The state of Georgia has been a pioneer in driving reimbursement for providers who use telehealth services in patient care; in fact, in 2005, it was the first state to require payers to cover these services. If you are a telehealth provider in Georgia, here's what you need to know.
What Are Telehealth Services?
It's important to clarify what does and does not constitute telehealth in the eyes of the Georgia statutes. The key hinges on two-way, real-time communication between a patient and provider to facilitate consultations and diagnosing and treating a qualifying health condition in a covered individual. It's important to note that telephone calls, email exchanges, or fax transmissions do not qualify as telehealth for the sake of reimbursement purposes. Non-secure webcam communications such as Skype or mobile video chats also do not qualify.
Any physician or non-physician provider licensed to practice in the state of Georgia is eligible to provide telehealth services; it is recommended that providers are affiliated with the Georgia Partnership for Telehealth. Services must be delivered in accordance with HIPAA privacy regulations using secure, high-quality audio/video conferencing protocols.
What Is the Telehealth Process for Providers?
The patient's physician or NPP refers the patient for specialty care using telehealth services. Once an appointment is arranged, the patient goes to a qualifying "originating site," which is usually the referring provider's office or other facility such as a hospital, community health clinic, nursing center, or dialysis center. The originating site initiates secure video conferencing with the telehealth provider at a "distant site."
By law, the telehealth provider is required to have performed an in-person examination of the patient prior to the telehealth session unless once of the exemptions apply:
- The telehealth technology enables an examination equal in quality to an in-person examination.
- The telehealth service is at the request of a qualifying provider who has personally examined the patient.
- The telehealth provider is examining the patient at the request of a public health professional (public health nurse, public school nurse, Department of Family and Children's Services, etc.).
Note that the Georgia Department of Community Health guidelines for telehealth examination require the following conditions be met:
- The originating site must be capable of enabling a complete visual examination of the patient's body, including orifices (ears, nose, throat).
- The distant provider must be able to hear heart tones and breath sounds and other audio signals as needed.
What Telehealth Services Can I Bill For?
The Center for Medicare and Medicaid Services (CMS) released its 2016 guidebook for qualifying telehealth services, which include these frequently billed procedures:
- office/outpatient visits (CPT codes 99201-99215)
- subsequent hospital care services (CPT codes 99231–99233)
- individual or group diabetes self management training (HCPCS codes G0108 and G0109)
- individual psychotherapy (CPT codes 90832–90834 and 90836–90838)
- telehealth pharmacological management (CPT codes 90832–90834 and 90836–90838)
- individual and group medical nutrition therapy (HCPCS code G0270 and CPT codes 97802–97804)
- smoking cessation services (HCPCS codes G0436 and G0437 and CPT codes 99406 and 99407)
- family psychotherapy (CPT code 90846)
- transitional care management services (CPT code 99496 and 99495)
In addition, originating sites may also bill a site facility fee using HCPCS code Q3014.
Telehealth providers must maintain appropriate documentation for each encounter, including (but not limited to):
- start and stop times for the encounter
- provider's credentials and signature
- patient consent form
- chart notes, diagnosis, treatment plan
Are There Restrictions I Should Know About?
The Georgia Medical Board requires that telehealth providers make "diligent" efforts to see their remote patients for a face-to-face examination at least once a year, or to ensure they are seen by a licensed provider once a year.
Telehealth services performed in the patient's home are not eligible for reimbursement with public payers; however, private carriers are required to reimburse telehealth in any location.