Modernizing the approach to Psychiatry: Telehealth and Telemedicine

There has been a vast rise in the use of Telemedicine in healthcare since the pandemic hit the world in 2020.Telemedicine is now a part of a hybrid approach to delivery of healthcare services and will be continuously used since the gap between patients and doctors has been bridged allowing easier access to healthcare without sacrificing comfort.Telemedicine not only allows easy doctor-to-patient interaction but also, is beneficial to doctor-to-doctor or any health worker involved.Psychiatry is one of the disciplines of medicine that has been able to utilize its benefits fully in doing patient consultations.

Telehealth and Telemedicine

telehealth and telemedicine

Telehealth and Telemedicine are sometimes used interchangeably by most people but in reality, these two are different. Telehealth is a broader term used to any approach that aims to bring health in all aspects to people. Telemedicine, however, is under telehealth and pertains to the actual provision of medical services to those who need it. Other terms are used to describe this approach but basically have the same meaning such as electronic Health (eHealth), virtual health, virtual care, remote care and even online medicine. Telehealth’s purpose is broad and can be used by different industrial groups in society. It can be used to deliver health education purposes, online training, data collection, public health information and information sharing.

There are different modalities that this can be brought to the target population. A provider or an educator can use as simple as a google form for patient or participant registration or a more complicated software available for each encounter. Live videos are used in telehealth and are very useful in telemedicine. They are very direct in what they do, for example, a provider may schedule a live video chat to a patient to do his assessments online and may refer to another specialist for a second opinion using that video.

Remote patient monitoring is another modality that physicians use in chronic care management such as in cases of hypertension, cardiac conditions and diabetes. Clinic devices are now revolutionized to transmit data directly to the physician’s end to monitor their health status. Examples of these are the glucometers, blood pressure cuffs, EKG + stethoscope and weighing scales that are able to send information to the providers. An Apple watch is a wearable device that tracks the daily activities of a person and can help the provider manage the patient since it can track heart rate and how mobile a person is in a day.

The Use of Telemedicine in Psychiatry during the Pandemic

Covid 19 has definitely sped up the transition of medicine into the digital world. In just a matter of days, the world was forced into resiliency and embraced technology even by the most reluctant ones. My RCM Group was no exception during this time and quickly adapted to these changes, being one of the backbones in maintaining workflow orders in its partner clinic and health facilities.

Digital platform businesses boomed overnight as the need for their services increased and completely became a part of the new normal. To make matters clear, the words “Social distancing” were corrected and were changed to “Physical distancing”. People weren’t advised to become a social shut in but rather told to just maintain a physical “aloofness” to strangers that they don’t know and even to those that know,a certain physical safe space should be maintained. Live video calling and meetings were used to keep daily work activities running. Education did not stop as online teaching became a tool during this time. Parties, concerts and live performances by various artists were also delivered in an online set up.

In Medicine, psychiatric consultations in office clinics saw this adjustment doable and with the vast and increasing impact of the pandemic on the mental health of population, the doctors knew that no time needs to be wasted and they need to be on their toes to keep up with the changes. In a survey conducted by the American Psychiatric Association last 2021, 64% of its member respondents were seeing 0% of their caseload using telehealth approach. However as of January 2021, 81% of respondents indicated that they continue to see between 75 – 100% of patients via telehealth, with 39% reporting that they have transitioned back to seeing at least some patients in-person (67% reported seeing between 1 – 25% of patients in-person). This survey proved the continuous use of telehealth by psychiatrists in managing their patients and patient satisfaction did not falter since the patients were mostly at the comfort of their own home or preferred location during consultation.

Medical Billing in Telepsychiatry

Reimbursements in telepsychiatry are done by the usual medical billers and coders but often times, they encounter terms that are almost exclusive to telemedicine only.

Originating Site

Pertains to the place where the patient was at the time of the teleconsultation. Medicare limits this to both the geographical area and the specific location of the patient when telemedicine wa delivered. Medicare recognizes these locations as:

  • Any county outside the Metropolitan State Area

  • A Rural Health Professional Shortage Area (HPSA) in a rural census act

  • From an entity that participates in a federal telemedicine demonstration project approved by the Secretary of HHS as of Dec. 31, 2000; and

In a specific eligible site

    • Physician and practitioner offices

    • Hospitals

    • Critical Access Hospitals (CAHs)

    • Rural Health Clinics

    • Federally Qualified Health Centers

    • Hospital-based or CAH-based Renal Dialysis Centers (including satellites)

    • Skilled Nursing Facilities (SNFs)

    • Community Mental Health Centers (CMHCs)

    • Renal Dialysis Facilities

    • Homes of beneficiaries with End-Stage Renal Disease (ESRD) getting home dialysis

    • Mobile Stroke Units

Distant Site

This is where the provider is when the telehealth took place. Medicare does not really define distant locations but due to the Medicare Act ban on foreign payments, a provider should not be physically out of the United States if he should perform telehealth services.

It must always be remembered that a telehealth consultation is always as good as a physical, face-to-face consultation therefore when it comes to coding and billing almost the same process and level of attention to details will apply.

My RCM Group caters to providers of mental health with its highly capable staff. We handle the medical billing and coding processes with our partner providers and keep in constant communication with them and insurance companies to ensure and verify patient eligibility. As partners of providers, we assist stand-alone office clinics or any health facility in managing daily workloads beginning from patient encounters to claim submissions and reimbursements and even cleaning up your accounts receivables

References: 2022BillingGuidefinal.pdf ( Psychiatrists Use of Telepsychiatry During COVID-19 Public Health Emergency

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