The Infectious Diseases Society of America (IDSA) supports the use of telehealth and telemedicine technologies that allow for high quality, cost effective care.
IDSA has developed a Position Statement on Telehealth that outlines the various uses of telemedicine and telehealth, and provides background materials for ID physicians and their staff.
The terms telehealth and telemedicine are often used interchangeably, but the two terms have quite different meanings. Telehealth has been defined by the Health Resources Services Administration (HRSA) as use of electronic information and electronic communications technologies to support long-distance clinical health care, patient and professional health-related education, public health and health administration. Technologies include the use of video-conferencing, the internet, store-and-forward imaging as well as streaming media and other forms of electronic communications.
Telemedicine, on the other hand is described as the provision of patient care to a patient that is separated from the healthcare provider by a geographical distance. Technologies used in the provision of telemedicine may include a simple telephone call or the use of sophisticated video-conferencing equipment. Telemedicine may also involve the use of mobile health technologies such as wearable devices to track medication compliance and to monitor disease progression.
There are three variations of telemedicine each of which have a distinct role in patient care.
- Synchronous telemedicine: The provision of real-time, direct patient care using audiovisual technology. This type of telemedicine may be a substitute for in-person care. Synchronous telemedicine may be used to diagnose a disease, provide treatment, or render a consultative service like those that are provided by an infectious disease physician.
- Asynchronous telemedicine: Is the use of store-and-forward technology (this is not direct patient care) whereby there is transmission of patient data to another healthcare provider or entity. Patient data may include items such as digital x-rays, MRIs or photos as well as the transmission of diagnostic test results and other recordable patient data. The transmitted data may then be used by other healthcare practitioners to provide patient care or provide an opinion. Infectious disease physicians may use asynchronous telemedicine to provide a consultation to other healthcare providers regarding the care of patient with an infectious disease.
- Remote patient monitoring: Is the use of patient monitoring devices such as those used to monitoring patient heart rhythms or monitoring medication adherence whereby the data is collected and subsequently transmitted back to the healthcare provider for use in medical decision making and patient care.
The Telehealth Resource Center, funded by the Department of Health and Human Services and HRSA provides resources and education for providers who are presently providing telehealth services as well as those providers who wish to begin the provision of telehealth services. Click the link Telehealth Resource Center for additional resources and information on EHR.
To assist our members with integrating telehealth technologies into their everyday clinical practice IDSA produced a webinar, Telehealth and the ID Physician; What You Need to Know Right Now. The panelists covered several topics including how to conduct a virtual physical exam (successes and pitfalls), the basics of a telemedical visit (the virtual bedside manner) and the technology needed for telemedical visits.
Basic Technical Requirements of a Telemedicine Consult:
- Synchronous telemedicine visits should utilize a high-resolution video camera coupled with broadband technologies.
- Connection speed of at least 384 kbps in both the downlink and uplink directions is recommended.
- Videoconferencing systems must use HIPAA-compliant encryption software. HIPAA requires 128-bit encryption and password-level authentication.
Payment for Telemedicine:
Medicare: The Centers for Medicare & Medicaid (CMS) reimburses for a limited set of services that may subsequently be reported as telehealth services. When a telehealth service is provided and has been designated by CMS as payable under Part B of the Medicare program, Place of Service (POS) code 02 should be used instead of Medicare modifier GT. POS code 02 indicates to the claims processors that the service provided meets Medicare telehealth requirements.
In addition to the use of POS 02 on the claim, there are other requirements for the provision and subsequent reimbursement for telehealth services under the Medicare program. The telehealth service must be provided to the beneficiary located at a Medicare approved, originating site. An originating site is the location of the beneficiary at the time the telehealth service is rendered and for Medicare reimbursement purposes must be in a rural location as defined by the following two geographical conditions:
- A rural Health Professional Shortage Area (HPSA) located either outside of a Metropolitan Statistical Area (MSA) or in a rural census tract; or
- A county outside of an MSA.
The originating site (location of the beneficiary) must then be in a medical facility such as:
- Physician or other practitioner office
- Hospital
- Critical Access Hospital (CAH)
- Rural Health Clinic
- Federally Qualified Health Center
- Hospital-based or CAH-based Renal Dialysis Center (including satellites
- Skilled Nursing Facility
- Community Mental Health Center
- The beneficiary’s home is not an approved originating site for the provision of telehealth services.
Medicare Telehealth Approved Codes of Interest to Infectious Disease Physicians,
- Office or other outpatient visits: CPT codes 99201-99215
- Subsequent hospital care services, with the limitation of 1 telehealth visit every 3 days: CPT codes 99231-99233
- Subsequent nursing facility care services, with the limitation of 1 telehealth visit every 30 days: CPT codes 99307-99310
- Telehealth Pharmacologic Management: HCPCS code G0459
- Prolonged service in the office or other outpatient setting requiring direct patient contact beyond the usual service; first hour: CPT code 99354
- Prolonged service in the office or other outpatient setting requiring direct patient contact beyond the usual service; each additional 30 minutes: CPT code 99355
- Prolonged service in the inpatient or observation setting requiring unit/floor time beyond the usual service; first hour (List separately in addition to code for inpatient evaluation and management service): CPT code 99356
- Prolonged service in the inpatient or observation setting requiring unit/floor time beyond the usual service; each additional 30 minutes (List separately in addition to code for prolonged service): CPT code 99357
The Medicare list of approved telehealth services for 2021 may be found on the CMS website.
Medicaid:
Many states provide reimbursement for telemedicine services under state Medicaid programs. States have discretion as to how telemedicine services are covered and paid for therefore coverage and payment varies from state to state. Providers should check with their state Medicaid agencies to understand the requirements and restrictions of Medicaid payments in their respective state. The Center Center for Connected Health Policy provides in-depth analysis and information on coverage and payment for Medicaid telehealth and telemedical services in all 50 states and the District of Columbia.
Commercial/Private Payers:
Commercial insurance companies may set their own policies regarding coverage and reimbursement for telehealth and telemedicine services, however some states mandate coverage for telehealth services in order to do business within that state. Providers should check with each insurance carrier that they do business with to determine what types of telehealth and telemedicine services are covered.