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Week 1: Defining the Field of Health Informatics

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Week 1: Defining the Field of Health Informatics

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HIT Terms
National Library of Medicine
What an FNP does

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Telehealth Billing for Nurse Practitioners During Covid-19: Policy Updates

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Telehealth Billing for Nurse Practitioners During Covid-19: Policy Updates

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Telehealth is a strategy used to monitor and assist patient care providers with a variety of health care issues. Telehealth can occur in a virtual format using video, audio technology, or a combination of both. Examples of telehealth technologies include live videoconferencing, store-and-forward transmissions, remote patient monitoring, and mobile health (mHealth). Telehealth encounters can occur synchronously in real time such as with live video conferencing. Conversely, telehealth can occur asynchronously and recorded as with remote patient monitoring and store-and-forward transmissions. Based on the type of telehealth encounter, nurse practitioners (NPs) need to have knowledge, skills, and competencies to properly and legally bill for telehealth services. This report provides resources for NPs providing and billing for telehealth services as well as updates on timely and relevant telehealth policy billing issues and updates.

There are multiple definitions of terms related to telehealth, and it is relevant to distinguish between and among them for billing purposes. While these terms are similar, there are subtle differences in definitions that make billing for telehealth services a challenge. It is relevant for NPs to understand terminology related to telehealth and telehealth services to accurately bill for the proper services rendered.

Store-and-forward transmissions involve capturing data, such as a radiology image or report, with future transmission to another source. Today digital images, prerecorded videos, and various documents can be sent via secure and encrypted email correspondence through store-and-forward technology.

The term remote patient monitoring refers to remote collection of point-of-care testing data, home blood glucose, or blood pressure readings to track and manage medical care issues.

Regardless of the method used for telehealth, NPs can provide telehealth care patient services using any of these means and bill for telehealth services.

Many health care providers, including NPs, were searching for strategies and best practices to deliver care in safe, timely, and effective ways as a result of the coronavirus disease 2019 (COVID-19) pandemic beginning in late 2019 and continuing into 2020. In early 2020, President Trump signed the Coronavirus Aid, Relief, and Economic Security (CARES) Act in an effort to broaden implementation of telehealth by health care providers and increase patient access to telehealth services. As a part of the CARES Act and the Paycheck Protection Program and Health Care Enhancement Act, the US Department of Health and Human Services allocated $175 billion to health care providers and hospitals through the Provider Relief Fund to assist providers with care during the COVID-19 pandemic. The Centers for Medicare & Medicaid Services (CMS) additionally broadened access to Medicare telehealth services to beneficiaries not able to travel to a health care provider.

Before the CARES Act and some temporary waivers related to billing, telehealth services were limited to patient care provided in designated rural areas and at originating sites such as offices, hospitals, or other approved medical facilities. In the midst of the pandemic, many people were ordered to shelter in place or elected to self-isolate to avoid the threat of coronavirus. The COVID-19 pandemic created an urgent and compelling need for telehealth services for many different kinds of patient populations and expanded sites. NPs are major providers of diverse patient populations and health care services, and they need to have the knowledge, skills, and competencies to deliver telehealth services and accurately and legally bill for the services.

Summary of Medicare Telemedicine Services

Medicaid-Specific Policy Updates

Another example of a major insurance payers response to COVID-19, is United Health Care's (UHC) published telehealth update allowing providers to bill for services using FaceTime, Skype, Zoom, or similar platforms during the pandemic. Patients wishing to use telehealth services offered specifically by UHC can access urgent care 24/7 through one of the approved platforms, Teladoc, American Well, and Doctor on Demand. During the pandemic and national public health emergency, UHC is waiving any out-of-pocket expenses for COVID-19 testing, visits, or treatments, regardless of the site choice of office, emergency department, urgent care, or telehealth.

Requirements for encrypted software meeting HIPAA guidelines were relaxed at the beginning of the pandemic in March 2020, but most Blue Cross plans may again be requiring encrypted software for telehealth reimbursement as of October 1, 2020. Additionally, Blue Cross now requires written telehealth policies and patient signatures authorizing the use of telehealth with care.

It is important to note that the recent changes made by private insurers regarding telehealth services and billing are subject to change, but there is no indication at what point this will occur. Most insurance carriers waive copayments and deductibles using International Classification of Diseases, 10th Revision, codes U07.1, COVID-19 diagnosis; Z03.818, an encounter for observation for suspected exposure to other biologic agents ruled out; or Z20.828, contact with and (suspected) exposure to other viral communicable diseases.

It appears the current changes to telehealth legislation will be in existence for federal as well as private third-party insurers until at least December 31, 2020. The only exception to this date for current changes lies with Medicare, Medicaid, and some Medicare Advantage plans. For example, Medicare states "until sunset," but this term has yet to be defined or interpreted. Effective dates may be extended due to ongoing COVID-19 status. NPs should check with the payer's website for updates to effective dates or changes. Additional state-specific plans may have other guidelines that NPs need to follow for billing.

The Center for Connected Health Policy (CCHP), a national telehealth policy resource center, outlines further policies affected by the COVID-19 pandemic. Examples of Medicare policies changes noted on the website include end-stage renal disease and home dialysis billing guidelines as well as nursing home and hospice care waived requirements for telehealth billing. Other topics are discussed, including frequency limitations for in-patient visits, subsequent skilled nursing facility and critical care consults, Stark Law waivers, and out-of-pocket co-pay waivers are discussed. Services included but not limited to interprofessional telephone, internet, or electronic health record consultations (eConsult), remote monitoring services, and online digital evaluation (E-Visit) remain unchanged.

The CCHP website contains current state laws and reimbursement policies related to telehealth. Another resource, the Regional Telehealth Resource Centers, serves 12 geographic regions in the US and can provide further information about state-specific reimbursement policies. For example, the Southeast Region serves Alabama, Georgia, South Carolina, and Florida and allows providers to view tools and resources, CMS waivers and billing guidance, and links to courses on telehealth presenting, telehealth coordination, and telehealth liaison. The CCHP website provides links to regional telehealth centers as well as further information on legislative updates. Table 2 provides a summary of these resource as well as other helpful websites, links, and information on telehealth services and policy updates.

Many factors may affect whether telehealth is available or used in certain areas. Among patient-reported barriers to the use of telehealth are competency in use of technology, fear of identity theft, potential threats to independence and self-care, as well as possible disruption to services.

For example, patients indicate barriers to telehealth use may include NPs and other health care providers being less likely to advocate for patient needs and wishes. In federally funded health centers, the location of services, operational factors, patient demographics, and reimbursement policies all influence the use of telehealth.

For example, because federally funded health care centers are often in rural areas, technical issues were reported as a challenge to telehealth implementation. Telehealth is actually not new, but because of legislation, it has not been used by many NPs unless they practiced in areas where telehealth was legally allowable.

Rural health centers are more likely to report miscellaneous technical issues. Examples include inadequate space, inadequate providers and partners, and broadband equipment issues.

Efforts to adopt telehealth services present challenges for the elderly. Currently little information is published about the impact of the COVID-19 pandemic on telehealth adoption in the elderly. Known barriers documented in the literature include lack of special skills to operate equipment, potential threat to identity, and concerns that interventions could undermine self-care and coping.

Because telehealth is becoming more widely used and accepted by insurance payers, NPs in multiple specialties can now begin to use simple technology to provide cost-effective health care to patients. Telehealth is valuable not only to providers in primary care but also for NPs working in mental health performing psychiatric mental health counseling and treatment. Resources to assist NPs with reimbursement can be found on various sites as noted in Table 2. Further information regarding billing summaries for common payers can be found in Table 3. One of the main differences in the policy changes during COVID-19 is the implementation of audio-only codes in addition to visual codes. A second difference is relaxation of the requirement for secure HIPAA-compliant video platforms. Thirdly, the originating site of services definition was expanded as previously mentioned.

Telehealth implementation is becoming a fast-growing means for delivering health care. NPs are in a favorable position to use current technology to support the needs of patients. They are also uniquely stationed to advocate for expansion of the APRN Compact to allow multistate licensure and impact the care of patients in many geographic areas. It is imperative that NPs review the Nurse Practice Act for the state where they practice. NPs should always review state-specific resources related to policy, current legislation, and billing guidelines to develop a solid plan for implementing telemedicine into the practice site.

Implications for Practice

Implications for Education

Implications for Research

The COVID-19 pandemic provided the impetus and facilitated several timely and relevant telehealth legislative changes. Many resources are now available to assist NPs to accurately and legally bill for telehealth services. Baseline knowledge of skills and competencies related to telehealth billing are key concepts for all NPs desiring to provide care in a remote fashion. Keeping abreast of key telehealth policies further supports telehealth billing practices.

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Telehealth Billing for Nurse Practitioners During COVID-19: Policy Updates

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Telehealth is a growing valuable strategy to assist patients accessing needed care when unable to get to a health care setting for one of several reasons. During the coronavirus disease 2019 (COVID-19) pandemic of 2020, many health care practices were forced to implement telehealth services to meet patient and practice needs.

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Ways Electronic Health Records Will Continue to Improve in 2021

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Electronic Health Record (EHR) is an electronically stored collection of patient-related information. Progress in the proliferation of screening tests, medical imaging, and diagnostics have produced a plethora of data on patient health.

There are ways to share information across numerous healthcare networks, for instance, providing the ability to offer a greater level of healthcare based on the ease of information availability and collection, to medical professionals.

Electronic health record systems are a perfect solution for better patient care. These days as more patient data is getting digital and an increasing number of consumers are aspiring to have mobile access to health records, the role of EHR is improving and digitizing in healthcare .

In general, the EHR features and framework has constantly been perceived as a surefire method of improving medical care frameworks.

In this article we will talk about the EHR implementation challenges over the years, benefits of electronic health records, and how technology is helping to overcome the issue for the year 2021.

Based on expert opinions, here's what the future holds for electronic medical record systems and trends in 2021 and beyond:

A report by medical economics stated that 87% of physicians are known to be using an EMR system or EHR system.

According to the dashboard of HealthIT.gov , nearly 83% of physicians were using EHRs in the United States by December 31, 2014.

Another stated that people spend $117,672 every year on EHRs, that if compared, is nearly $31,710 more than their limit.

With the facts and statistics stated above, it's evident that EHRs are expected to improve even more in 2021 for both providers and patients. But there are still some limitations that are being faced in the current situation.

Current Challenges of Electronic Health Records

With the healthcare sector moving towards technology in a fast-paced movement, it also needs to be aware of the risks associated with it. History is a witness for incidences where these types of technologies became prone to hackers because of being exposed to the internet without any security mechanism. Despite all the potential benefits that it provides, physicians still have a hard time adopting EHRs.

Physician Burnout

EHRs contribute to the burnout of physicians because of their hard-to-understand user interface. There's a significant amount of time required to feed the data in EHR systems. Due to this, physicians don't get enough time to work on communication with patients.

As a result, the quality of patient care is decreased and physicians also experience more stress and lower job satisfaction. Moreover, in multiple instances, EHRs are also said to be a financial burden on both the providers and practitioners.

Interoperability

Interoperability is described as the capability of EHR softwares to provide data and information to other devices so that multiple users can make use of it.

There are a number of issues standing in front of the complete adoption of interoperability in the healthcare sector -

The issues ripple down to the EHR systems as well where challenges implementing electronic health records becomes a big problem because of a lack of interoperability between disparate systems. To get a complete picture of a patient's medical history, it is imperative for the systems to communicate efficiently with each other.

Communication of data in an EHR often gets delayed because of insufficient interoperability inside segments of a similar EHR or from the EHR to a different system. There can be cases such as where clinicians couldn't get to labs for an emergency or a hospital patient from records held in a different part of the hospital.

It remains an immense test for healthcare app development company providers to build an interoperable framework that enables the exchange of data among multiple providers.

Technology As a Boon for Improvement of EHR System

There are many factors that are affecting the adoption and EHR usability in hospitals and medical care practices.

Apart from technical issues like interoperability, the main concern comes from the issue of privacy and confidentiality and a lack of health information data standards. Technology is changing the face and future of (EHR) electronic health records domain through automation and data storage and usage.

Let's see the numerous ways in which the effects of EHR are expected to improve in 2021

1. Combining EHR With Artificial Intelligence and Voice Recognition

Voice recognition technology is a great asset for EHR systems as it helps clinicians to enter information and patient data hands free. It reduces inaccuracy and errors by dictating records in EHR which further speeds up the information recording process.

2. Making More Informed Care Decisions with Predictive Analysis

The healthcare industry is also influenced highly by the predictive analytics application. From impacting cancer treatments to optimizing emergency staffing, predictive analytics technology is being used in a wide range of applications and will soon be adopted even more.

Specific healthcare app development services use AI-powered analytic methods such as statistics, data mining, and modeling in compliance with AI to provide clinical outcome predictions based on real-time device data and EHR to enhance the patient experience and care delivery.

The NorthShore University Health System has already developed a Predictive Engine for Clinical Analytics that works with the EHR system to provide more actionable information to clinicians about the patients in 2018. Known popularly as CAPE, the project uses critical information such as admission histories, lab results, and vital signs to generate a risk score for patients that helps in determining their likelihood of suffering from cardiac arrest.

3. Preparing Extensively for the 5G Network

It's a no-brainer that the 5G network will capture the major share of the healthcare market in the future. There are several infrastructural updates going on in many residential areas to check the performance of the network.

However, not all the preparations are dependent on EHR optimizations. For example, there's a 5G network tower installed in the Rush University Medical Centre of Chicago just because it didn't want to manage the outdated wiring.

The scope for 5G in the healthcare sector is immense with offerings like real-time data monitoring, telemedicines and so forth. That is why people are looking out for the best healthcare app developers to enable better healthcare delivery.

The preparations for the arrival of the 5G network are expected to pace up very shortly. As it happens, the authorities also need to determine in what way it will affect EHR and several other aspects of patient care.

4. Moving to the Mobile and Cloud

As you may already know that the major benefit of having an EHR system in place is the ease of accessibility of patient data, it completely makes sense that the data will become more complex as the population rises.

It's evident that EHRs have already come a long way in the industry. However, there's still a lot more to achieve and the future holds numerous benefits for electronic health record systems.

Healthcare mobile app developers will be soon seen using the model of value-based health care to answer How to Prepare for EHR Optimization. Do you have an idea around betterment of EHR process and making it future-proof? Share it with our business consultants.

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Ways Electronic Health Records Will Continue to Improve in 2021

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Electronic Health Record (EHR) is an electronically stored collection of patient-related information. Progress in the proliferation of screening tests, medical imaging, and diagnostics have produced a plethora of data on patient health. There are ways to share information across numerous healthcare networks, for instance, providing the ability to offer a greater level of healthcare based on the ease of information availability and collection, to medical professionals.