Temperature • Pulse/ Pulse Rate Oximeter • ECG Monitoring/ Respiratory • Heart Rate/ Arrhythmia • Ischemia • ECG Measurements • Cardiac Output – Continuous and Intermittent • Hemodynamic Calculator • Weight Management • Glucometer • Temperature ©2012 AHC. All Rights Reserved http://avidohealthpromo.org 3
4. Billing for Telemedicine: Primary Factors Two Principles: • The place determined to be the provider site is the billing site (originating site) • A provider can – under certain circumstances – enter the “four walls” virtually using telemedicine ©2012 AHC. All Rights Reserved http://avidohealthpromo.org 4
5. Billing for Telemedicine: Coordinating Factors The factors that determine the billing scenario are: • Where the patient is physically located • Characteristics of the specialty provider site • Payment arrangement with the specialty provider • If there is medical reason for a provider to be present with the patient ©2012 AHC. All Rights Reserved http://avidohealthpromo.org 5
6. Model One: FQHC Patient Site to Specialist (Medicaid approved) Scenario: • Patient is physically present at FQHC site • Specialist is a Medicaid/ SCHIP specialist not physically present at the FQHC • FQHC and specialist have agreement to provide services, but FQHC does not compensate the specialist • No medical reason for a provider to be present with the patient at the FQHC site • Patient virtually enters specialist site via telemedicine Outcomes: • Specialist is the provider site, and can bill for fee-to-service rate. • FQHC did not provide a medical service and cannot bill state Medicaid for a face-to-face visit • Though the FQHC cannot bill for a face-to-face visit, in most- not all - states it can bill for the originating site fee and/or other services it may provide to the patient ©2012 AHC. All Rights Reserved http://avidohealthpromo.org FQHC Site Specialist/ Remote Office 6
7. Model Two: FQHC Patient Site to Specialist (Grant Funds, Self-pay Commercial Payer, etc.) Scenario: • Patient is physically present at FQHC • Specialist is a contracted provider/ specialist not physically present at the FQHC • FQHC and specialist have agreement to provide services, but FQHC compensate the specialist via grant funds, sliding scale (clinical services operating budget, etc.) • No medical reason for a provider to be present with the patient at the FQHC site • Patient virtually enters specialist site via telemedicine Outcomes: • Specialist is the provider site, and can bill for fee-to-service rate. • FQHC did not provide a medical service and cannot bill state Medicaid for a face-to-face visit, however can utilize grant funds, commercial insurance, etc. to pay provider • State laws, sites, Medicare, etc. dictate whether and how much the originating site fee may be (Generally ranges between $50-75 per encounter ©2012 AHC. All Rights Reserved http://avidohealthpromo.org FQHC Site Contracted Provider Specialist 7
8. Model Three: FQHC Patient Site with Provider Present to Medicaid Specialist Scenario: • Patient is physically present at FQHC • Specialist is a Medicaid provider not physically present at the FQHC • FQHC and Medicaid specialist have agreement to provide services, but FQHC does not compensate the specialist • Medical reason for a provider to be present with patient at the FQHC site • Patient virtually enters FQHC site Outcomes: • Medicaid specialist is the provider site and can bill fee-for- service rate • FQHC provided a medically necessary service, thus also a provider site, and can bill Medicaid for a face-to-face visit • Please note that telemedicine services do not change or modify other FQHC billing provisions, including any current limits on visit frequency*** ©2012 AHC. All Rights Reserved http://avidohealthpromo.org FQHC + Outside Provider Remote Medicaid Specialist 8
9. Model Four: FQHC Patient Site with Provider Present to Non-Medicaid/ Grantor Specialist Scenario: • Patient is physically present at FQHC • Specialist is a Non-Medicaid provider not physically present at the FQHC • FQHC and Non-Medicaid specialist have agreement to provide services and FQHC compensates the specialist with grant funds • FQHC protects the patient via FTCA liability protection • Medical reason for a provider to be present with patient at the FQHC site • Patient virtually enters FQHC site Outcomes: • Medicaid specialist is the provider site and can bill fee-for-service rate • FQHC provided a medically necessary service, thus also a provider site, and can bill Medicaid for a face-to-face visit • Grant funds can transfer to the external Non-Medicaid specialist for a ‘cash visit’ by the patient via telemedicine – even onsite visits when needed • Please note that telemedicine services do not change or modify other FQHC billing provisions, including any current limits on visit frequency*** ©2012 AHC. All Rights Reserved http://avidohealthpromo.org FQHC Non-Medicaid Specialist 9
10. Model Five: FQHC Patient Site to FQHC Specialist Site Scenario: • Patient is physically present at FQHC 1 • Specialist is physically present at and receives compensation from FQHC 2 • FQHC 1 and FQHC 2 have agreement to provide services, but FQHC 1 does not compensate FQHC 2 • No medical reason for a provider to be present with the patient at the FQHC site • Patient ‘virtually’ enters FQHC site via telemedicine Outcomes: • FQHC is 2 is the provider site, and can bill Medicaid for a face-to-face visit • FQHC 1 did not provide a medical service and cannot bill Medicaid for a face-to-face visit • In certain scenarios, FQHC1 can secondary bill certain grantor organizations for services/ costs related to certain conditions and patient populations ©2012 AHC. All Rights Reserved http://avidohealthpromo.org FQHC1 FQHC2 10
11. Model Six: Patient Site to FQHC Specialist Site Scenario: • Patient is physically present at FQHC 1 • Specialist is physically present at and receives compensation from FQHC 2 • FQHC 1 and FQHC 2 have agreement to provide services, but FQHC 1 does not compensate FQHC 2 • No medical reason for a provider to be present with the patient at the FQHC site • Patient ‘virtually’ enters FQHC site via telemedicine Outcomes: • FQHC is 2 is the provider site, and can bill private payor, Medicare or grant funds as primary funding for a face-to-face visit • FQHC 1 did not provide a medical service and cannot bill Medicaid for a face-to-face visit ©2012 AHC. All Rights Reserved http://avidohealthpromo.org FQHC1 FQHC2 11
12. Model Seven: FQHC Patient Site 1 with Provider Present to FQHC Specialist 2 Scenario: • Patient is physically present at FQHC 1 • Specialist is physically present at and receives compensation from FQHC 2 • FQHC 1 and FQHC 2 have agreement to provide services, but FQHC 1 cannot compensate FQHC 2 • Medical reason for a provider to be present with patient at the FQHC site • Patient ‘virtually’ enters specialist site via telemedicine Outcomes: • FQHC specialist is the provider site, and can bill Medicaid for a face-to-face visit • FQHC 1 provided a medically necessary service, thus also a provider site, and can also bill Medicaid for a face-to-face visit • This model is very effective for the Super FQHC ©2012 AHC. All Rights Reserved http://avidohealthpromo.org FQHC1 FQHC2 12
13. Model Eight: FQHC Patient Site 1 with Provider Present to FQHC Specialist 2 Scenario: • Patient is physically present at FQHC 1 • Specialist is physically present at and receives compensation from FQHC 2 • FQHC 1 and FQHC 2 have agreement to provide services, but FQHC 1 cannot compensate FQHC 2 • Medical reason for a provider to be present with patient at the FQHC site • Patient ‘virtually’ enters specialist site via telemedicine Outcomes: • FQHC specialist is the provider site, and can bill private payor or Medicare for a face-to-face visit • FQHC 1 provided a medically necessary service, thus also a provider site, and can also bill Medicaid for a face-to-face visit • This model is very effective for the Super FQHC ©2012 AHC. All Rights Reserved http://avidohealthpromo.org FQHC1 FQHC2 13
14. Model Nine: Medicaid (Fee-for-Service) Patient Site to FQHC Specialist Site Scenario: • Patient is physically present at a Medicaid (Fee-for- Service) site • Specialist is physically present at and receives compensation from FQHC • Medicaid site and FQHC have agreement to provide services, but Medicaid site does not pay FQHC • No medical reason for a provider to be present with patient at Medicaid site • Patient virtually enters the FQHC site via telemedicine Outcomes: • FQHC is the provider site and can bill Medicaid for a face-to-face visit • Medicaid site did not provide a medical service and cannot bill for a visit but is eligible for site fee and transmission charges under Medicaid ©2012 AHC. All Rights Reserved http://avidohealthpromo.org Medicaid Fee-for-Service Site FQHC 14
15. Model Ten: Medicaid (Fee-for-Service) Patient Site to FQHC Specialist Site Scenario: • Patient is physically present at a Medicaid (Fee-for- Service) site • Specialist is physically present at and receives compensation from FQHC • Medicaid site and FQHC have agreement to provide services, but Medicaid site does not pay FQHC • No medical reason for a provider to be present with patient at Medicaid site • Patient virtually enters the FQHC site via telemedicine Outcomes: • FQHC is the provider site and can bill Medicaid for a face-to-face visit • Medicaid site did not provide a medical service and cannot bill for a visit but is eligible for site fee and transmission charges under Medicaid ©2012 AHC. All Rights Reserved http://avidohealthpromo.org Medicaid Fee-for-Service Site FQHC2 15
16. Model Eleven: FQHC Site to Other Specialist Site Scenario: • Patient is physically present at FQHC • Specialist is not physically present at FQHC • FQHC and Specialist have an agreement to provide services, and FQHC compensates specialist. (This agreement is in writing and clearly states: the time period during which the agreement is in effect: the specific services it covers; any special conditions under which the services are provided; and the terms and mechanisms for billing and payment). • Provider ‘virtually’ enters ‘four walls’ of FQHC via telemedicine Outcomes: • FQHC is the provider site and can bill Medicaid for a face-to-face visit • Medicaid site did not provide a medical service and cannot bill for a visit but is eligible for site fee and transmission charges under Medicaid ©2012 AHC. All Rights Reserved http://avidohealthpromo.org FQHC Remote Specialist 16
17. FTCA Liability • FTCA coverage affects the provision of telemedicine • Community health centers must have wrap-around coverage to protect not only the clinic but also any contract specialists willing to work with the clinic patients • For contract providers, the contract should be between the Health Center and the individual provider. All payments for services must be from the Health Center to individual contract provider • FTCA only applies to part-time contractors is 5) licensed or certified healthcare practitioner contractors (who are not corporations) providing part-time services in the fields of family practice, general internal medicine, general pediatrics, or obstetrics and gynecology. ©2012 AHC. All Rights Reserved http://avidohealthpromo.org 17
18. Conclusions • Many community health centers leave patients unserviced/ underserviced due to lack of availability of specialist care • The federal government provides clinics many alternative ways than face-to-face visits for care • Private specialists are willing to see FQHC patients via telemedicine visits as long as liability is covered and payments are met ©2012 AHC. All Rights Reserved http://avidohealthpromo.org 18