Pediatric Coding Alert

As you may recall from Pediatric Coding Alert Volume 26, Number 10, telehealth will play prominently in the CY 2024 Medicare Physician Fee Schedule (MPFS). There has been plenty of buzz about telehealth being a new norm in the post-PHE world, which means it’s time to seriously consider what that means for pediatric offices.

Whether you need some ideas to start a new telehealth program in your office, or you are simply looking to enhance your existing process, here are some tips to help you start making the most of telehealth in the new year.

Background: The Centers for Medicare & Medicaid Services (CMS) plans to implement the 2023 Consolidated Appropriations Act (CAA) telehealth services provisions through the end of 2024. The proposal includes paying the non-facility PFS rate for at-home telehealth services, lifting geographic restrictions, and allowing Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) to provide telehealth services. This kind of patient convenience and accessibility has the potential to not only free up in-house staff for more appointments, but it also could dramatically improve care quality and compliance when parents are able to schedule appointments without taking time off from work or taking kids out of school.

Tip 1: Be Confident With Telehealth Coding

Knowing the correct codes may seem too obvious a point to make, but that’s why it’s often overlooked. As guidelines change, so does the coding, which means you need to stay on top of the most current changes. Additionally, some services require a physician, and some can’t be used if an E/M has been billed in the last seven days. Knowing the correct codes to use will ensure your clinicians are appropriately compensated.

The following chart should clear up that confusion:

Tip 2: Look For a Good Vendor

Do your homework to find the vendor that’s not just great but will also fit the needs of your practice. Even if your practice is already using a telemedicine platform, “it’s worth looking around. The market has matured massively since COVID hit,” says Chip Hart, director of Pediatric Solutions at Physician’s Computer Company in Winooski, Vermont.

The market is not only maturing, but more players are entering the field. Therefore, finding the right technology to implement can be confusing. “We’ve got a lot of different types of technology. It’s really a noisy space, and it’s making it very difficult for buyers to make a good, solid decision on what’s the right technology pathway to go,” said Lisa Lavin, founder and CEO, Ōmcare Inc. in Bloomington, Minnesota.

If you’re experiencing this kind of confusion, consider the following:

User-friendly platform: Healthcare providers and the patients should all be able to use the system. If it’s too complicated, no one will want to use it.

Compliance: Your vendor should prioritize relevant healthcare regulations, such as HIPAA, to ensure patient information is secure.

Compatibility: You also want to look for a system that can easily integrate with your existing electronic health record (EHR) system. You don’t want a new system to trigger EHR errors. Also, you’ll want to be sure that the internet speed is a good match for the services you’re looking into. Some locations don’t have reliable internet, so offering patients accessibility on multiple devices, such as a mobile app or text message can be good choices.

Ongoing Support: Be sure to ask about the company’s technical support. Good vendors will provide ongoing support to make sure your system is always up and running.

Tip 3: Establish a Solid Training Program

There will be a learning curve, even with an easy-to-use technology. Remember, it’s not just about learning new technology. It’s also about integrating new processes into everyday practice. Because of this, you’ll want to establish an organized, clear training program that addresses a variety of in-house processes. The company may offer their own version of this but consider setting up a follow-up training internally to be sure everyone in the office is on the same page. In addition to training on the technical aspects of the new platform, here are a few other things to consider:

Clinical Training: Clinicians need to know how to effectively conduct a virtual examination.

Communication Training: Staff need to effectively communicate with patients and their families through a virtual platform. This includes both verbal and non-verbal communication skills.

Legal and Regulatory Training: Staff need a solid understanding of all aspects of telehealth, including understanding the relevant telehealth laws and regulations in their state, and how to maintain compliance with HIPAA and other privacy laws.

Emergency Procedures Training: Establish a protocol and make sure all staff members know how to handle emergencies during a telehealth visit, including when and how to direct a patient to seek immediate in-person care.

Patient Education: Staff also need full understanding of how to educate patients and their families on how to use the telehealth platform, what to expect during a telehealth visit, and how to prepare for a telehealth visit.

Note: Don’t underestimate the role practice schedulers play. This is an area that some practice managers overlook. “Understanding which visits could be done with a simple telehealth visit and which ones require an in-person visit might be the most important success factor,” says Hart.

Tip 4: Promote the Service

No one knows your patients better than you do. But as you also know, there is no one right way to promote your telehealth services. The important thing is to keep talking to patients about it. “Over-communicate to your patients that telemedicine visits are available and whether they’re at home, work, or wherever,” says Hart.

Consider surveying patients: If you don’t periodically survey your patient base, consider that a first step to understanding how best to promote telehealth services. For example, suppose you found out that many of your newest patients found out about your practice through social media, then that will tell you that social media might be a great way to promote new and improved telehealth services.