Telehealth During COVID-19

Contributors: On behalf of the FHIMA Consumer Engagement Committee, 

• Sara Evans, CCA
• Deborah Guskiewicz
• Jean Patterson, LPN, CCA
• Takiyah Mitchell, BSHIIM, CCA
• Tamara Rodriguez, MSHIA, RHIA, CHTS-PW

With the emergence of the novel coronavirus and record-breaking infections across the country, the year 2020 was proven to be a challenging year for people, industries, and sectors world-wide. This is particularly true for the healthcare industry, as healthcare facilities, providers, staff, and patients all worked to find ways to deliver and receive healthcare safely. Telehealth is the use of electronic information and telecommunication technologies to provide care when you and the doctor aren’t in the same place at the same time (telehealth.hhs.gov, 2020). This method of delivering healthcare met healthcare safety requirements during a global pandemic; as such, providers and consumers relied on it heavily this past year. In fact, there was a 154% increase in telehealth visits during the last week of March 2020, compared with the same period in 2019. (Centers for Disease Control and Prevention, 2020)  So, what are the implications of increased telehealth use on providers, healthcare facilities, and patients? Let’s take a closer look at each of these cohorts. 

Telehealth from the Healthcare Provider Perspective

Telehealth provided many benefits for healthcare providers. The ability to virtually screen patients and to refer patients for the correct course of treatment is beneficial to both the patient and the healthcare provider as it protects both parties from possible COVID-19 infection. Telehealth also provides an effective way to follow up with patients after hospitalization and keeps the patient from interacting with possible infectious carriers. 

However, there are some downsides to telehealth from a healthcare provider’s perspective. Patients may present with emergent symptoms which would be best to diagnose in-person to perform an adequate physical exam. The provider must rely on the patient’s self-reports. Providers would need to ask more questions to obtain a comprehensive health history which may prolong the appointment time or the patient may leave out a symptom that would have been perceptible during in-person care which could compromise diagnosis and treatment. Other disadvantages are providers relying on technology and patients not having access to smart devices as well as reliable internet connections.

Telehealth from the Patient Perspective

Convenience is very important to many people. With telehealth, your physician has the ability to talk with you anywhere, anytime and about anything from a rash to medication planning. A visit that may have taken an hour or more is decreased with telehealth. In addition to convenience, patients do not visit facilities, so there is less possibility for exposure to COVID-19.  In the future, telehealth would be great for people with a compromised immune system, STDs, Hepatitis or cancer. 

Examples of telehealth for cancer patients would be managing and teaching about medications or treatments, check-ups between treatments, and consults with a palliative care specialist for signs and symptoms (The American Cancer Society). Additionally, telehealth would increase preventative care because more people will have access to physician counseling services, which will also decrease hospital admission rates. “Trends in telehealth encounters during January–March 2020 were compared with encounters occurring during the same weeks in 2019. The number of telehealth visits increased by 50%, and most encounters were from patients seeking care for conditions other than COVID-19.” (Koonin et al., 2020)

However, telehealth can only be used as a communication tool which means physicians would be unable to have hands on experience. For example, if you see discoloration in your skin that your camera does not, then your physician will not be able to help you as much as they would with an in person visit. Also, your physician will not be able to touch your body and feel if there is a lump or abnormality. The quality of care could go down and may result in misdiagnosis or changes in diagnosis after a correct examination.

Telehealth from the Healthcare Administrators and Facilities Perspective

The advantages of telehealth to healthcare administrators and facilities may include reducing the number of front desk and support staff required along with the amount of office space needed for waiting and exam rooms which would decrease overhead costs. Also, less exposure of staff and patients to illnesses and infections. Most importantly the ability to provide billable services to patients during the COVID-19 pandemic. The disadvantages include licensing and insurance billing requirements across state lines if the patient lives in a different state than where the office is located, finding the right digital platform for your practice and cost of said technology as well as adequate connections to provide quality care. Healthcare administrators must ensure the program is secure and fully compliant with privacy laws as well. 

The relaxation of laws and regulations around privacy and billing during the COVID-19 pandemic has provide expanded opportunities to use telehealth to provide patient care at a distance (Hawkins, 2020).  Moving forward, something to consider is the impact on privacy and security. Telehealth has been the savior of healthcare during this pandemic and will continue to provide quality care and services in the future. However, as healthcare providers and administrators know, preparation is the best medicine for the unknown. There must be laws and regulations in place for these extreme situations. 

References

Centers for Disease Control and Prevention. (2020, October 30). Trends in the Use of Telehealth During the Emergence of the COVID-19 Pandemic — United States, January–March 2020. Retrieved from Centers for Disease Control and Prevention: https://www.cdc.gov/mmwr/volumes/69/wr/mm6943a3.htm

Hawkins, M. (2020, July 07). Think Ahead for Telehealth Security and COVID-19. Retrieved December 26, 2020, from https://journal.ahima.org/think-ahead-for-telehealth-security-and-covid-19/ 

How to get or provide remote health care. (2020). Retrieved December 28, 2020, from https://telehealth.hhs.gov/

Koonin, L. M., Hoots, B., Tsang, C. A., Leroy, Z., Farris, K., Jolly, B., . . . Harris, A. M. (2020). Trends in the Use of Telehealth During the Emergence of the COVID-19 Pandemic — United States, January–March 2020. MMWR. Morbidity and Mortality Weekly Report, 69(43), 1595-1599. doi:10.15585/mmwr.mm6943a3

TELEHEALTH.HHS.GOV. (2020, November 18). Understanding telehealth. Retrieved from Telehealth.HHS.Gov: https://telehealth.hhs.gov/patients/understanding-telehealth/?gclid=EAIaIQobChMIhbHU_53z7QIVBbGGCh2Opw-wEAAYASAAEgLs4PD_BwE 

Villines, Z (2020 April, 20) Reviewed by Martinez, K M.D. Telemedicine benefits: for patients             and professionals Medical News Today Newsletter

COVID-19 Timeline and Coding and Reimbursement Challenges

Submitted by: Lesly Carreras, RHIA, CCS
FHIMA President-Elect

Last year at this time we could not have begun to imagine the changes and financial impact COVID-19 would have in our places of work. The media began to report the first few COVID-19 cases in the United States and bring forth images of the devastation coming our way. The images from China, Italy, and all of Europe were extremely worrisome.

On February 29, 2020 state labs in Tampa, Jacksonville, and Miami gained the capability to process COVID-19 tests; previously only the federal labs were able to process these tests. On March 1, 2020, our Governor, Ron DeSantis, announced that the first two Floridians have tested positive for COVID-19, a 29-year-old woman from Hillsborough County who had recently returned from Italy, and a 63-year-old man from Manatee County who had come in contact with someone who had tested positive. A few days later, the Florida Department of Health issues guidelines to stop the spread of COVID-19 asking residents not to travel overseas.

After a few more incidents, DeSantis declares a state of emergency to create a pathway to obtain funding and resources to stop the spread of COVID-19. On March 11, 2020, the CDC declared Coronavirus a pandemic. Then the toughest news for South Floridians came on March 24, 2020 -- the stay-at-home orders were issued for parts of Miami-Dade, Alachua, and Orange County. About half of the states reported COVID-19 cases were in Miami-Dade, Broward, and Palm Beach counties; there were 1,467 cases in Florida at that time.

As everyone was scrambling to stay safe and gather supplies from our stores, which could not keep up with the demand, our Emergency Room and hospitals doors remained open. We began to formulate our plans for the next couple of weeks; yet that later turned to months, and a year later here we are. 

On March 18, 2020, the World Health Organization put out the emergency code U07.1, COVID-19, to be used for confirmed cases after April 1, 2020. Since then, we have had multiple updates with additional ICD-10 CM diagnosis codes and ICD-10-PCS codes related to treatment for the virus, along with many more CPT procedure and HCPCS codes for laboratory tests and vaccines.

Telemedicine took the front seat. In a matter of days, our outpatient visits turned to virtual encounters. Our hospitals and clinics scrambled to develop new policies and procedures on how to document and bill for these new services. Extensive calls with our payers to establish a claim submittal and reimbursement workflow was of utmost importance.

To deal with the “new kid in town”, Telehealth, virtual meetings, and daily huddles flooded our calendars as we deciphered with our coding staff the new coding workflows and updates. We created a grid for our outpatient coders with our payers Telehealth guidelines for coding and reimbursement (see links for resources below). For our inpatient coding team, the challenge was showing our clinicians how to document when they were busy treating our very sick patients.

Moving forward the focus is to be ready for anything. As your staff moves to working offsite, ensure a good sound Telecommuting Policy is available. If you do not have one, draft a policy that addresses PHI protocols, remote connectivity, equipment, work schedule, and work expectations. Fortunately for many of the HIM Departments out there, we had experience with staff working remotely. This new concept was new to many hospital departments that did not have policies or the processes in place to make this a smooth transition, and they reached out to HIM for guidance. 

As we begin 2021, we are still facing many of the same challenges of 2020, but we are hopeful that with the COVID-19 vaccine a cure is on the horizon. The HIM Professionals have once again stepped up to the occasion and demonstrated we are resourceful bunch, and we are here for the long haul.

 It is very important to stay “In the Know”. Bookmark AHIMA’s COVID-19 Resources:

• Journal of AHIMA—COVID-19. An authoritative source for healthcare-relevant news and perspectives on the global response to the COVID-19 pandemic. Click here.
  
• AHIMA.org COVID-19 Index. Continuously updated with resources, AHIMA news, and navigable links to public health and professional organizations. Click here.

The January 2021 ICD-10-CM Addenda and updated ICD-10-CM Official Guidelines for Coding and Reporting are available at:  https://www.cdc.gov/nchs/icd/icd10cm.htm.

Additional References:

• Medicare Telemedicine Health Care Provider Fact Sheet
• HHS: Notification of Enforcement Discretion for telehealth remote communications during the COVID-19 nationwide public health emergency
• HHS Limited Waiver of HIPAA Sanctions and Penalties During a Nationwide public Health Emergency
• HHS: Waiver or Modification of Requirements under Section 1135 of the Social Security Act as the Result of the Consequences of the 2019 Novel Coronavirus (COVID-19)
• HHS BULLETIN: Civil Rights and the Coronavirus Disease 2019 (COVID-19)
• CMS: MLN Booklet – Telehealth Services
• HHS: Defending Against COVID-19 Cyber Scams
• CMS Medicare Claims Processing Manual – Telehealth included
• Center for Connected Health Policy
• SAMHSA COVID-19 Public Health Emergency Response and 42 CFR Part 2 Guidance
• Health IT.gov: Your Health Information Security
• Health IT.gov: What is a ‘Secure Wi-Fi Network’?
• CMS Announces Relief for Clinicians, Providers, Hospitals and Facilities Participating in Quality Reporting Programs in Response to COVID-19
• American Medical Association quick guide to telemedicine in practice

FHIMA Empowers People to Impact Health

Health Informatics and Information Management is the study of the principles and practices of acquiring, analyzing, and protecting digital and traditional medical information vital to providing quality patient care. It is the link to clinicians, technology designers, and information technology; and is the value-adding bridge between leadership and management of health information in all formats, and is a critical component of the electronic health record work-force. In summary, Health Informatics and Information management is a combination of clinical, business, science, and information technology.

In January 2021 the FHIMA Advocacy & Government Relations and HIM Awareness committees teamed up to create the video below, with the goal of educating the public, potential HIM students, HR societies, etc. about the work that our HIM professionals do and the value they add to their organizations and healthcare as a whole.