Duane C. Abbey

Telemedicine: Coding, Billing and Compliance

Presenter : Duane C. Abbey, PhD
Event Date : 05/23/2019
Duration : 90 Minutes



Product Description

Telemedicine services continue to grow both in volume and breadth of coverage. Much of the guidance for telemedicine or telehealth services comes from the Medicare program and changes occur almost every year.  Hospitals large and small participate in telemedicine services although in different capacities. Making certain that all the rules and regulations are faithfully followed can be challenging.  While the Medicare program has many rules and regulations in this area, private third-party payers tend to be more liberal in reimbursing for these types of services. The recently enacted 21st Century Cures Act direct CMS to expand telemedicine services. Remote robotic surgery is on the horizon. Medicare Advantage programs are being given more latitude in what they can include relative to telemedicine. Hospitals, clinics and physicians must regularly update policies and procedures in this area to keep current as the technology continues to outstrip payment and compliance issues.

  • How is telemedicine supposed to work?
  • Why is the terminology so confusing?
  • What is the difference between telemedicine and telehealth?
  • Who is involved in telemedicine?
  • Who is allowed to provide telemedicine services?
  • How are telemedicine services paid under the Medicare program?
  • What do hospitals, CAHs and clinics need to do in order to bill for telemedicine services?
  • Is there anything special about RHCs (Rural Health Clinics)?
  • Are there any compliance issues for telemedicine?
  • How do private third-party payers view telemedicine and telehealth services?
  • How will the 21st Century Cures Act impact telemedicine and telehealth?
  • What will Medicare Advantage programs do with increase latitude for the provision of telemedincine?

Session Objectives:

  1. To understand the general concept of telemedicine and how it works.
  2. To appreciate the underlying technology and advancements that allow telemedicine services to work.
  3. To understand the special terminology used in telemedicine.
  4. To review the current Medicare rules and regulations surrounding telemedicine services.
  5. To understand special requirements for physicians and practitioners.
  6. To appreciate how to code, bill and the reimbursement process for telemedicine services under the Medicare program.
  7. To appreciate clinical and billing privileges surrounding telemedicine.
  8. To review changes in credentialing for physicians providing telehealth services.
  9. To review changes in coverage and types of services that can be provided through telemedicine.
  10. To assess unusual requirements for different providers relative to telemedicine services.
  11. To discuss how private third-party payers view telemedicine.
  12. To review the new latitude that Medicare Advantage programs have in the telemedicine area.
  13. To review the 21st Century Cures Act relative to telemedicine.
  14. To assess future changes for telemedicine particularly with Medicare.

Session Agenda:

  1. Overview
    1. Telemedicine Services
    2. Telehealth Services
    3. General Process
    4. Review of Terminology
    5. Current Legislation – 21st Century Cures Act
  2. Underlying Technologies
    1. Interactive Communications
    2. Electronic Monitoring
    3. Remote Robotic Services
  3. Clinical Issues of Telemedicine
    1. Physicians
    2. Non-Physician Practitioners
    3. Consultation Services
  4. Updating Telemedicine
    1. What services can be provided?
    2. Who can provide services?
    3. Where can services be provided?
    4. New Place-Of-Service (POS) Code
  5. Coding, Billing and Reimbursement Issues
    1. Coding and Claims Filing Requirements
    2. Special Codes and Modifiers
    3. Distant Site Consideration
    4. Originating Site Considerations
    5. Medicare Payment Process and Rates
    6. Special Considerations for CAHs and RHCs
  6. Compliance Issues for Telemedicine
    1. Credentialing for Telemedicine Providers
    2. Incident-To Services
    3. Telepresenters
  7. Private Payer View of Telemedicine Services
    1. More Liberal Usage
    2. Cost Savings Perspective
    3. Medicare Advantage Latitude
  8. Congressional Action Relative to Telehealth
    1. 21st Century Cures Act – Section
    2. Proposed CONNECT Act
  9. Future of Telemedicine -Rapid Technological Change
  10. Sources for Further Information
Related Courses:

Suggested Attendees:

  • Hospital/CAH Case Management and Utilization Review Personnel
  • Hospital/CAH Coding Personnel
  • Billing and Claims Transaction Personnel
  • Nursing Staff
  • Outpatient Service Area Personnel
  • Chargemaster Coordinators
  • Financial Analysts
  • Compliance Personnel
  • Physicians
  • Non-Physician Practitioners
  • Other Interested Personnel

About the Presenter:

Duane C. Abbey, PhD, CFP, is a management consultant and president of Abbey & Abbey Consultants, Inc., a consulting firm specializing in healthcare and related areas. Duane earned his graduate degrees at the University of Notre Dame and Iowa State University and has more than 20 years of experience as a consultant. Dr. Abbey works extensively in all areas relating to compliance reviews, coding, billing and reimbursement with particular emphasis on the chargemaster and outpatient payment. His consulting activities include hospitals and physicians based clinics.

In addition to his consulting practice, Dr. Abbey also teaches workshops and makes presentations on a regular basis. He has taught at the University level and speaks nationally. He is a regular presenter for hospital associations, medical societies, Boards of Trustees and various other organizations and groups. In addition, professional societies such as HFMA use Dr. Abbey’s services to present seminars and workshops.

Dr. Abbey is a nationally recognized expert in payment systems. A special area of expertise includes APGs/APCs. He is recognized as the leading expert in the nation in APGs/APCs by the thousands who have attended his seminars, read his publications and/or contracted for his services. Attendees at these seminars over the years have included personnel from hospitals, clinics, integrated delivery systems and multiple consulting firms.

Dr. Abbey is also the author of numerous articles and books including: Compliance for Coding, Billing & Reimbursement, Outpatient Services: Designing, Organizing & Managing Outpatient Resources, ChargeMaster: Review Strategies for Improved Billing and Reimbursement, Ambulatory Patient Group Operations Manual, published by McGraw-Hill and Non-Physician Providers: Guide to Coding, Billing & Reimbursement, Chargemasters: Strategies to Ensure Accurate Reimbursement and Compliance, and Emergency Department Coding & Billing: A Guide to Reimbursement & Compliance published.

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