Hospitalist telehealth services

Medicare pays for three types of telehealth: telemedicine, virtual check-in, and e-visits.

Prior to the COVID-19 pandemic, Medicare only covered certain services furnished via telehealth, including professional consultations, office medical visits, office psychiatry services, and any additional service specified by the HHS Secretary when furnished via an interactive telecommunications system (known collectively as the Medicare Telehealth List).

Image by Getty Images
Image by Getty Images

Back then, telehealth services were attracting interest in some hospitalist circles, and some studies of telehospitalist models had been published. The most common model involved hospitalists providing remote part- or full-time consultation and coverage for local clinicians in critical access and rural hospitals that were unable to support in-house hospitalists. Naturally, telehospitalist companies sprang up to organize, support, and market these services.

The explosion of telehealth services that came with the COVID-19 pandemic mostly hit outpatient office visits, but some inpatient and observation services were also added temporarily. In some institutions, hospitalists began using telehealth for inpatient and observation encounters to minimize the chances of spreading COVID-19 among patients and hospital staff. This has created an entire new telehealth model for hospitalists, at least for the time being.

Medicare identifies and pays for three types of telehealth services: telemedicine, virtual check-in, and e-visits.

For Medicare telemedicine services, clinicians may use telecommunication technology to provide services that generally occur in person, in all settings including the office and hospital. An interactive audio and video telecommunications system that permits real-time communication between the clinician and the patient is required for reimbursement of hospital televisits.

These visits are considered the same as in-person visits and are paid at the same rate as in-person visits currently (although it's not certain that will continue after the pandemic). Clinicians who can furnish and be paid for covered telehealth services (subject to state law) include physicians, nurse practitioners, physician assistants, nurse midwives, certified nurse anesthetists, clinical psychologists, clinical social workers, registered dietitians, and nutrition professionals.

Telemedicine hospital services that are currently reimbursable include initial inpatient (codes 99221-99223) and observation (codes 99218-99220), subsequent inpatient (codes 99231-99233) and observation (codes 99224-99226), discharge day inpatient (codes 99238, 99239) and observation (code 99217), and same-date observation/inpatient (codes 99234-99236). Currently, reimbursement for all of these, except those for subsequent inpatient care (codes 99231-99233), is authorized temporarily under the Public Health and Medical Emergency Declarations and Waivers for the COVID-19 pandemic. How the duration of the pandemic will be determined remains uncertain. Payment for subsequent inpatient care by telehealth is currently set up to continue beyond the pandemic.

Virtual check-ins are for established Medicare patients at home who initiate a brief communication with a clinician via telephone or exchange of video or image. Patients and physicians who have an established relationship can use a virtual check-in to communicate about subjects not related to a medical visit within the previous seven days that do not lead to a medical visit within the next 24 hours.

E-visits are non-face-to-face, patient-initiated communications with doctors using online patient portals. The clinician must have an established relationship with the patient. The services may be billed using CPT online codes 99421-99423 and HCPCS codes G2061-G2063, as applicable.

Hospitalists would be unlikely to perform virtual check-ins or e-visits as part of their normal care, but these types of telehealth could be relevant if a hospitalist is called upon to follow up with a patient after discharge.