Frequently Asked Questions About Secure Telehealth

What is the "facility fee" paid by some insurers?

A. The facility fee is a second fee paid to the facility where the beneficiary (consumer) presents. It is paid by Medicare throughout the US, and by half of the state Medicaid programs. Click here to check if your state pays this fee. The states highlighted in green have Medicaid programs which pay the facility fee.

CMS calls this the "originating site facility fee" because it is paid to the site where the beneficiary originates. The CPT code is Q3014. The rate is about $18 per session (above and beyond the physician fee). Many providers negotiate contracts with originating sites to share the proceeds from this fee.

Is telehealth right for my organization?

If you answer “yes” to one or more of the following questions, telehealth could be a great asset to your organization.

  • Do you have dispersed locations within the same health system?
  • Do you provide outreach services?
  • Do your patients travel to other facilities for services not available at yours?
  • Have you identified health disparities in your community for which you don’t have the services or expertise necessary to provide care?
  • Do your competitors utilize telehealth services and are you losing market share as a result?
What does Secure Telehealth do?

Secure telehealth provides HIPAA-compliant video conferencing technology (on your Mac or Windows PC) and support to mental health providers who use it to conduct secure telemental health sessions and assessments with their patients anywhere on the Internet. We don't hire Doctors, we just provide the technology to Doctors, hospitals, and community mental health clinics. We sign HIPAA Business Associate Agreements (BAA's) with our customers.

What are the technical requirements for Secure Telehealth?

Computer - Any reasonably fast (Dual-Core) Windows or Mac computer (laptop or desktop).

Internet - Any broadband conncetion with 700kbits per second upload and download available to the telemed PC (available with almost all broadband connections - cable and DSL)

Accessories:  Web Cam + Microphone + Speakers

What CPT codes are covered for telehealth?

Services conducted via telehealth and reimbursed by Medicaid and Medicare use the same billing codes as face-to-face (with a "GT" modifier). These services include:

  1. Consultations (CPT codes 99241-99275)
  2. Office or other outpatient visits (CPT codes 99201 - 99215)
  3. Individual psychotherapy (CPT codes 90804 - 90809) Replaced by time-specific codes in 2013: 90832 (30 minutes) 90834 (45 minutes) 90837 (60 minutes)
  4. Pharmacologic management (CPT code 90862) Replaced with Evaluation/Management coding (99xxx). For example, use 99213 for outpatient, use 99212 for refills, use 99214 for complex situations.
  5. Psychiatric diagnostic interview examination (CPT code 90801) Replaced by 90791 and 90792 in 2013.
  6. Neurobehavioral status exam (HCPCS code 96116)
  7. Initial Assessment (96150)
  8. Intervention - Individual (96152)
  9. Problem Focused (G0425)
  10. G0426 (Detailed): HCPCS G0427 (Comprehensive):
  11. G0406: Follow-up inpatient telehealth consultation, limited, physicians typically spend 15 minutes communicating with the patient via telehealth;
  12. G0407: Follow-up inpatient telehealth consultation, intermediate, physicians typically spend 25 minutes communicating with the patient via telehealth; and
  13. G0408: Follow-up inpatient telehealth consultation, complex, physicians typically spend 35 minutes or more communicating with the patient via telehealth.
How do I get reimbursed for telehealth sessions?

Q. Which insurance companies pay for telehealth?

A. The answer:

  1. Medicare = yes but only if the beneficiary presents from a facility in a non-metropolitan area. See the map here to determine if your facility qualifies. Medicare pays a facility fee ($18/session) as well as the physician fee.
  2. Medicaid = yes in 40 states, no in 10 states. Half of the states pay a facility fee in addition to the physician's fee. Click here to check the medicaid policy in your state.
  3. Private Insurance - depends on the state. Click here for more info.
  4. Private Pay = yes.
iPads?

Q. Will Secure Telehealth run on my iPad?

A. Yes. Follow this procedure:

  1. Go to the App Store
  2. Download OmniJoin from Brother Corp (it is free)
  3. Tap Omnioin icon
  4. Choose "Join an existing meeting (no need to login)
  5. Enter your Secure Telehealth Meeting ID and Password
  6. To change to full screen video, tap the icon at the bottom of the screen that has three tiny boxes across the top and one larger box underneath (second from the left). Then choose "Video Only"
  7. To leave the meeting, tap the icon in the upper right corner (door with an arrow) and choose "Leave Meeting"

Notes:

HIPAA requires that the Doctor safeguard the physical surroundings of a workstation that provides access to PHI. This pertains to iPads too, and restricts some of the mobility which is possible with an iPad.

How are notes entered into a telehealth session?

Q. Do I type notes into Secure Telehealth?

A. No. Secure Telehealth just handles the audio and video. We do not store any patient notes or PHI. Many of our customers use two monitors on the provider's telehealth computer: One for Video and one for the Electronic Health Record (EHR) program (which is not supplied by Secure Telehealth). Notes are typed into the EHR program during video sessions. If you don't already have an EHR program, Practice Fusion is an example of a free EHR program that may be used along side of Secure Telehealth. The EHR program obviates the need to copy charts back and forth between the physician site and the patient site, becuase clinicians at both ends have access to the same data.

Can we use our telehealth virtual meeting room for administrative meetings too?

Yes, you may use your Secure Telehealth meeting room for administrative meetings and training, as long as you schedule your administrative meetings around your telehealth schedule to avoid double-booking of the room. Up to 30 individuals may attend. Up to 12 individuals may be seen on camera. Powerpoints and other documents may be shared. There is no extra cost.

What hardware does Secure Telehealth use?

Secure Telehealth uses the webcam and audio devices on your Windows or Mac computer.

It also runs on your iPad or iPhone or android device (Download the OmniJoin App from iTunes or the play store)

Quality varies, so we may recommend specific hardware to maximize the telehealth experience. We check the quality of your existing hardware by comparing side-by-side with us during a brief demo. If you are buying new hardware, we recommend Logitech C920 Webcam ($75) and the ClearOne Chat 60U microphone ($120). Many new Laptops have excellent built-in web cams and microphones, which obviate the need for the external devices. We can recommend specific laptop makes and models upon request.

How does Secure Telehealth Licensing work?

Q. What is a meeting room? Can it be shared? How much does it cost?

A. Secure Telehealth customers buy a virtual meeting room for $300 per month. This room allows 2 to 12 computers to join on camera at once. The other participants/facilities who join with you in your room don't pay anything, although they get the software and direct tech support from us. One Secure Telehealth meeting room may be used serially in any number of facilities and shared by multiple providers as long as providers adhere to a master call schedule to avoid double-booking of the meeting room. The trigger to buy a second meeting room is when two providers need to schedule meetings with their patients concurrently. Physicians may present from their homes, offices, or clinics. Patients may be seen in any number of facilities. Each facility needs to download our software on a Windows PC with a webcam and microphone. They also need a good broadband internet connection.

How does HIPAA regulate telehealth?

The live video transmitted during telehealth sessions contains the likeness of the patient and therefore constitutes protected health information (PHI) protected under HIPAA. PHI must be safeguarded with encryption during transmission. Many other technical, Administrative, and Physical safeguards are required as well. The company that provides the telehealth technology should sign a HIPAA Business Associate Agreement with the Covered Entity. The HIPAA Omnibus Rule published in the Federal Register on January 25, 2013 makes business associates directly liable for violations of these requirements, as if they were covered entities themselves. A sample BAA has been published by the US Department of Health and Human Services (HHS) here.

According to the HIPAA Privacy Rule, "Covered entities that engage business associates to work on their behalf must have contracts or other arrangements in place with their business associates to ensure that the business associates safeguard protected health information, and use and disclose the information only as permitted or required by the Privacy Rule" The Security Rule states that "covered entities must have contracts or other arrangements in place with their business associates that provide satisfactory assurances that the business associates will appropriately safeguard the electronic protected health information they create, receive, maintain, or transmit on behalf of the covered entities.

The HITECH amendment to HIPAA which is in effect as of March, 2013, lists "Health Information Organizations (HIO), E-Prescribing Gateways, and other persons that provide data transmission services with respect to protected health information to a covered entity and that requires routine access to such protected health information ; as Well as Vendors of Personal Health Records" as Business Associates.

Big screen or little screen?

Q. Which is better for telepsychiatry, a big screen on the wall or a little screen like a laptop?

A. It depends. Traditionally, telepsychiatry has relied on specialized video conferencing equipment from Polycom and other vendors which included large screens so a roomful of people can see. Conventional wisdom that "bigger is better" for telehealth presentation grew out of this application. In cases where a group of people are observing, the conventional wisdom ("bigger is better") is true.

Lately, high-quality video images have become available on PC's and laptops with smaller screens (through cloud computing technology from companies like Secure Telehealth). In certain applications (like a middle school girl talking to her psychiatrist about side effects from her medications), a smaller screen held in the patient's lap might foster more transparent answers than talking to a giant Wizard-of-Oz type image on the wall. This would make the small screen held close a better alternative than a large screen on the wall. We are not aware of any studies that investigate this, but it is something with which each practitioner might want to experiment.

Getting scripts to the patient?

Q. How does the remote Doctor get the prescription to the patient/pharmacy?

A. Currently most prescriptions are sent by Fax, Fedex, USPS, and phone. ePrescribing is preferable if it is available in your area. Congress has recently lifted a prohibition against ePrescribing controlled substances. As soon as the ePrescribing clearinghouses are certified, physicians and nurse practicioners will be able to ePrescribe all drugs, including controlled substances.

Click here for more information on availability of ePrescribing from SureScripts.

Click here for information on a free ePrescribing product from Practice Fusion.

Click here for a status report from August 2012

Mobile Telehealth in facilities?

Q. Can we bring telehealth to the patient's room via a laptop on a mobile cart?

A. Yes - but only if the WiFi signal is strong in the patient's room - or if the laptop on the cart can be plugged into an ethernet port on the patient's room. Otherwise, the desired mobility will cause our quality to suffer. WiFi is often implemented less than optimally in facilities such as Skilled Nursing Facilities or rural hospitals. Our quality suffers and dies when the WiFi signal is weak due to excess distance to the closest WiFi access point or solid concrete walls which can't be penetrated by the WiFi signal. Our quality remains high in a mobile setting if the WiFi signal is strong and ubiquitous throughout the facility.

In-home telemental health?

Q. Can we conduct telehealth video sessions with consumers in their homes?

A. From a technical perspective - yes (as long as they have a PC with a webcam and a broadband Internet connection, or if a strong 4G signal is present at the consumer's home and a laptop with 4G capability is brought to the home by a case manager).

From a HIPAA perspective - yes (as long as the consumer accepts responsibility for safeguarding their physical surroundings by closing a door during a session).

From an Insurance reimbursement perspective - Mostly No

Medicare = No

Medicaid = No in most states.

Private Insurance = no in most cases.

Private Pay = yes.