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Disclaimer: We keep monitoring the situation in relation to Telemedicine options available to Neuro-Ophthalmologists and will be sharing new resources on our listservs and our website as they become available. The guide below has been created to provide some guidance and resources for NANOS members in this unprecedented time. However, as information from CMS is changing rapidly, we encourage you to go directly to their sources for more up-to-date information.
Does NANOS have any resources available to members about Telemedicine in Neuro-Ophthalmology? Yes, NANOS volunteers have sent out several updates on the NANOSnet and YONO listservs about Telehealth in Neuro-Ophthalmology. The situation is rapidly changing but the shared resources can be found below.
I'm not on NANOSnet, YONO or WIN listservs. How can I sign up to receive any future updates? Email firstname.lastname@example.org and we'll be happy to add you to our listservs.
NEW!! Is the symposium on Telemedicine presented at the NANOS 2020 Annual Meeting available for streaming? Yes, the symposium entitled Telemedicine 20/20 in 2020: How Far Have We Come, Where Are We Headed and How Is It Relevant to Neuro-Ophthalmology is now available on demand on NOVEL.
What's recent from CMS?
Are there any webinars about telemedicine? Here's the link to the Webinar: Outpatient Telemedicine Billing and Coding in the Age of COVID-19 that was presented by Dr. Melissa Ko on March 18.
Are there any apps that can be used for telemedicine services? HHS has a list of examples of apps that can be used for telemedicine services during this time.
Are there any forms that can help me with providing telemedicine services? The American Telemedicine Association (ATA) has sample forms that institutions have donated to figure out consents, documentation, etc.
Are there any telemedicine data sheets? The AAN and AAO have released telemedicine data sheets to help with figuring out the coding stuff - if you see a discrepancy between what I've said previously and what these say, probably should err on the side of what those resources say (they've had their billing experts review it, and I've been mostly trying to keep up with the updates in between clinic and trying to triage my schedule).
What is Live Synchronous ("Real-Time Video")?
What is "Virtual Check-In"?
What qualifies for Review/Interpretation of Remote Patient Data?
What qualifies for Online Patient Portal Communication?
What is Interprofessional Consult ("E-Consult")?
How do I bill for Telemedicine Services (U.S.)? We recognize that many of our non-U.S. members will have different rules regarding the billing of telemedicine services. Within the U.S., Medicare and Medicaid have some rules regarding billing that may or may not be recognized by other insurers. While cash payment (concierge-type services) is the most direct method for payment, not all patients will choose to use this route. While the focus of this section is geared towards some of the specific billing/coding regulations in the U.S., we hope that this discussion will also be useful in other contexts.
With the declaration of a national emergency in the U.S., many of the restrictions previously placed on telemedicine services have been temporarily lifted, including restrictions on requiring separate state licenses if a physician is remotely treating a patient located in a different state (4). Some private insurers have announced measures to also aid in telemedicine services, though the scope of these waivers remains variable and may be limited to COVID-19-related visits (5).
What are the reliable sources when it comes to billing for Telemedicine? The Centers for Medicare and Medicaid Services (CMS) has several articles on their website addressing implementing and utilizing telemedicine services that may be helpful:
The CDC also has many resources listed on their website.
There have been several press releases discussing the recent emergency funding laws and the broad language that is designed to waive restrictions on telemedicine care for Medicare and Medicaid patients (6, 7). Unfortunately, the details of what specific restrictions were waived and how to apply for those waivers (if necessary) were not readily apparent on the CMS website.
Based on previous articles from CMS regarding the use of telemedicine services prior to the COVID-19 outbreak, Medicare and Medicaid patients can receive telemedicine services of the types listed above, and Medicare/Medicaid can be billed for those services. The patient must provide verbal or written consent for the service and billing their insurance (documented in the chart) prior to the service, as they may be responsible for a co-pay. Some private insurers will also reimburse for the same codes (dependent on state parity laws or other emergency policies).
How do I bill for Live Synchronous ("Real-Time Video")?
How do I bill for "Virtual Check-In"?
How do I bill for Review/Interpretation of Remote Patient Data?
How do I bill for Online Patient Portal Communication?
How do I bill for Interprofessional Consult ("E-Consult")?
Summary: We want to support and encourage all providers during this challenging situation. One of the ways we may be able to help serve our patients better is to start considering new methods of delivering care without compromising quality. We welcome additional ideas and considerations as we work together as a community to innovate and adapt. We hope everyone stays safe and healthy!