Webinar: Updates on E-Visits and Telehealth for Outpatient Therapy Services—Part 2

Disclaimer: This transcript is intended to provide an overview of the main topics discussed in the original version of this webinar. Because it has been auto-generated, it might contain errors (including to proper names, industry terminology, numbers, and punctuation) that result in altered meaning. To hear the original version in full, please view the archived recording.

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Thank you very much for that introduction and either good afternoon or good morning to everyone depending on where you are at. Again, here are the latest updates that Nancy and I will be speaking on today in this part two. I’m sure there will be a part three and a part four down the road as well. Here is my disclaimer: Because I did turn these slides in on Wednesday, all the information was current as of 8PM Eastern time on Wednesday, April 8. And the reason I say that is information has changed since I put these sides together. I will give you some updates that occurred yesterday, concerning e-visits and telephone services. And then Nancy is going to give you an update about occupational therapists and the home health setting. Again, I do want to stress for both Nancy and myself, the content in today’s webinar provided by Nancy and myself does not imply consulting or legal advice.

So some of these sides will be a repeat and then we’ll have some new slides here today, but we still have confusion that people think e-visits and telehealth services are the same and they’re using the terms synonymously interchangeably, and I cannot stress enough. They are not the same.

So CMS, Centers for Medicare and Medicaid Services put out a document about three, three and a half weeks ago where they have the main heading called virtual services and under virtual services, they talk about telehealth number one, virtual check-ins number two, and number three e-visits. So again, think of virtual services as being the mothership, under that you’ve got three types of virtual services, which means telehealth visits and he visits in virtual check-ins don’t all mean the same thing. They’re each their own individual quote entity.

Now, when we go to e-visits, I won’t go over all the visit details again, because we did that in part one, but here are the three codes for traditional Medicare for the visits. And again, it’s for based on a true time during a seven day period. So the only thing I want to stress is if the patient reaches out to you. So again, the patient must initiate the visit and they can initiate that visit via an email to you. The provider could be via text to you, the provider they could call and say, they have a question about their exercise program, about their pain in their knee, et cetera. You would want to document that in the medical record, how and when the patient initiated the visit, but the seven day period does not begin until you respond to that initiation until you respond to the patient’s question.

So the patient may reach out to you on March 24th. You don’t respond to the patient until March 25th, March 25th is going to be day one of that two to seven day period. So let’s just say on March 25th, you spend seven minutes responding to the patient’s inquiry, responding to their question, and you send us back to them via maybe your electronic health record through a secure online portal. Then seven minutes doing that on March 25th and March 30th, the patient responds to you with some additional questions and March 30th, you spend five minutes responding to their additional question. And then again, and now during that seven day period, you don’t do another easy visit. She had seven minutes on March 25th, responding to them five minutes on March 30th, responding to them. You have to add up those minutes. You see it’s 12 minutes, 12 minutes would fall between 11 to 20 minutes and you would build one unit of G 2062 with the therapy specific modifier, whether it be GP for PT, G O for OT, G for speech, along with the CR modifier.

So the G codes would have two modifiers on both the therapy specific modifier and the CR modifier. Also the other two codes or the G 2010. So think of this one. And again, I’m not saying it’s the best way to do it, but let’s just say a patient, you know, takes a video through their iPhone of themselves, that they record the video and maybe them doing an exercise that they have a question on. They send you the video, you reviewed the video and respond back to the patient about how to do the exercise correctly. Or if yes, you are doing it right, no, you’re not doing it right. Here’s the way you should be doing it. So again, it’s a recorded video and, or picture image that the patient has sent you, you review it and then you respond back to the patient.

You know, [inaudible] my opinion only, I don’t see PT, OT, SLPs doing this a lot. Because again, it’s really five to 10 minutes of medical discussion. And again, you see it’s a brief communication using a technology based service, or it’s a virtual check-in with the patient that virtual check-in, you know, think of if any of you have ever used Teladoc. Think of that possible virtual check-in where patients may have a quick question for you. You kind of see them, you answer their question and then it’s over. And it’s about between five to 10 minutes. That’s going to be G 2012, where the previous slide [inaudible] 63, you use a secure on-line patient portal, which could be video that most times is probably going to be the richest communication. When you think about email texting through the electronic health record portal, that you may have something like that.

Now we’re also going to send medbridge the link to this interim final rule that was released on March 30th and they will get this out to all of you. Now, when you read the rule they did clarify those five G codes that I just spoke on in slide six and seven as sometimes therapy CPT codes, which means, as I said, they’re going to need either the GP, GN, or GO modifier attached to them. In addition to the CR. You see at that bottom bullet point, that when I put these sides together, we were still waiting for CMS to clarify whether an assistant can do the visits and the virtual check-ins. We received clarification yesterday. So I was on a CMS call that began at five o’clock east coast time yesterday. And had an opportunity to ask this question, can a physical therapist assistant or an occupational therapy assistant, do an EE visit, do a virtual check-in.

And the CMS presenter said, no, that it’s their opinion that the visit, the virtual check-in would need to be done by the physical therapist or the occupational therapist. I also asked about institutional providers like skilled nursing facilities. We had agencies, hospital, outpatient departments being able to do an ER visit and a virtual check-in and submitted any UB04 claim form. Can we do that? Can you do that? And the presenter said they received many questions about that issue. They don’t have an answer yet. They are looking into that question and looking into seeing if that is a possibility. So the latest update as a blast night, PT assistants and OT assistants, can’t do EBAs. If they can’t do virtual check-ins CMS is aware of the [inaudible] issue and they’re looking into it. And then here are the EBITDA codes. You may see some non-Medicare insurance carriers use.

So again, when Nancy and I say Medicare today, that is traditional Medicare. Only when we say non-Medicare, that can be Medicare advantage plans at NUS, Cigna blue class, et cetera. So many non-Medicare insurance companies have also also allowing physical therapists, occupational therapists, and speech language pathologists to do either visits. Some of them may be allowing either the code you see here on slide nine or the G 2061 G 2062 G 2063. They may allow either one, some may say, you have to use a G codes. Some may say you have to use the codes here on slide nine. So again, with every insurance company and Nancy Nabal keeps saying this, you have to check with each insurance company, what they are paying for, who it can be done by, in which codes to use some breaking news here. The telephone services, CPT codes. We talked about this in part one in the interim final rule CMS did change the status of this three codes here on slide 10 from non-covered to active status, meaning they’re going to be paying for these codes during the public health emergency, due to the COVID 19 pandemic.

Now, I will tell you nationally, they have still not switched these codes over to active status. You know, we don’t really know the price of these codes. I kind of did the calculation myself for Detroit Michigan in roughly 9, 8, 9, 6, 6 is going to be about $14 and 30 cents. I think 9, 8, 9, 6 7 is around $29 and 9, 8, 9, 6, 8 Kima to be maybe 43, 40 $4. And that was just for Detroit, Michigan doing the calculation myself. So again, there’s 112 different payment localities across the United States on just kind of giving you a sense of what they’re that they’re paying, okay. Based where you do business. That number could be, is going to be either higher or lower. But again, it’s CMS is stone that made these codes active yet, which means the Medicare contracts have not updated their payment systems yet. And that’s true with those Chico’s. I spoke about the G 20 61, 20 62, 20 63 2010 and 2012.

I’m finding that most Medicare administrative contractors have not updated their payment systems yet to accept those codes being built by PTs OTs and or SLPs. No, again, also the telephone service codes. They’re going to need the G N G O O G P modifier attach them on the claim form again, during a phone call earlier this week that I was on with CMS, I had the opportunity to ask a question, do these telephone service codes need the C R modified appended to them? And the presenters said, no, they don’t. So again, the telephone service codes only need the therapy specific modifier appended to them on the claim form. Once your Medicare contractor is ready to accept these codes in their system, again, as of last night, the presenter said that the telephone service codes need to be done by a physical therapist or an occupational therapist that can assist it.

Also, they are looking into these codes as well to be built any UB0 for a claim for them. So they know that is an issue still, unfortunately, as you and I are speaking today, the Medicare program has still not added PT, physical therapists, occupational therapists, and speech language pathologists as telehealth providers. And because of that, those services are still considered statutorily. Non-covered under the Medicare program, which means if you want to do a telehealth visit on a Medicare patient, you can do so you can charge them your fee in cash. The Medicare patient would pay you and an ABN is not required to be issued because it’s a statutory non-covered service with that being said, I would strongly encourage and recommend you issue a voluntary ABN to the Medicare beneficiary. If you do issue a voluntary ABN, do not ask the patient to select an option in box G and section G of the ABN form.

They would not select an option. Also, the patient is not required to sign and date the ABN form. Since, as we are talking today, 9:16 AM Pacific time, 8, 4 10 since a statuary non-covered you would also not submit a claim to your Medicare contractor. You know, here’s just a list of some of the major insurance carriers that we see either have been covering telehealth or have expanded telehealth coverage due to COVID 19. And you see on the left side, some of the major national payers that have expanded telehealth, unfortunately to that, you don’t see Medicare and Humana has still not expanded Telehouse services. In addition, many state governors has issued executive orders mandates that require insurance carriers regularly within their state covered telehealth services for therapy services at the same payment amount as if they were to come into your clinic. So many states have what we call parody laws that require insurance companies to pay the same rate for a telehealth visit as they would, if they came for an in-person visit.

Also here in California, we do not a work tap. We actually received a fax from one call, a fax from med risks saying they are now covering telehealth services for physical therapy, for their injured work comp clients. So again, you’re going to want to check with those insurance companies, you know, place the service codes, if a patient were to come into your clinic and you’re a private practice and you send the pain any 1500 claim form, a place of service code is an 11. If you are a mobile clinic where you see people in their homes is outpatient ISO service code, any 1500 claim form is a 12. Now, if you’re doing telehealth most insurance companies want the place of service code to be zero two on the 1500 claim form, because that would indicate that service was delivered via telehealth. Now, two exceptions to that we know is, is Cigna and United healthcare to the national payers have both indicated on their website, that if you’re doing a telehealth visit to use place of service code 11, because they want, even though you’re doing telehealth, they’re saying to use the same place of service code you would use as if the patient came in to your clinic.

Now, what is considered a patient’s home is here on slide 16. I need to stress the bottom bullet point, a licensed daycare center. You know, a certified daycare center is not considered a place of residence for Medicare. And because of that, most non-Medicare insurance carriers, but also not consider that a patient’s home telehealth modifiers. You know, if an insurance company is requiring one of these modifiers, most of them are requiring either modifier nine, five, or the GT modifier. And both of those modifiers indicate that Telehouse services were provided through eight synchronous communication system and synchronous it’s, it’s live two way, audio visual between you and the patient. Again, just think of FaceTime. You know, you’ve got the phone in front of you, your friend can see you talk and you can see them talking that is live two way visual audio. So again, if insurance companies are requiring a modifier, be attached to the CPT codes on the claim form, most of them are saying either modifier 95 or the GT modifier and different payers are doing different things.

You have to look, the CQ modifier indicates it was done via an asynchronous telecommunication system, which is kind of the stored and forward. It’s not live. Now, Cigna is saying to, you know, do synchronous communication, you know, live two-way audio. But Cigna is saying to use the GQ modifier on the CPT codes on the claim form. So even though you may be doing live two way, audio visual, and a Cigna patient Cigna saying to use the C to moderate dumpsite, the GQ modifier. So again, something needs, and I will probably say multiple times today, there’s no consistency between all of the insurance carriers. You must look at each insurance carrier that you’re doing telehealth with, what are their requirements for place of service codes? What are their requirements for telehealth modifiers? Now, what CPT codes do you use? There are no specific CPT codes for telehealth, for PT, for OT, and for SLP.

There’s also no consistency between all of the insurance carriers and what CPT codes they are allowing to be charged for telehealth services. As I said earlier, if you’re in a private practice, you submit claims on a 1500 claim form to insurance companies. If you’re a rehab patients seat, many rehab agencies submit claims and a 1500 claim form to private commercial payers. Most of them want place of service code would be the zero two again, two exceptions that I know of nationally, Cigna and United healthcare, both say to continue to use place of service code 11 and the 1500 claim form. For those of you that submit claims any UB04 claim form, there is no place of service code to use any UB04. And again, those of you that submit claims any [inaudible] you have to check with each insurance carrier.

Are they paying for telehealth services for PT, OT, SLP, for providers that submit claims any you B zero four claim form. Some may be yes. I think some are going to be no. We know United healthcare did an update on April 5th, about 11:50 PM, central daylight time, where they said they are accepting PT, OT, S L P any, you be zero for claim from, for telehealth. And you are to use revenue code seven 80. Also, Aetna has told a PTA, the American physical therapy association, they are allowing telehealth to be done by PT, OT, SLP, and submitted on the UB04 claim form. But again if you have any questions about telehealth coverage from any insurance company, it’s not a question Nancy and output going to be able to answer while I was going to say, you need to check with the insurance company as Nancy has trademarked this phrase, go to the source.

If they say, yes, you can do it, ask them, where is it written down on their website? You know, ask them to refer you to somewhere on their website. Again, I’m just going to go through the list of possible CPT codes here over the next several sides. So here are the PTE valid Reval codes. Here are the OT eval and Reval CPT codes. You know, when you look at slide 21, you see therapeutic exercise, neuromuscular education, gait training, and slide 22. We got state Pedic activities, self care, whole management. And again, you see my disclaimer. This list is not an all inclusive list because some payers may be, be paying for a 9 77 5 0. The physical performance test and measurement code. They may be paying for 977, 6 0. The initial orthotic management encounter code 9 7 7 6 1, the initial prosthetic training CPT code. So you’re going to want to check with each insurance company because we are seeing variations between them is that Cigna only is paying for the PT and OT low and moderate complexity eval codes, and only two units of exercise per telehealth visit.

So the only treatment code Cigna recognizes is 9 7 1 1 0 does not list 9 7 5, 3 0 as a CPT code for telehealth in there and they’re released. So again, you must check with every insurance company and here are some possible CPT codes for SLP on slide 23 and 24 and 25. Again, this is not all inclusive. You must check with each insurance company, no documentation. How do you document for telehealth? Well, number one, you’re going to document exactly as you would, as if they came into your clinic. In addition, you also need to document that the patient consented to the telehealth visit. If you are recording this telehealth visit, you also need to document that the patient consented to being recorded. So again, before you go live on telehealth you’re going to want to make sure you’ve got the verbal consent from the patient for the telehealth visit.

Now you go alive. You want to ask that patient again? Do you consent to the telehealth visit? If you recording, do you consent for this to be recorded? You want to have all that in addition, check with your state practice, act state with your administrator, check with your state administrative rules, check with each insurance carrier. Are there any additional documentation requirements that you must adhere to if doing telehealth services? Again, I know many of you listening today attended a webinar that I did back on April 3rd, we did an over two hour webinar getting started with telehealth services, where Mark spoke about and gave examples of consent forms and gave examples about HIPAA compliant platforms that you use. Marketing gave you some good research studies that have been done to, you know, maybe give to insurance carriers. You know, I spoke for about 30, 45 minutes in greater detail, going over the CPT codes to use modifiers or use things like that.

So again, you can go purchase that recorded webinar. You see the link at the bottom. I gave you the Bitly link there. It’s on my website. You can purchase it and you can watch it as many times as you want. You can fast forward. We wind it, go at it. I think if you’re going to start telehealth and those of you that listened to Nancy and I today, our hope is that you’re starting telehealth or you’ve implemented telehealth. You’re not doing so just for this next two, three months. If you’re going to take the time, take the time to do it right. Nancy’s going to talk about compliance, get compliant, get yourself set up, right? Because we hope that you’re going to continue to do this. And in 2020, in 2021 in 2022, so a great webinar to help you get started. You know, how do you keep up to date, obviously your national association, your state associations also, you know, bookmark your top four or five, six insurance companies.

Most all of them now have a dedicated COVID 19 read page, you know, go back and check that daily because information is changing daily. From a lot of these national payers around the country, you could follow Nancy and myself and Facebook. You can follow us on Twitter. We’re both posts a lot of free information out there. I’ll say, I know it’s tough to kind of read it all because there’s no, I guess, consistency between us. Not like all in one place, but you’re going to have our contact information. You can follow us on Twitter, follow us on Facebook. You know, I know many of you also are going there with my website, my opinion only while we’re at the 180 right now for per year. I I’m really publishing about four or five stories a day lately, keeping up to date on telephone services. He visits tele house, Medicare, all these updates, all on my website for my gold members.
And you can sign up there on line. Here’s my contact information. Again, if you’re not following me on Facebook, if you’re not following me on Twitter and you on social media, follow me on Twitter. Like my company on Facebook, I do post a lot of stuff out there daily. So all those updates, I just told you today of what happened last night. If you followed me on Twitter, if you’d like me on Facebook, you had all that information last night when we found out. So there’s some free stuff. There’s some stuff you pay for with that said, let’s go over to Nancy.

Thank you, Rick. And I’m going to give my disclaimer just like Rick did and cruise right through that, welcoming everybody back, especially those that attended our first webinar next week. There’s a lot that we’re going to be updating you on today. And some more additional information you may have remembered playing a telephone game. When you were a kid, there was something I learned in brownie girl Scouts, the leader whispers a message to the first brownie scout in the circle. And she in turn whispers that to the next girl. And it continues where all the brownies are giggling. And by the last time, the last brownie receives the message. The message has changed. And that seems to be what’s happening right now with some of the information that’s going on about therapy and telehealth, where there was a CMS memo recently that mentioned all of the therapy codes were now added to the codes of allowable list during the public health emergency within seconds, it was posted on social media and then within seconds, there was a proclamation and a very large telehealth Facebook group saying PTs, OTs and speech could now bill Medicare for telehealth.

So you can see how rumors spread quickly and they weren’t quite correct. So I think of it as the telephone game, I’ve got a lot of slides that I updated and refreshed from our first webinar, mainly to give context for those as we’re going through this and to point out some reference slides. So this is who’s on first and the construction of the department of health and human services and the various agencies that have been offering guidance and putting up bulletin during the COVID crisis. Wow. A little bit of good news. CMS has authorized reviews to stop. And I can’t think any better news for many of my clients that are currently under targeted probe and educate or various other Medicare reviews. This is retroactive to March 1st. Medicare fee for service operations are going to stop for additional documentation requests as well as the targeted probe and educate program.

So take a brief look at these slides. The important highlight is if you were told you’re going to be under targeted probe and educate and already got your notice, or you are already involved in targeted probe and educate, and you were submitting your ABRs or if you went to round two, you should have received notice that this has been ceased and stopped. So if you haven’t received notice, get in touch with your max. Some of the Macs have been really good about reporting on this, like no VITAS and WPS updated it in their webinar a few weeks ago, but make sure that you get that from your Mac Noridian is one that I’ve had a couple of clients had a go beg for Meridian. Could you please let us know if this has stopped? We would like it in confirmation. So couple of good tidbits here on home health, I wanted to bring home health to the attention of everybody because we’re always concerned in outpatient therapy that we started treating somebody and lo and behold, we submit our claim and find out sometime later the person was still in a home health episode of care that had been discharged.

And as we’re looking at this particular period here, there’s been an expansion of the definition of home bound during the COVID crisis. So during COVID public health emergency, a person may be home bound for home health purposes. If the physician has determined, it’s medically Contra indicated for the patient to leave home because of confirmed or suspected case of COVID or a condition that may make the patient more susceptible to contracting. COVID so pay attention to this where I was concerned about it. And, you know, don’t let up your guard if you’re seeing somebody for telehealth and forget to check for, I mean, the visits and whatnot to check, to see if they’re still under a home health plan of care with Medicare. And one more little tidbit of good news on home health that Rick mentioned I would be giving to you is that yesterday hot off the press same Burma’s press announcement, and you can pick it up.

And the CMS press room that occupational therapist from home health agencies can now perform an initial assessment on certain home-bound patients, allowing home health services to start sooner and freeing home health nurses to do more direct patient care. So physical therapists could always do that, but I want it to point that good news out that was late breaking. This is a reference slide to point to the initiatives under the office of civil rights. Let’s review some of the selected information moving forward. I kind of coined this term last week, HIPAA holiday. It is not a HIPAA holiday and there is a key bit of infant misinformation that’s circulating, especially I think about small therapy practices who may not have is HIPAA program in place. So what I want to highlight is is that the law, the HIPAA rules that relate to the good faith provision of telehealth during COVID have been eased.

So let’s kind of keep that in mind. They are not saying it’s a HIPAA, and you can just forget about HIPAA because you can’t. So the waiver here, and this was a slide from last week that I’m keeping in is that CMS is acknowledging in the office of civil rights that some of the technologies and the manner in which they’re used by HIPAA covered healthcare providers. And if you submit electronic claims to anybody, you’re a covered entity under HIPAA may not fully comply with HIPAA enforcement rules. So at OCI OCR office of civil rights is going to exercise its enforcement discretion. During this period of time, we took a look at this last week and OCR has suggesting some flexibility and stating that apple FaceTime, Facebook messenger, video chat, Google Hangouts, Skype, and zoom, and I’ve highlighted zoom here are generally then use that they suggest you might want to take a look at however they’re exercising, caution and suggesting that you seek additional privacy protections for telehealth while using video communication products.

So under this notice, the office of civil rights also said, these are out Facebook, live Twitch, and Tech-Talk, if you’ve watched tic-tac videos, I don’t understand how you would possibly communicate with a patient. Maybe somebody can tell me how, but you are not to be using these nor other similar public facing things. Now, we all want to step back and take a second to look at zoom. Zoom has become incredibly popular. Teachers are using it because school’s out businesses are using it to conduct business meetings and whatnot. There is even an, a zoom, you know, health version where they offer a business associate agreement. The first thing I want to bring to your attention, and you can Google zoom, but carefully look at all the stuff you’re reading. There has been zoom bombing in meetings, meaning that publicly posted meeting numbers or meeting numbers that are circulated the hackers have got in and have actually bombed the meetings with just, you can only imagine what they’re bombing meetings with.

The FBI has issued warnings on this. So you can see how this is publicly reported. There are ever privacy issues and security issues that predate the COVID crisis that probably went unnoticed. And these are what you should pay attention to today. Apparently within the community, some of their, you know, information was passed along to Facebook and they weren’t clear in their privacy practices that they notified their users. What information was data, mine incentive Facebook. There’s also some additional concerns on the ones where there is a health care business associate agreement signed, what was not, or what was and was not sent to Facebook. So these are something that you should pay attention to Google, put out an announcement yesterday that said their workforce cannot use zoom because of the privacy and security issues. So just, just a heads up in a warning you know, more so public information, as opposed to my opinion about zoom, grab your notice of privacy practices.

If it’s handy, I want to go through a couple of things because this question came up a million times for me this week, for people not quite understanding what they need to do and what HIPAA was all about. And they said, well, we have a HIPPA notice. Well, what do you mean by a HIPPA notice as your notice of privacy practices that has been required for quite some time. And I want to review a couple of elements that should be in your notice of privacy practices from a HIPAA perspective. So when it comes to your health information, that starts out, you have certain rights. And so when you have a notice of privacy practices that you’re giving to a patient that steps into your physical clinic or a patient that is a new patient to you, that you’re going to be doing some type of an electronic visit with whether it’s Medicare or not.

You have to provide them with a notice of privacy practices. So when you give them your notice of privacy practice is you’re telling them how you operate. So this slide here, I want to highlight a couple of things. It says, ask us how we will do this. So if people ask, how can I get a copy of my health information? And they ask you somebody better have a policy on it that says how they can, I won’t go through every single one of these in the interest of time. But another one that very often happens is a patient comes to you and says, I want to correct my medical record. And I’ve bumped into many occasions in many reasons, somebody wants to amend their medical record. So do you have a process for doing that? Is there a form for doing that? What’s your policy on doing that?

These are all things that when you tell patients that they have these rights, what’s your process, what’s your policy, what’s your process on when a patient states, they want to request confidential communication with you and ask us to limit what information that we share. So you’ll notice at the bottom of this one, and I want to point this out is ask us to limit what we use or share. Many people indicate that this might be used to actually take private pay in violation of the mandatory claim submissions rule for Medicare. So you’ll notice at the bottom in blue, it says, we will say yes, unless a law requires us to share that information. And that wall is the inventory claim submission on that. I know there’s lots of different opinions on this, but just kind of following the dots on it. The next slide I notice of privacy practice goes into other things regarding get a list of those with home.

We’ve shared information. So if somebody asks for an accounting of disclosures, how do you do that? What’s the process at your practice for giving the person that information and do you know what disclosures you don’t have to share? And of course, patients have a right to get a copy of your notice of privacy practices. So you could also ask somebody to act for you and you could also file a complaint. And so these are information pieces that should be in your notice of privacy practices. If you don’t have a notice of privacy practices, or if you’ve just grabbed one from your previous place of employment or somebody else that you knew, I suggest you step back, go to the HHS office of civil rights. You can find the model, notice of privacy practices. You’ll still have to determine what your practices are, but it’s a great way to start.

And then last but not least, I want to advise you that if your notice of privacy practices predates 9 23, 2013, the implementation date for covered entities and business associates, that that it is incorrect technology vendors under HIPAA compliance. We took a look at some vendors related to being HIPAA compliant or non-compliant. I want to kind of use the word HIPAA secure cause everybody states that they’re HIPAA compliant. So I want to step into my next section here talking about how you take a look at a business associate agreement. And I’m using an example here from med bridge and I’ve showed on the right hand side there, notice their business associate agreement. If you subscribe to their platform, showing a picture on the top right of their platform, but I’ve called out on the bottom, left two phrases. So when you’re signing business associate agreement with a vendor such as a telehealth vendor or your EMR vendor, or you’re offering a business associate agreement to somebody like myself or Rick, that’s going to do an audit for you.

I want to call out these phrases by signing this HIPAA business associate agreement you represent and warrant that you have read and understand this HIPAA business associate agreement. And this HIPAA business associate agreement will govern each parties obligations regarding Phi. So when you sign a business associate agreement, you two have obligations as a provider. And it’s important that you know what they are. This is a reference slide that will show you how get to a sample business associate provisions so that you can present a business associate agreement from your practice to your vendors. I reviewed the context of civil rights last week and our women are, but I want to bring this slide. And the next slide up to show you and demonstrate that the office of civil rights is quick to enforce during this period of time. So we had a situation that is actually the first enforcement action by the office of civil rights.

Since that bulletin reminding covered entities of the continued applicability of civil rights laws during the public health emergency and the office of civil rights reached an early case resolution with the state of Alabama after it removes discriminatory ventilator triaging guidelines that had been in place since 2010, but somebody had filed a complaint and the office of civil rights moved in very quickly, got a quick response by Alabama to remove this discriminatory guidelines regarding triaging related to certain patients with certain disabilities. And it prompted the office of civil rights to close the compliance review and the complaint investigation without a finding of liability. So it might be worth a quick review on the April 8th, 2020 civil rights press release.
This is a quick reminder slide to determine if you are subject to civil rights laws under section 1557 of the affordable care act. And I’ve got a reference point at, in the slide so that you can go and take a look at that.
Generally speaking, you’re a covered entity. If you receive federal financial assistance, which means you’re a part A provider, rehab agency, SNF, hospital home health agency, or a part B provider such as a private practice that accepts Medicaid and tri care. And also you may have a commercial payer contract that requires you as part of your participation with them to participate under section 1557, most likely a Medicaid managed care contracts. Another kid that to bring to you this week is the equal opportunity. Employment commission has posted an update on their website, which I have here regarding the Americans with disability act and the rehabilitation act and COVID 19 and employment. So if you’re in a position to be an employer, this would be a great opportunity to revisit equal opportunity employment commission related to these two laws. So the OIG waivers we looked at in the first webinar, the waiver of cost sharing the scope of the office of the inspector General’s policy statement, as well as there stating that there is no requirement, waive cost sharing, and they I’ll give particular guidance on this.

Additionally, this past week, there is further guidance in a separate policy statement on stark law waivers impact of the anti-kickback statute. If you’re in a situation where the stark law or an I kicked back statute are applicable in particularly in relationships to positions, please seek advice and counsel of attorneys that specialize in this particular area. So best practice from my perspective here, update and educate on your HIPAA policies and procedures. I took some time here to go through what needs to be in your notice of privacy practices, document compliance with other applicable privacy laws, which may be stricter than HIPAA update your HIPAA security risk assessment, which is required. I talked about posting your notice of privacy practices to your website and make sure you have all those policies. This is different from your websites, privacy policy, good news. We now have payer policies for providers, a telehealth policies for providers, and I’ll give you information on how you can get ahold of those.

Rick had mentioned, take a look at payer policies for telehealth. I’m real big on bring your own device to work policy. As people are working from home, as well as the social media policy, which probably may be the most important policy your practice has right now during COVID and all the communication that’s going on in social media. Here’s the reference slides sites that I used in my presentation today, I collected them all on one slide rather than trying to correlate them on the individual slides. So please take a look and reference out there. Each of the sites are going to have subsites and many, many, many more updates are going to be at each site that you go to, but this is their major starting point for COVID. This is a little bit about my policies and procedures. We’ve got a discount code for that as well as other policy manuals that you can take a look at. And if you are going to stop by my store today, there is a special Easter egg with a code called Fabry shade. Please visit, the code’s only good today. Now we’re going to head into the Q and a session.

Thank you, Nancy. And thank you, Rick, for the great presentation, lots of really good information there. This is Craig Johansen, the manager of regulatory affairs here at med bridge, and I will be leading the Q and a session for us for attendees. If you could submit your questions we’ll try to get as many answers as can, right? Let’s jump into it. So as you both discussed in the presentation, there was a lot of confusion around CMS, interim rule announcement last week. It looked like therapy providers would be able to bill for telehealth and we know that’s not actually quite the case. Can you give us any insight into why CMS stopped short of providing full telehealth support therapy providers and Rick, can you start us off?

You know, can I give the insight again? I think this is going to be, you know, the, the opinion of Nancy and I if you know, anything was CNS and for them to change, I guess, current rules and regulations, it is quite a process in terms of red tape within CMS. All I can say is I know they’re working feverishly on trying to come up with something quickly to expand telehealth, to PT, OT, and or SLP services, whether that’s going to be an in a, in a rulemaking or most likely to a CMS fact sheet that would come out announcing the change. So again, it’s just time consuming and the red tape. And again, just keep in mind CMS and all the people that are working on this are just not working on PT, OT speech you know, there’s hospital issues as critical access issues as home health issues, their skilled nursing facility issues, their suppositions and lab labs, and is much, much, much that they’re working on.

So by adding the CPT codes to the list of covered telehealth services, that was a good step. At least that one is done. And the reason people go, why did they do that? Number one, if they’re going to expand this to PT, OT speech, those codes would have had to been added anyhow. So that is now done. And as I think, Nancy and I said, in part one of this webinar, got to keep in mind that physicians and we’re allowed physician assistants, nurse practitioners, if they’re allowed in the state, they practice and also do therapy physicians, physician assistants, nurse practitioners, and our specialists can do therapy and build those CPT codes to the Medicare program. So they’re just not for PTs and OTs and SLPs antsy.

Rick, I tend to agree with you and I, I don’t, I think CMS is keeping this very close to the vest in terms of how that decision rolled out. I think now with the waiver authority, there certainly is an opportunity to do that. I know with inquiries as to doing this. And I think we are all hoping that this will be added. And I think Rick, as you know, from anything that CMS has added for therapy, let’s just say in the real world prior to COVID, if they were considering statutorily adding therapists, we would have had lots of memos, lots of instructions in Nashville, provider call a test pilot and whatnot. Remember how you know, functional limitation reporting was rolled out. So you know, I, I hope that they’re thinking, and I think it on behalf of our professional associations, they’re continuing and contact. And what I hear from, you know, my folks at NEHRA is that they’re encouraged that, that something may be forthcoming, but, but that’s all anybody’s saying.

Yeah. And if you that are listening today, if you’ve been following myself or Nancy on any social media, we continue to post those links where you can copy templates that have been created by a PTA or a OTA. And you can send these emails, you know, to the government, you know, to whether it be the 1135 waiver, you can comment in an interim role, things like that. So again, I will be reposting that stuff out on Twitter later today. So if you’re not following myself or Nancy yet on Twitter, you know, the next couple of hours, follow us on Twitter because you’re going to then see what we’re going to post and gives you a chance then to take what we’re giving you all you got, it takes us five minutes to copy and paste this stuff in a letter. And they do read the letters and they don’t care if it’s the same letter over and over and over again, if they’re getting 10, 12, 14,000 letters, it makes a difference.

Great. so we’ve got a question regarding incorrect information coming from CMS and attendee in New Jersey called Medicare to check for telehealth. And Medicare said it was covered and gave them specific CPT CPT codes that say, you need this covered. They said that is also separate from these visits. So this attendees just confirming that this is incorrect, right. They didn’t mention if they identify themselves as a therapy provider, but it sounds like there’s some misinformation coming out. Have you guys heard that?

Oh yeah. In my opinion, to ever ask that question, they did not call a CMS. I think they probably contacted their Medicare administrative contractor, whoever that may be like no VITAS national government services, et cetera. And again, those people have an impossible job trying to answer all these questions and all that. But as Nancy and I speak today at almost 10 near 10 o’clock Pacific time, April 10th, physical therapists, occupational therapists, and speech language pathologists had still not been added as telehealth providers under the Medicare program.

And I want to add to that. Go ahead, Craig.

I was just going to ask you if you had heard any of this information coming from CMS.

Yeah. Here’s what I would like to say is that, you know, if you’re in New Jersey, you know, that would be no, the costs would be your Medicare administrative contractor. People call the one 800 number Medicare, and you get a customer service representative. That’s not the same as talking to people that are back in medical review or provider outreach and education. You know, I’ve attended multiple different webinars with the various Macs that are targeting the coding. And of course their direct audiences, all the part B suppliers, which the vast majority are physicians. And those are the people that were jumping on the calls that I were on. You know, the people that are coding specialists, the people that code for physicians, practices and hospitals on behalf of physicians for our patients and to a T they’re basically saying exactly what Rick and I have said that therapists are not allowable telehealth providers. I think you have people that may be answering the phone that are customer service reps, and they’re, they’re, they’re off script. I’ll put it that way.

Okay. Rick, you had covered updates from commercial payers on, and what’s possible for telehealth for therapy providers. And you mentioned that Humana doesn’t cover this and for therapy providers that are using Humana’s, should they contact an advocate for telehealth? What would move that needle on the individual payer level?

Yeah, I think a couple of things, number one, is providers contacted Humana, but I think the biggest thing is your patients contacted Humana. Can you patients contacting your state insurance commissioner? You know, obviously if you are in a state where the governor has mandated all insurances, you know, that are managed by the state cover telehealth, you know, Humana would fall into that government order. If you’re in a state though where the governor has not done that Humana is under no obligation then to expand telehealth. So if you have one of those states where the governor has not issued a, an executive order, a mandate, whatever you call it in your state, I think the biggest thing is have your patients contact Humana, have your patients contact the state insurance commission? No offense, the state insurance commission doesn’t care about you, the provider, they care about the patients complaining the patient’s not having access to needed physical occupational and or speech therapy services.

Great. So we’ve gotten a lot of questions from hospital outpatient and sniffs and home health providers. And so I just wanted to have you guys confirm that hospital outpatient SNIF and home health are not able to use the visit post based on the CMS call that took place last night. The answer to the question I put forth, and again, once this call gets recorded, I mean, it is the call was recorded. I did check on the CMS website. It’s not out yet for public because they do, they will put this out. Once it comes out, I will send this to med bridge and then members can get this recording out to everybody. And then I would tell med grudge at what point to listen to in this talk, based on the gentleman’s response, he clearly stated with hospitals, skilled nursing facilities, you know, anybody that Smith’s games in a UBS or a four, that they are looking into those institutions, being able to build the G code go, the ER, visits, the virtual check-ins to telephone service codes. He did not say yes, he did not say no. He just basically said they’d had lots and lots of questions about that, and they’re looking into it.

All right. And Rick earlier you also clarify that assistant staff PTA’s, can’t use the visit codes for Medicare. Are there, however, any commercial payers that you know of that are allowing assistant staff to bill those codes?

This is going to be Nancy myself’s favorite answer. It’s going to be payer specific with that being said, I’ll give you my opinion. I’ll pass it by Nancy. If you look at the definition within the codes, you know, they say assessment and management, and I think you then get into a legal scope of practice issue because assistants don’t assess they don’t manage their patients. And then same when you look at telephone assessment and management service. So I think you look at those words also in both the telephone service codes and the EBITDA codes, it’s, it uses the word qualified non-physician healthcare professional. And then when you look at the definition of a qualified non-healthcare professional per AMA, that would be a physical therapist or an occupational therapist. They define a physical therapist assistant and an occupational therapy assistant as clinical staff who provides services under the direction and supervision of a qualified healthcare professional. So I would, I would go even, I would say overall, no, because of the terms assessment and management is not done by an assistant, also a PT assistant, an OT assistant do not meet the definition of a qualified non-physician healthcare professional.

Actually, you know, one of the things I’m following Rick, and you did a very good job of answering that. It’s what happens in the hopeful event that the definition of distance side practitioners is expanded to include PT, OT, and SLP for PT and OT, what that does on the private practice side with respect to supervision, because some of this has been addressed on some of the physician side with some of those, you know, and I know that we, as therapists are not paying attention to physician and physician supervision requirements. So that’s another thing we need to stay tuned to if this expands, what is it going to meet with, not with respect to assistance doing it, but how would the supervision take place, which has required?

All right. Nancy, I’ve got some questions for you about zoom. We’ve received several of these, but for providers that are using zoom right now should they thought, well, I’m not in a position to advise providers to stop using zoom. I think that, that it goes to your security risk assessment that you would do under HIPAA, which has required an annual security risk assessment. And if you don’t feel like you have the capabilities to do it yourself right now, during, during everything else that you’re doing, get a qualified IP professional affirm that specializes in this type of stuff. And once you move through an assessment on a determined at that’s the platform that you would like to continue to use I know that there’s very different opinions out there, but I would, in any instance, encourage people to use moving forward one that is HIPAA compliant, so that it’s zoom for healthcare and you’ve signed a business associate agreement. And you understand what both parties, obligations are for providers that were maybe just using zoom free. Do you expect some kind of larger action against zoom itself or against zoom providers using zoom that had been part of that breach?

What, what I mentioned was zoom bombing and that was zoom bombing when people had access to meeting numbers. You know, for example, it’s just a cute post in a Facebook group that you’d like to have a meeting. Maybe you have a patient group and you want to talk with your patients and, and have a meeting with them. Many providers have Facebook groups that their patients can go to believe it or not. You know, that would be the place that if you’d publicly posted a meeting, notice that that, that could be you know, related to zoom bombing. So I think people need to be attentive to what’s free zoom and what’s the paid zoom. You know, there are also some platforms that I didn’t go into detail this week. I didn’t mention them, but doxy.me actually, you know, has a platform that is HIPAA secure that is free. So, you know, check out everything, ask your questions, you know, do your security risk assessment with respect to evaluating the different platforms. And, you know, for presume, if you’re going to use it for patient meetings, you know, whether it’s eVisits or for Medicare or telehealth for other payer sources really have a, have a good understanding of your risks.

Are there any specific guidelines that are out there that you would recommend for evaluating telehealth platforms?

Well, for me personally, I haven’t telehealth platforms. I think you would start with making a determination, just like you, for example, would with any platform that you would use, like your EMR platform, cause your EMR platform is going to be HIPAA compliant. Everybody that has a therapy EMR should have signed a BAA with their, you know, therapy platform or their hospital-based platform such as epic or historian or something of that sort. And then, you know, gather a checklist of what you need to go through. And if you need assistance from a security professional, I would, I would simply do that if you’re at a loss for what to do, but definitely start with platforms. In my opinion, as a compliance professional, I would only evaluate platforms right now that will offer you a business associate agreement, even though the office of civil rights has, you know, eased their enforcement.

Great. all right. So I have some questions about each visit. Specifically we got some questions about licensing. Do licensing rules still apply can PTs provide eVisits visits across state lines for big coordination,
I’ll go first and I’ll pass the Nancy. You, you must be licensed in the state where the patient is at when you providing that service. So obviously you’ve got, we have PT con compact. So if any of you are in the PT combat compact, if the state you are physically in and the state, the patient is physically in or both participate in the PT compact, and you’ve done the PT compact and you’re spilling cash, then you’re fine. Use that same situation. And you now want to build the insurance company of that patient in that state. You’d also have to be credentialed with that insurance company in that state. So the key is you always have to be licensed in the state where the patient is at.

Much confusion comes from the fact that in the first round of waivers that CMS put out and they were, you know, clearly directed at physicians to get positions assisting with the crisis where they could move CMS, ease the licensing requirements, but made it very clear that they could not do anything with respect to the state. It was just from their process. They were easing licensing requirements and expediting physician enrollment to operate in a different jurisdiction. So that has, you know, the same for therapists. Now, if you’re going across state lines for telehealth that you would need to be licensed in the state.

All right. We also got several questions around consent. So I have several questions on that. And the first one that we have is when does the patient consent to the EBIT. Patients don’t consent to an e-visit, they have to initiate the visit. So for example, I’m a physical therapist. If Nancy was my patient in, you know, she’s been doing exercise at home and maybe she’s got some questions about the exercise, maybe they’re too easy, she’s having pain, whatever she has to initiate contact with me. And she can either call me, text me send me an email. You know, I know a lot of us use electronic health records that have that component where patients can email their therapist. So she’d have to reach out to me somehow saying, Rick, I’ve got a question about my exercises. And so she initiated the visit, say on March 31st, I then respond to her on April, the first VSA, the electronic health record, some secure patient portal, April 1st becomes day one of that seven day period. And depending on how many times we do an EE visited in those seven days, I would just add up the minutes. I spent responding to her inquiries, typing out the email responses, et cetera. Can’t see, does the patient oh, sorry, go ahead. I don’t have anything to add to what Rick said. Okay. Does the patient need to consent during each interaction? So you said that the cumulative amount, so say there’s, you know, three separate encounters. Do they need to consent each time?

And again, we don’t want to use the word consent it’s they have to initiate it. So yes, for each visit, the patient would have to reach out. So again, you know, the patient we set on March 30th, I respond March 31st. Obviously, if they respond back to me on April 2nd with further questions, that would be the initiation. Then for that next visit, that would then, you know, that would then respond to. So I think really the first one is just making sure the patient knows that if they’ve got any questions about their therapy exercises, whatever it is that they have to reach out to initiate that first visit. Now CMS did say that PTs OTs SLPs can make their patients aware of the availability of the visits, because obviously patients are not going to know this is available. So they did say you can make them aware that, Hey, you know, we know you’ve been coming to therapy. We know you can’t come in right now, just so you know, if you do have any questions about your exercises, if you have any pain, swelling, whatever, if you’ve got some questions, here’s how you can reach us. So you can inform them about this, but then the patient would have to reach out to you if they had any questions.

Okay. And earlier we also talked about potentially recording. Recording the call for a telehealth visit it’s not required.

Okay. And for telephone service calls does the provider also need to get consent for that? So if it’s being conducted on the phone call you know, do they need to consent to receive service over the phone?

Again, I’m not sure if they use the word consent as in like a consent form is if a patient comes to the initial appointment and they sign all the consent form, or if they’re using the term consent as they have, the patient has to initiate the call to initiate. So I’m going to go with, does the patient have to initiate it? And again, for you to, for me to call Nancy, I just, can’t cold call Nancy and say, Hey, Nancy, just want to check up on you, see how things are going. You know, again, I think Nancy would reach out to the therapist to myself, either via email, via a phone call. I then call Nancy and we talk on the phone. So I’m going with the initiation piece of it. You just can’t cold call a thousand of your patients and see how they’re doing. And then if they have questions, be able to bill for the telephone service codes.

So I think it’s really the patient having the question, reaching out to you first, you then decide to get on the phone with them to talk through whatever their issues are, but I’m going to go with the initiation, not quote consent as in consent forms, which I think would be a great question for Nancy that maybe add in and why she thinks with compliance. And, and should there be some kind of consent documented from a compliance standpoint, I think terminology must be accurate. Was this a consent to have a call, a consent to treat? Was it an initiation of a call what’s needed to be done? And I want you to want to throw another little compliance thing in there. There are FCC rules regarding calling people on phones. If you’re going through your list of every patient that’s been a patient of your practice, which is different than posting a notice on your website that people can come in for telehealth. And additionally if you’ve got, you know, have your patients under your HIPAA, have they opted into marketing messages? If they’re not a current patient, meaning they weren’t a current episode of care. So I’ll kind of toss those wrinkles in when people are considering what are your telehealth policies?

If you could just briefly just summarize the consent documentation needed and where they can do that.
Well, I’m going to come back to the process of consent versus you know, agreement to treat versus a patient initiating from a compliance perspective. You always want to document the process that, you know, we’re going to, we’re on a telephone call. Do you consent to me speaking with you? Do you consent to, you know, if you’re going to record the call or if you’re going to take any other information and recorded for that call, as opposed to a formal document, so to speak that you might be initiating when a patient starts physical treatment and your therapy clinic, where it’s consent to treat.

Okay. One more quick question on consent. And this could be for either of you, if a PT provider is doing an ER visit and it’s actually with a minor does a parent need to be present for the entire thing during that video visit? Or is there a verbal consent at the beginning of the session? Is that sufficient, but how does how does the minor you know, working with children affect that?

Actually I would, I would stop me personally compliance and answering that question and say, I’d like to look it up before I, so I could make an informed answer. And and I put it at that one, cause that’s just generally the way that I would approach something. That’s you know, a question like that particular during this time where we’re not dealing with what I would call standard practices for sure.

And while you said you’re there, you’re my compliance expert, Nancy, Sally, that one to you.

All right. We have a question on the CRM modifier and it looks like someone has been watching different webinars and they’re kind of confused around that because it looks like physicians aren’t having to use the CR modifier, but perhaps therapy providers are. And there’s some confusion around that. Could you address that, Rick?
Yeah. I mean the latest information we have from CMS is if that you are going to be doing the 3g codes for the EBIS as 2 20 61 G 2062 G 2063, as well as G 2010 Hinchey 2012. The latest and greatest is not only do those five codes need the therapy specific modifier, either G N G O G P, but also that’s C R modifier. The telephone service codes were clarified during a call on Wednesday that they do not need the CR modifier. So again, that’s the answer as of today, that answer may still be the same next week. It may change next week. I will also say again, most Medicare contracts are probably not updated their billing software yet to accept those codes though, you know, with say G 2061 GPCR. So just because you may be submitted in getting paid, don’t think you’re doing it wrong. My opinion is they have not updated their software yet.

And I’m going to echo what Rick just said on that. We’re, we’re seeing various different inquiries and posts around and, you know, directly from our clients, as well as seeing people that have submitted a claim and they’re getting air codes, the air quotes aren’t consistent. Of course we may not necessarily be understanding everything that people, people are submitting on a claim. And you know, in many people are saying, this is what their biller told them to do. So people, people are attending millions of webinars out there. And the, at a point in time that they heard information it’s light years just like Rick and I turned in our slides Wednesday night, and we have updates from what happened on Thursday from attending CMS meetings and from you know, the CMS press announcements that happened yesterday. And I, so we, we absolutely can’t go with anything until we get confirmed experience from people that have had a claim positively adjudicated. And by the way, I know people that have decided to make test claims with the [inaudible] for each visits to see what happens, knowing that it, that it may not be a possibility, you know, just doing a test claim to make a determination and providers did this under what they feel is a compliance perspective because they said we can’t provide you with any you know, guidance on that.

All right. Another question on e-visits regarding the seven day period does Medicare policy require a patient to wait an additional seven days after the initial seven day visits? You know, or can they happen consecutively in terms of the seven day period? And they basically just have the visits every week or do they need to have a waiting period between them and that’s the unknown you know, something we’re also trying to seek clarification again, but people need to realize these evisit codes we’re talking about, they were not created for what we’re using them for today. These codes were not created because of COVID-19 pandemic. These codes were created for, you know, earlier this year they came, became effective this year, but it was not because of this. So we are in unchartered territory, you know, trying to use these codes for the purpose that we are using them for right now. So what we’re trying to find out from CMS is can a provider, for example, bill G 2062, say from, for March 24th through March 30th, but then also maybe build G 2062 again, say from April 2nd to April 8th or April 1st to April 7th. That’s what we’re waiting to get from. If CMS does come back and say, yes, you can bill the G code during multiple seven day periods.

I don’t think they, I don’t think they would implement a seven day waiting period between, so for example, you know, March 24th to March 30th typically is seven days. If you count the days and say you do G 2062, then could you go March 31st to April six for another seven day period. If, if Medicare CMS will allow more than one 70 period, the answer’s going to be yes, but CMS, you know, has been answered. Can you do this for more than one seven day period yet alone? Does it have to be a waiting period between the seven day period? My opinion, if they’re going to allow this to be built more than during one seven-day period, they’re not going to have a waiting period, but again, I don’t think he visits, you know, my opinion if you’re doing he visits three, four times during a seven day period, and then you do e-business as again, another three to four times during a seven day period, I guess I would question if you use in the cold correctly, and should you maybe me doing a telehealth visit that may be cash for that Medicare patient?

Do providers need to do an in-person visit first or can you do an eval over telehealth potentially for cash and then do an either and again, number one, you can do telehealth right now today for PT, OT speech has cash. Now, now, if you do a telehealth visit, I don’t know if you’re going to so much do any visit the next time, because again, if they need an e-visit is not to take the place of a therapy followup visit. An e-visit is just, if a patient has maybe a question or two about their exercise program, maybe you set up, you know, things like that. So you, you have to look at that piece of it. So if you do a telehealth Eve out today, and now two days later, should you be doing another telehealth visit and charging cash, or is this more of a teller? Is it more of an e-visit, you know, related to something that the patient had questioned about their telehealth IE valid exercise program? You know, things like that. So I guess, I think I really want to stress is an e-visit does not take the place of an actual in-person visit or a telehealth visit. They are separate and distinct interventions, Nancy
And, and, you know, Rick, I think what’s happening is people are jumping in to try and do everything under the sun. And by documenting in your notes that you’re doing e-visits, and then you’re doing a non-covered telehealth visit in you accepted cash. I just get concerned about therapy, notes, and potential reviews and potential and potential concerns and potential just all the potentials that could potentially exist with CMS. And it doesn’t take much for CMS or the OIG to make a determination that something went haywire. And that I, my, my mind always kind of goes to, you know, you know, totally think through exactly what you’re going to do and, you know, kind of trying to co-mingle these e-visits with telehealth by charging cash. I would just ask people to carefully think through that. That’s my opinion from a compliance perspective, You would accept it.

All right. Here’s one regarding patient initiated, he visits can they be initiated over the phone without a patient portal at all?

Yes. So a patient could contact Rick and over the phone say I’ve got some questions for you. And then again, that’s what you want to document in the medical record that the patient contacted myself had questions and then that would then lead to an e-visit done over a secure a patient portal.

All right. And I think this will be our last question. And I’m not sure if we have guidance on this one, but it’s good to check in because we’ve received this question quite a bit. Is it possible for a therapy provider to offer telehealth services under physicians in PEI?

Great question. And that is what we’re seeking clarification from, from C M S on because normally for what we call an in-clinic visit, if you had a PT or an OT employed and physician owned practice, and they had a Medicare patient come into that practice, the PT, the OT could treat the Medicare patient and bill that what we call it incident to the physician that’s on the premise. So the PT and OT, maybe they’re not enrolled in the Medicare program. The not a Medicare provider don’t have an MPI number, whatever it may be. So they do the visit, the physician that’s in the office suite that that PTLT service gets billed under the NPI of the physician, a box 24 J on the 1500 claim form that’s for an in-person visit. So now we’re thinking, okay, telehealth, they’ve added these CPT codes.

Can this be done? And we can see logic both ways because we can see logic and Hey, it’s really being built under the physician’s NPI, but at the same time, who really is conducting the telehealth visit, it’s really the physical therapist or the occupational therapist. And again, right now, as we speak today, the PT and OT have not been added as a telehealth provider. So my conservative answer right now is no don’t do that. Because again, the PT, the OT has not been added yet as a telehealth provider. And also, you know, we are trying to get clarification from CMS does incident to physician billing really apply to telehealth services because we think about it in clinic visit PT and OT can do PT and OT. Tele-Health technically speaking, PT and OT. Can’t do telehealth.

I concur and that’s the conservative compliance approach. And I think that we need to get clarification on first blush. One would think that this was a good opportunity that was happening. But when you take a look at incident two with nurse practitioners and what not, that are working in a positions office, they’re eligible practitioners for dish insight practitioners. So they, and they do incident to services or bill on their own, by the way. So when you start applying this and you take the vines off the branch, those are questions that, you know, we really you know, want to have an affirmative green light on. And this would be something that, you know, even if you put the caution light on and say, well, we’re doing this now during this emergency you should do it by examining once again, a risk assessment as to what are your risks of doing this?

All right. Great. and that’s all the time that we have in the Q&A session. If I could have you guys give your closing statements, you know, what are your takeaways? What are you watching in the next few weeks? That would be really helpful. And thank you so much.
Well, my takeaway is for everybody, as I focus, my presentation is please take a moment to look at your HIPAA policies and procedures and your notice of privacy practices. The HIPAA policies and procedures that I had on my website actually were, were, I took them down because they were being updated. They’ll, there’ll be backed up because they’re going to be updated. But I I’m asking everybody to really pay attention to this and not sort of say, this is a HIPAA holiday. That’s, that’s where my focus is Rick.

Yeah. I think my focus is on. You got to check with every insurance company number one, because they’re going to, as you implement telehealth, or you implement e-visits or virtual check-ins, every pair is going to have their own rules, regulations the way to do it. And again, asked for the resource, ask for the source document. I will also say, and I mean, it’s all due respect. Nobody has an excuse that the information is not available. Check your national associations website, sign up for emails, checked your state associations website. I’m not saying social media is the end off all information. You got to pick and choose who you accept information from. I feel pretty confident what Nancy puts out and what I put out is going to be accurate. Follow us on Facebook, follow us on Twitter.

There’s lots of resources out there for you. And also get to keep in mind. Don’t get frustrated. Things are going to change. You already know things have changed because you know, if you listened to part one of Nancy and my talk you’re at medbridge, some of the stuff’s already changed. I pretty much can guarantee you stuff would change next week. I do feel confident. I’ll use the word optimistic. I do feel optimistic that CMS is going to add PT, OT, SLPs as telehealth providers. I’m also, I guess, called pessimistic that don’t need to do it on a temporary basis during this COVID-19 pandemic, but follow Nancy on Facebook. Follow me on Twitter. Follow me on Facebook. Follow me on Twitter. Stay current things are changing all the time. Go to Nancy’s website, go to my website. Just, just keep plugging away. Okay. It’s going to be it’s. It’s tough. We’re going to get through it. You’re going to get through it and we’re going to keep on going. But if you do in telehealth now, if you implement telehealth, now do it for the future. Keep on doing it. Do not do it just for this pandemic. Keep it moving forward. Those are my closing thoughts.