TeleHealth Setup for athenaPractice

This is a Step-by-Step Guide on how to set up the appropriate features in athenaPractice to facilitate TeleHealth billing and reporting without needing to create additional facilities. Configuration occurs in both the Practice Management and EHR administration as described herein.

General

In this model of TeleHealth setup, it does not include the build of additional Facilities and Locations of care. Other than Providers selecting the appropriate CPT codes, this setup will create minimal workflow change as staff will not be required to log into TeleHealth specific locations of care.

Practice Management Setup The setup needed in practice management allows health centers to bill for TeleHealth visits as

well as track and report on them throughout the revenue cycle process. These

recommendations take into consideration that many procedures may not be billable at the time

of service but could become reimbursable in the future.

The general steps needed to properly configure athenaPractice are:

1. Establish TeleHealth Department Codes

2. Create Place of Service Codes

3. Create Procedure Modifiers

4. Load Procedure Codes

5. Create Internal Procedure Codes

6. Create Internal Tracking Codes

7. Setup EDI Plugins

Establish TeleHealth Department Codes

Establishing TeleHealth departments is important for reporting and grouping procedures. While

this is not a requirement for reimbursement, it is highly recommended for managing the

TeleHealth revenue cycle.

Financial Folder > Department

• TeleDentistry

• TeleMedicine

• TelePsych

Creating Place of Service Codes

A place of service (POS) code shows the location where the provider renders services and is

required when billing charges. Some payers may implement POS rules differently than

Medicaid; therefore, always check your payer’s documentation to ensure that you are using the

correct POS code.

Claims > EDI > Place of Service

• 02 - TeleHealth

Create Procedure Modifiers

Procedure modifiers play an important role in the reimbursement process for TeleHealth visits.

While CMS defines a standard set of modifiers to be used in reimbursement, payers across the

nation have differing requirements for how to use them. The guidance below is based on the

CMS standard and can safely be added to any athenaPractice system without causing harm.

The rules for using them will vary state by state and payer by payer.

The modifiers are managed in the athenaPractice Administration module.

Codes > Billing System > Modifiers

• Description (include modifier in the description)

• NSF Code (enter modifier only)

TeleHealth Modifiers

• 95 - Synchronous telemedicine service rendered via a real-time interactive audio

and video telecommunications system

• GT - Via interactive audio and video telecommunications systems

• GQ - Via an asynchronous telecommunications system

• G0 (zero) - Used to identify TeleHealth services furnished for purposes of

diagnosis, evaluation, or treatment of symptoms of an acute stroke.

Note: Be sure to add any other modifiers that may be Carrier Specific.

Load Procedure Codes

You can pull a subset of available codes from this master database. However, we recommend

reviewing your State TeleHealth guidelines and only loading codes for which you will be

providing services for.

Note: Loading more codes than are needed creates unnecessary slowness in the practice

management system. Loading only codes that are used by a health center provides optimal

performance for reporting and system usage.

The procedures are managed in the athenaPractice Administration module.

Codes > Billing System > Load HCPCS and CPT Codes

• CPT Code

• Department

• Procedure Code Qualifier (assign appropriate qualifier based on service)

• Assign Specialty

Create Internal Procedure Codes

Once the standard CPT Codes are loaded, we recommend that health centers create a set of

internal codes for TeleHealth based on their normal procedure codes. This setup allows health

centers to meet various Carrier specific filing requirements. Such as setting up modifiers and

place of service codes on specific fee schedules. If any codes should be repeated, this setup

will differentiate a face to face encounter from a telehealth encounter.

An example of this would be:

• 99213 becomes 99213TEL for TeleHealth visits.

Note: Once a procedure has been established, the fee schedule section will need to be

completed for each. This will require fee information in addition to any payer specific rules.

The procedures are managed in the athenaPractice Administration module.

Charge Maintenance > Procedures > New Procedure > Information Tab

• Copy description from correct CPT Code

• Create New CPT Code ▪ Code (add the ‘TEL’ or ‘TH’ suffix) ▪ CPT Code (this should be the true CPT and not the internal code) ▪ UDS Qualifier (assign appropriate qualifier based on service) ▪ Description (paste copied description from true CPT code) ▪ Department ▪ Assign Specialty (this can be done via the ‘Assign new Specialties'

function for versions CPS 12 and above or using Active Report)

Procedure > Fee Schedules Tab

Fee Schedules tab contains information on all fee schedules associated with the

procedure.

• Fee

• Allowed

• CPT Code (this will be the true CPT and not the internal code created)

• Revenue Code (some carriers may require specific revenue codes e.g. Home

0522)

• Contract Type

• Place of Service (this is only needed if specific carriers require a different place

of service other than your facilities e.g. POS 02 – TeleHealth)

Note: If specific Insurance Carriers requires the place of service 02, this will need to be added to

the carriers specific Fee Schedule. The Visualutions plugin will then override the facility’s place

of service and report CLM 02. Without the plugins, it will pull the claim level POS from the

facility and not from the procedure fee schedule. The customer must be on the latest VisEDI

install 1.6.37 and load the latest plugins that we have updated.

Create Internal Tracking Codes

This feature is completely optional to the health center and has no impact on the filing or

reimbursement of a claim. An internal tracking code allows each visit to get tagged with a

common procedure code that can be used in reporting to isolate all TeleHealth visits. The

process that is followed will mimic the previous step, except all procedure codes will receive a

$0.00 fee and not be filed electronically.

An example of an internal tracking code would be COVID19TEL. This code could be attached

to all visits that require providers to treat patients using TeleHealth methods during the current

COVID-19 Pandemic.

Charge Maintenance > Procedures > New Procedure > Information Tab

• Create New CPT Code ▪ Code – COVID19TEL or COVID19TH ▪ CPT – COVID19TEL or COVID19TH ▪ Qualifier – Health Care Financing Administration ▪ Description ▪ Department

▪ Assign Specialty (this can be done via the ‘Assign new Specialties'

function for versions CPS 12 and above or using the Active Report)

Procedure > Fee Schedules Tab

• Fee - $0

• Allowed - $0 • Contract Type NF (no file)

NOTE: If using a contract type of NF for the purposes of tracking only, the health center

must be using the Visualutions Approval plugin for any impacted visits. If you find that

the NF code is getting placed on claims, check the approval processor that was used to

approve the visit.

Setup EDI Plugins

This new setting for TeleHealth claims allows the customers to continue utilizing current

provider fee schedules and facilities. It will report the correct Place of Service at the Claim Level

in the outbound file. This will prevent the need to create multiple Facilities and Providers

changing their Location of Care. The new logic checks to see if any procedure on the visit has a

telehealth place of service 02. When any procedure with this place of service is detected, the

new logic will report the CLM POS with ‘02’.

An example would be when filing CMS1500 claims. The VisClaims Professional PI plugin

setting will need to have the box checked ‘If line level POS = 02 replace CLM POS with 02’.

Insurance > Insurance Carriers > Select Carrier > EDI Tab > Claim Creator Plugin

Settings

All Payer (1) > Loop 2300 Settings Section

• Check Box: If line level POS = 02 replace CLM POS with 02

Note: Without the plugins, it will pull the claim level POS from the facility and not from the

procedure fee schedule. The customer must be on the latest VisEDI install 1.6.37 and load the

latest plugins that we have updated. Visualutions Revenue Cycle Management Customers can

skip this step, as our team will work with your IT department to install and complete.

EHR Setup

The following section describes the steps needed to create a service code and link it back to the

billing codes that were setup in the practice management system. If this setup is not completed

in conjunction with the practice management setup codes will not transfer between EHR and

PM.

• Create Service Codes

Create Service Codes

A service is created for procedures that are performed and billed by the organization. This table

will allow providers to create an order that will then cross over into Billing.

Codes > Charts > Codes and Categories > Services

• TeleDentistry

• TeleMedicine

• TelePsych

Associated Order > New > Find CPT Code > Add Code > Change Code

Create Modifiers Codes

A service is created for procedures that are performed and billed by the organization. This table

will allow providers to create an order that will then cross over into Billing.

Codes > Charts > Clinical Modifiers

• 95 - Synchronous telemedicine service rendered via a real-time interactive audio

and video telecommunications system

• GT - Via interactive audio and video telecommunications systems

• GQ - Via an asynchronous telecommunications system

• G0 (zero) - Used to identify TeleHealth services furnished for purposes of

diagnosis, evaluation, or treatment of symptoms of an acute stroke.

Note: Be sure to add any other modifiers that may be Carrier Specific.

Customer Specific EHR Setup

The following sections are very site specific and health centers may opt to utilize the following

features of athenaPractice EMR to better present TeleHealth services to their providers.

• Create Order Sets

• Create an Order Custom List

• Create Quick Text

Create Order Sets

Order Sets are a grouping of related order codes that can be named and added to an orders

custom list. For example, a TeleMedicine set can include orders for an office visit, labs and a

referral. When the order set is selected, the individual orders in that set are automatically

checked.

Codes > Charts > Order

• TeleDentistry

• TeleMedicine

• TelePsych

Associated Order Set > New > Order Type

Create an Order Custom List

*Please note: Your organization may choose to add the other order set(s) to existing custom

lists, or, you may choose to create another order customer list.

Custom lists can contain a combination of services, referrals, and tests and procedures. Custom

lists can only include orders that have already been set up in the application. These also be

associated to a specific Encounter Type.

Codes > Charts > Order Custom List > Order

• TeleDentistry

• TeleMedicine

• TelePsych

Create Order Set > Code > Order Set (use Header to separate order sets)