2020:
Telemedicine Comes Forward

 Telehealth Basics
 Relaxing Regulatory Issues
 How Telemedicine Can Help Your
Practice
 Challenges
 The Future of Telemedicine
2

3
Telehealth
Basics

4
E-visits
Communication with patient and provider through an online portal
Remote Patient Monitoring
Collecting of vitals and physiologic information by the patient that is then sent
to the health care professional for interpretation and monitoring of the data.
Telehealth visit/virtual visit
A real-time two-way audio and video communication visit between a clinician
and patient using a smartphone, webcam, or online chat.
Telephone visit Synchronous telephone conversation, telephone evaluation,
and management of services.
Virtual Check-ins/Digital Visits
A brief (5–10 minute) check-in with a health care professional via telephone or
other telecommunication device, or a remote evaluation of recorded video or
images submitted by an established patient.
Types of Telemedicine
www.cms.gov

5
“There’s the assumption in primary care that you always had to have
in-person contact, and that telemedicine would be unsatisfactory, or
wouldn’t fill the void. That’s been exposed — actually, it’s safer, it’s quicker,
and it’s easier. If I just have a quick question, I want to see someone and
engage them and see their focus is on me. But do I have to be in that office?
And for a physician, can I get more things done, be more efficient, and
protect myself, as well as my patients? People are now seeing this model,
which we thought would take years and years to develop. And it’s probably
been accelerated by a decade.”
Chris Jennings, policy consultant and former health care adviser to the
Obama and Clinton administrations:
Telemedicine Accelerated

6
Telemedicine Fun Facts
Telehealth programs used
to take almost two years
to implement. With
COVID-19, that time has
been shortened to less
than a month.
Medical group in Oregon
went from 700
telemedicine visits per
month to 70,000 per
week.
Updox survey found that,
out of 2000 respondents,
42% have used telehealth
services during the
pandemic.
91% of seniors had a
favorable experience &
78% are likely to use it
again for a medical
appointment in the
future.
Better Medicare Alliance
Modern Healthcare
Opthalmology Times

7
Relaxing
Regulatory
Issues

• $200 million in funding
• Funding is in the eighth round - $50 million has been distributed in
rounds 1-7
• Part of the CARES Act
• Limited to nonprofit and public eligible health care providers (More
information on Eligibility in FCC Form 460)
• Must apply through online application portal:
https://www.fcc.gov/covid-19-telehealth-program
Funding: COVID19 Telehealth Program
o Telecommunications
o Information services
o Connected patient monitoring devices (e.g.,
pulse-ox, BP monitoring devices)
• Covers:

• CMS is waiving limitations on the types of care providers eligible for Medicare reimbursement, thus allowing
physical and occupational therapists and speech language pathologists.
• Hospitals can now bill for outpatient services furnished remotely by hospital-based practitioners, including
telehealth to patients at home – considered a “temporary provider-based department of the hospital.” They can
now bill Medicare as the originating site for telehealth services furnished to those patients.
• CMS is expanding the list of audio-only phone services reimbursable through Medicare to include many
behavioral health and patient education services, and the agency is increasing reimbursements for those
services to match similar office or outpatient services, retroactive to March 1.
• The agency has added numerous new services to the list of telehealth services reimbursable under Medicare.
• Federally qualified health clinics and rural health clinics will now be reimbursed for providing telehealth
services.
• CMS is waiving the video requirement for certain evaluation and management services, enabling providers to
bill Medicare for services delivered by audio-only phones.
• HIPAA currently allows non-traditional platforms - Facetime and Skype are currently allowed even though they
are not HIPAA compliant - This will likely change as things progress and penalties could occur.
• Patients’ written consents are currently not required in all states, but it is best practice
9
Relaxed Guidelines and Expanded Waivers

10
Challenges

11
Patients do not have access to cell phones,
computers, or webcams.
Elderly and chronically ill population may
have difficulty accessing appointments
Wifi or cell phone service may not be reliable
Challenge: Technology

12
Obtaining patient consent may prove difficult
HIPAA compliance has been [relaxed] by The Office for
Civil Rights (OCR) at the Department of Health and Human
Services (HHS). Vendors with HIPAA-compliant
communications include:
Skype for Business / Microsoft Teams
Updox
VSee
Zoom for Healthcare
Doxy.me
Google G Suite Hangouts Meet
Cisco Webex Meetings / Webex Teams
Amazon Chime
GoToMeeting
Spruce Health Care Messenger
Challenge: Patient Privacy and HIPAA

13
Make sure the schedule has Telehealth as a Visit type,
especially if you are still seeing some patients in the
clinic. This will help avoid confusion.
Decide how you will collect copays or check the
patient’s insurance.
Monitor patient Follow Up items such as referrals and
labs and how these get to other medical staff
members to complete.
Determine who schedules the follow up visit.
Challenge: Workflow

14
Making sure patients are educated and know
what they need to bring the appointment.
Vital Signs and Physical Exams are limited.
Deciding when and where to have the
telemedicine visits. Quiet and private rooms are
needed for the medical staff and the patient.
Other Challenges

15
How
Telemedicine
Can Help
Your Practice

16
• Can Calm Fears
• Limits exposure of sick patients to your Medical Office Staff
• High risk patients can receive care without leaving their home
• Removes barriers to care, including transportation to the clinic and limited
appointment slots
• Seeking care from the comfort of your home is time saving and convenient to
the patient
• Patients with chronic conditions can use remote monitoring devices (blood
pressure, glucometers, etc.) connected to the EHR platform to be closely and
regularly monitored by medical staff, which can improve results
• Improve provider productivity
• Increase revenue/reimbursement/reduce costs
• Allows for Integrated scheduling
Patients can schedule their own appointments on a website such as doxy.me or
through a patient portal which is integrated with your practice management
system and EHR.

17
The Future
of
Telemedicine

18
Medicare lifting the originating site requirements for the pandemic
was a big leap forward. That always seemed to be the issue and
roadblock for most groups, as it blocked the use of codes for many
urban/ suburban areas.
There may be some more reform around requirements.
Telemedicine is here to stay
• Enables providers to conduct additional visits without requiring
additional staff
• Reduces hospital admissions, unnecessary ER/office visits
• Provides access to care to patients without reliable
transportation
• Better patient outcomes

More Resources
www.careoptimize.com/insights
www.youtube.com/careoptimize
https://www.fcc.gov/covid-19-telehealth-program
https://www.americantelemed.org/covid-19/news/
https://covid19.linkhealth.com/#/step/1
https://www.hhs.gov/hipaa/for-professionals/special-topics/emergency-
preparedness/notification-enforcement-discretion-telehealth/index.html
https://www.cms.gov/Medicare/Medicare-General-
Information/Telehealth/Telehealth-Codes
https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-
care-provider-fact-sheet
19

CONTACT
Lauren.Picone@careoptimize.com
info@careoptimize.com
20