Wiki Telemedicine - can someone clarify?

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Jessim929

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Forgive me if this question has been asked already, I couldn't find anything definitive. I have never worked for a practice that's even entertained the idea of telemedicine, so it's brand new to me. :)

Everything I'm reading on telemedicine (from Medicare and Medicaid) indicates that it's primarily for "underserved rural areas". Does this mean that it's for when a patient is in a hospital or PCP office in the middle of nowhere and needs a specialist to consult on their case and that's how the specialist is brought in rather than one of them having to make the trip to wherever? Or if the doctor is on call for a local facility and gets "dialed in" (for lack of a better term) rather than rushing over to the hospital? Or is it for a patient after hours who has a minor ailment that can be addressed without making them wait for the next business day to physically come into the office?

I would imagine that in the the instance of the first two scenarios, all the elements of the E&M could be hit because it'd be almost a collaborative effort, right? (the practitioner who's physically with the patient does the exam) But in the last scenario - the after hours patient - it really could never be higher than a 99213 because it would be a limited physical exam.

Do I have the right idea on this or am I not even in the right ballpark?

Thanks!
 
If you have read the Medicare rules for Telemedicine you will see that the patient must be located in a qualifying rural area and be in a qualifying originating site such as a hospital or a physician clinic. The distant site provider must be one of eight qualified provider types but they can be in any specialty.
It was a program set up to be able to provide necessary health services to those located in the rural setting. however the patient cannot be in their home or work. Medicare will pay for this service when it is used properly. there are a number of states that have state laws mandating commercial carrier cover this service as well. I have read where some state that different states have different rules on the place of service however I do not know this to be truth. I would make sure you get any individual payer rules in writing or go by Medicare until you have something different.
there is no requirement that a provider at the originating perform any exam or that there even be a provider in the room. The patient must just be in the originating site. The originating site fee pays only approximately $24 so there is not an expectation that much work and effort be expended at the originating site.
 
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