Medicare Virtual Visits

FQHC & RHC Telehealth Reimbursement – Updated for 2022 Medicare Virtual Visits

Lesson 3 of 6

Let’s say you’re providing services that are not equivalent to a face-to-face visit and will not be able to bill for telehealth as a distant site… What other choices do you have available? Let’s explore the following options!

Virtual Check-Ins

Virtual Check-Ins are billed with code G0071.

These interactions are patient initiated telephone or live video interactions. They involve a physician or non-physician practitioner having a brief, at least 5 minute, check-in with a patient to assess whether the patient needs to come in for an office visit. The practitioner may respond to the patient’s concern by telephone, audio/video, secure text messaging, email, or use of a patient portal.

The virtual check-in must be for a condition not related to an E/M service provided within the previous 7 days and does not lead to an E/M service or procedure within the next 24 hours or soonest available appointment.

There are no frequency limitations at this time.

Billable providers are physicians, nurse practitioners, physician assistants, certified nurse midwives, clinical psychologists, and clinical social workers. If the discussion could be conducted by a nurse, health educator, or other clinical personnel, it would not be billable as a virtual communication service.

A medical professional taking a young patient's vitals to demonstrate how telehealth can improve health care workforce retention.

E-Visits

E-visits are billed with code G0071.

E-visits are patient-initiated digital communications via an online patient portal that requires a clinical decision that otherwise typically would have been provided in the office.

Billable provider spends at least five or more minutes over the course of seven days providing online E/M services. Seven days must lapse before you bill G0071 again for the same condition.

Includes multiple digital visits over the course of seven days if for related signs/symptoms/conditions.

Remote Evaluation Services – Store & Forward

Remote Evaluation Services are billed with code G0071.

Remote evaluation services are patient initiated and consist of a practitioner evaluating a patient’s transmitted information via pre-recorded video or image. The practitioner may respond to the patient’s concern by telephone, audio/video, secure text messaging, email, or use of a patient portal.

The services can only be billed if the condition is not related to a service provided within the previous 7 days and does not lead to a service provided within the next 24 hours or soonest available appointment.

There are no frequency limitations at this time.

Billable by physicians, nurse practitioners, physician assistants, certified nurse midwives, clinical psychologists, and clinical social workers. If the discussion could be conducted by a nurse, health educator, or other clinical personnel, it would not be billable as a virtual communication service.

For more information on Remote Evaluation Services, click HERE.

Billing the G0071

Use a UB 04 claim form

- - RHC Type Of Bill 711
  - FQHC Type Of Bill 771

Assign revenue code 0521

No modifier is required

For the emergency period effective Jan 1, 2022, CMS will pay $23.88. See here.

Consent for Medicare Services

A verbal patient consent is required for all Virtual Visits (Virtual Check-Ins, e-visits, and Remote Evaluation).

Consent can be obtained at the time that the service is furnished or prior to the service being furnished during the emergency period.

Consent may be obtained by ancillary staff under the general supervision of the RHC or FQHC provider.

A Note About Video Platforms

The federal Office of Civil Rights (OCR) has temporarily relaxed its enforcement standards during this national emergency to allow covered health care providers to use video technologies that do not fully comply with HIPAA rules. These include non-public facing “popular” video products such FaceTime or Skype.
Health care providers choosing to use these products a required to inform patients that there may be privacy risks and obtain consent.
Health care providers seeking more privacy for patients should consider products that use encryption and tools such as passcodes to restrict the session, and vendors that will sign HIPAA Business Associates Agreements (BAAs) in connection with their video solutions.