Practice Management Alert

Regulators are scrutinizing your telehealth billing choices.

The official end of the COVID-19-related public health emergency (PHE) means many practices are again finding their footing in terms of complying with local, state, and federal regulations.

Try your knowledge about some inconvenient truths to make sure you know how to remain in compliance.

Myth No. 1: If an established patient is vacationing in another state, a practitioner can legally provide telehealth services, regardless of whether the practitioner is licensed in that state.

Myth busted: At the onset of the COVID-19 PHE, some states allowed physicians to practice beyond the states where they were licensed. Since then, almost all states have relinquished that flexibility.

The physician must be licensed in the state where the patient’s at, and where the physician is at. The regulation doesn’t say they have to be licensed in the state where the patient resides; they must be licensed in the state where the patient is located at the time of the encounter.

“You’re in violation of the law, and basically treating without a license, if you treat a patient via telehealth, whether it be audiovisual or audio-only or any virtual care, if the provider is not licensed in the state where the patient is located,” warns Terry Fletcher, BS, CPC, CCC, CEMC, CCS, CCS-P, CMC, CMCSC, CMCS, ACS-CA, SCP-CA, owner of Terry Fletcher Consulting Inc. and consultant, auditor, educator, author, and podcaster at Code Cast, in Laguna Niguel, California.

When a provider sees patients in other states via telehealth, they should know they are also potentially facing issues with medical malpractice coverage.

Find the rules for your state at this Federation of State Medical Board resource: www.fsmb.org/siteassets/advocacy/pdf/states-waiving-licensure-requirements-for-telehealth-in-response-to-covid-19.pdf.

Myth No. 2: Lab results from a previous visit can count toward an evaluation and management (E/M) visit at a later date.

Myth busted: Fletcher says the CPT^® guidance is clear: “Ordering a test is included in the category of the test results, that’s category 1, and reviewing the results is part of the initial encounter, not a subsequent encounter.”

The guideline is based on the assumption that a person who orders a test will also probably want to review the results, Fletcher says.

However, there is an exception. In a situation where a patient switches providers, and the new provider receives and reviews their previous medical records, calls and tells the patient that they’re going to order some labs or tests to move forward with the patient’s treatment, and then discusses the results when the patient comes in again, the diagnostic review can count toward the subsequent visit.

“Independent test interpretation is completely different than ordering a test and giving a result,” Fletcher explains.

Myth No. 3: Providers can bill 99441 when the patient calls to have a prescription refilled.

Myth busted: The evaluation and management (E/M) service codes 99441-99443 (Telephone evaluation and management service by a physician or other qualified health care professional who may report evaluation and management services provided to an established patient, parent, or guardian not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion) (… 11-20 minutes) (… 21-30 minutes) are replacement for an E/M service where a patient couldn’t come in the office or were not able to participate in an audiovisual encounter.