Embed Size (px)
Citation preview
National Telehealth Technology Assessment Center (TTAC)
HCCN 2019 HIPAA & Telehealth/Virtual Health TrainingJune 5-6, 2019Helena, MontanaDoris T. Barta, MHA, DirectorNational Telehealth Technology Assessment Center (TTAC)Alaska Native Tribal Health Consortium (ANTHC)
Who is TTAC? TTAC is federally funded
through the Office for the Advancement of Telehealth (OAT)
TTAC provides Technology Assessment services to the 12 regional TRCs as well as the other national TRC.
Between the three TTAC staff, there is over 50 years of experience in Telehealth
TTAC Technology Showcases
• Provided at Regional Conferences
• Allows attendees to experience and compare medical peripherals
• Vendor Neutral
4
Provide FREE RESOURCES for Telehealth program development and sustainability
Telehealth Resource Centers
Telehealth Resource Centers
Telehealth in Montana
Telehealth in Montana
Began in early 1990’s with grant funding RUS/OAT
Three Dedicated Networks Initially Eastern Montana
Telemedicine Network (EMTN)
REACH Telemedicine Network (Benefis)
Partners in Health Telemedicine Network (PHTN)
8
Telehealth in Montana
Telemedicine-Based Collaborative CareCentral Montana Medical Center & Northcentral Montana Hospital
Alliance – Team Approach
CMMC CARE Management
Team
Care Manager Program Manager
BH Care Manager
Psychiatric Consultant
SITE 3 CARE TEAM
Primary Care Provider
Care CoordinatorPatient
SITE 1 CARE TEAM
Primary Care Provider
Care CoordinatorPatient
SITE 4 CARE TEAM
Primary Care Provider
Care CoordinatorPatient
SITE 2 CARE TEAM
Primary Care Provider
Care CoordinatorPatient
Components of Collaborative Care Model
Care Coordination and Care Management
Proactive Monitoring & Treatment to Target
Regular, Systematic
Caseload Review
Program Activities Engagement and Assessment using validated
measures, resulting in a treatment plan
Weekly review with psychiatric consultant and TX modifications, as recommended
Use of registry (REMEDE) to track visits and outcomes
Ongoing collaboration with PCP and other treatment providers
Provision of brief Evidence Based Treatments
Outcome Monitoring using validated scales
Relapse Prevention and Discharge Planning
Wall Street Journal - Sept 2013
ROI for collaborative depression care:$ 6.50 for each $ 1.00 spent
Patient Encounter
Type
July –December
2018
251 Total BHI/ CCM Encounters
39
53
5
108
46
1
Patient Encounter Type
CC Encounters Therapy - Video Therapy - Phone
Therapy - In Person Psych Reviews
Reimbursement Potential
57% of patients are Medicaid/ Medicare
9% Self-pay
10%
11%
4%
5%
27%
30%
9%2%1%1%
Patient Insurance July '18 thru December '18
Allegiance BenefitPlan Management
BCBS
EBMS
Humana
Medicaid
Medicare
Self-Pay
Tricare
United Healthcare
University of UtahHealth Care
Potential Revenue…. 39 Care Coordination Encounters at 20 minutes
each Billable at $48.60 under CPT Code 99484 = $1895.40 in
revenue
39 Care Coordination Encounters at 60 minutes each Billable at $93.67 under CPT Code 99487 = $3653.13 in
revenue
According to research and professionals in the BHI field a care coordinator that is designated to just Care Coordination services should be able to manage a caseload of 200-250
A Care Coordinator that is working in the clinic rooming patients, refilling medications, doing AWV’s, calling patients etc. should be able to carry a caseload of 50 patients
***50 Care Coordination patients a month for 20 minutes each = 4 hours a week designated to these 50
patients = $2430.00 in revenue***
Care Management Services –Billing, Claims Processing, and
Payment
How do RHCs and FQHCs bill for care management services, and how are they paid?
Care Management Services Billed and Paid
TCM – TCM services furnished on or after January 1, 2013 can be billed by adding CPT code 99495 or CPT code 99496 to an RHC or FQHC claim, either alone or with other payable services.
If it is the only medical service provided on that day with an RHC or FQHC practitioner, it is paid as a stand-alone billable visit.
If it is furnished on the same day as another visit, only one visit is paid
Care Management Services Billed and Paid
CCM – CCM services furnished 1/1/16-12/31/2017, add CPT code 99490 to the claim, either alone or with other payable services.
Payment is based on Physician Fee Schedule (PFS) national average non-facility payment rate for CPT code 99490
Care Management Services Billed and Paid
CCM services furnished after 1/1/2018 can be billed by adding the general care management G code, G0511, either alone or with other payable services
Payment is set annually at the average of the national non-facility PFS payment rate for CPT codes 99490 (20 minutes or more of CCM services)
99487 ( 60 minutes or more of complex CCM services)
99484 (20 minutes or more for general behavioral health integration services)
Care Management Services Billed and Paid
General BHI – general BHI services furnished on or after 1/1/2018, can be billed by adding the general care management G code, G0511, to the claim, either alone or with other payable services.
Payment is set annually at the average of the national non-facility PFS payment rate for: 99490 (20 minutes or more of CCM services)
99487 (60 minutes or more of complex CCM services)
99484 (20 minutes or more of general behavioral health integration services
Care Management Services Billed and Paid
Psychiatric CoCM – Psychiatric CoCM services furnished on or after 1/1/2018 can be billed by adding the psychiatric CoCM G code, G0512, either alone or with other payable services.
Payment is set annually at the average of the national non-facility PFS payment rate for: 99492 (70 minutes or more of initial psychiatric CoCM
Services)
99493 (60 minutes or more of subsequent psychiatric CoCM Services)
TCM (CPT code 99495 or 99496) – Same payment for an RHC or FQHC visit
CCM or General BHI (HCPCS code Go511) - $62.28
Psychiatric CoCM (HCPCS code G0512) - $145.08 To bill for the psychiatric CoCM, the team must include the
RHC or FQHC practitioner, a behavioral health care manager, and a psychiatric consultant.
The Behavioral Health Care Manager must have a minimum of a bachelor’s degree in a behavioral health field (e.g. clinical social work or psychology), or be a clinician with behavioral health training, including RNs & LPNs.
2018 payment rates for care management services
Telehealth Technology Trends
Marshfield ClinicFQHC Prioritized SUD in 2016• Large SUD Program• Using iPads on a Stick
for Telehealth encounters
• MAT initial assessment face to face
• Follow up via Telehealth
Meeting Owl
Logitech Meetup
Panacast 2
Market is moving to web-based videoconferencing
Webcams
Horus II
Total Exam 3
AMD 2600
Exam Cameras
Littman 3200
RNK PCP USD
Thinklab
Various streaming software options at varying price points
Stethoscopes
Eko Duo Core
Bluetooth Stethoscope
Stethoscopes
Basic components Mobile phone
Software “app” for phone
Peripheral medical devices
Centralized server for storing and sharing data
mHealth
Remote Patient Monitoring
• Prevent hospital readmissions
• Monitor patients with chronic conditions
• Blood Pressure, Blood Oxygen, Blood Glucose, Weight
• Various levels of user interaction
Telemedicine Platforms
Mobile and Kiosk Platforms
Imaging, vital signs, patient management
Live and Store and Forward
Augmented Reality
Add digital information to the physical world
View virtual objects in 3 dimensions
Transition to Web/Cloud based services
Less expensive/more consumer based devices
More industry participants
Challenges in keeping older equipment viable
33
Industry Trends
Improved Terrestrial Infrastructure
5G Mobile Networks
Satellite Broadband
34
Infrastructure Technologies
Forces Pulling at Patient Data:
35
Patient Data
Patient Data
EHR
Healthcare
CorporationsInnovators
Patients
Proliferation of Apps
Health and Wellness vs Diagnostic Apps
Role of the FDA
36
Mobile Health Applications
What do we do with all this data?
How can telemedicine care be better delivered to the patient at home?
37
Big Questions
Doris T. Barta, MHA
Director, National Telehealth Technology Assessment Center (TTAC)
406-690-0734
http:telehealthtechnology.org
http:telehealthresourcecenters.org
Contact Information
