Medicare Coverage of Telehealth Services: Presentation to ... to... · Presentation to Florida...

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Medicare Coverage of Telehealth Services: Presentation to Florida Telehealth Advisory Council January 17, 2017

Nathaniel Lacktman Partner, Foley & Lardner, LLP

Chair of Telemedicine and Virtual Care Practice [email protected]

www.foley.com/nlacktman

Report to Florida Telehealth Advisory Council ………………………………………………………………………………………………. Page 1 Medicare Telehealth Fact Sheet …………………………………………………..……………………………………………………………… Page 4 Foley Blog …………………………………………………………………………………………………………………………………………………… Page 10 Medicare Covered Telehealth Codes ……………………………………………………………………………………………………………. Page 14 MM9726 ……………………………………………………………………………………………………………………………………………………. Page 17 Medicare Coverage of Telehealth Services PowerPoint …………………………………………………………………………………. 0 Nathaniel M. Lacktman Resume ………………………………………………………………………………………………………………….. Page 27

Table of Contents

Medicare Coverage of Telehealth Services Medicare does cover telehealth services, but is currently very limited, and the definitions and restrictions are established in statute by Congress.1 For eligible telehealth services, the use of a telecommunications system is a substitute for an in-person encounter (e.g., it satisfies the “face-to-face” element of an E/M service).

In general, Medicare imposes five conditions of coverage on telehealth services:

1. The beneficiary is located in a qualifying ruralarea at the time of the consult;

2. The beneficiary is located at one of eightqualifying facilities (“originating sites”) at thetime of the consult;

3. The telehealth services are provided by one often professionals eligible to furnish andreceive Medicare payment for telehealthservices (“distant site practitioners”);

4. The beneficiary and distant site practitionercommunicate via an interactive audio andvideo telecommunications system that permitsreal-time communication between thebeneficiary and the distant site provider; and

5. The CPT/HCPCS (Current ProceduralTerminology/Healthcare Common ProcedureCoding System) code for the service itself isnamed on the CY2016 (or current year) list ofcovered Medicare telehealth services.

In order to bill Medicare for telehealth services, the provider must fully comply with each of the telehealth requirements. If the telehealth arrangement does not meet each of these above requirements, the service is statutorily non-covered, and the Medicare program will

1 See Section 1834(m)(4)(F) of the Social Security Act; 42 CFR 410.78(f); CMS Pub. 100-02, Medicare Benefit Policy Manual, Ch. 15 section 270.2; CMS Pub. 100-04, Medicare Claims Processing Manual, Ch. 12 section 190.3.

not pay for the service.2 To certify each of these elements have been met, the distant site practitioner must add the GT modifier when billing the claim (the practitioner adds the GQ modifier for asynchronous services in Alaska and Hawaii).

1. Rural Geographic RestrictionsUnder the Medicare conditions of payment for telehealth services, the patient must be located at a qualifying originating site (in a rural Health Care Professional Shortage Area (HPSA) outside a Metropolitan Statistical Area (MSA) or in a rural census tract, or a county outside of a MSA). This effectively renders facilities located in urban areas unable to qualify as an originating site and therefore ineligible for Medicare coverage of services to beneficiaries via telehealth. Entities participating in a Federal telehealth demonstration project approved by or receiving funding from the Secretary of Health and Human Services as of December 31, 2000, qualify as originating sites regardless of geographic location. Such entities are not required to be in a rural HPSA or non MSA. Recognizing the confusion and limitation this restriction has generated, HHS created a website where a beneficiary or provider can enter a zip code and determine whether or not the geographic location is potentially eligible for Medicare coverage of telehealth services. It is called the “Medicare Telehealth Payment Eligibility Analyzer.”3

2. Originating Site RestrictionsNot only must the beneficiary be located in a qualifying rural area at the time of the consult, the beneficiary must be located at one of eight qualifying originating sites. Eligible originating sites are:

2 See Section 1834(m)(4)(F) of the Social Security Act; 42 CFR 410.78(f); CMS Pub. 100-02, Medicare Benefit Policy Manual, Ch. 15 section 270.2; CMS Pub. 100-04, Medicare Claims Processing Manual, Ch. 12 section 190.3.

3 Available at http://datawarehouse.hrsa.gov/tools/analyzers/geo/Telehealth.aspx.

Report to Florida Telehealth Advisory Council

Presentation to Florida Telehealth Advisory Council (Page 1)

» Offices of a Physician or Practitioner;» Hospitals;» Critical Access Hospitals;» Community Mental Health Centers;» Skilled Nursing Facilities;» Rural Health Clinics;» Federally Qualified Health Centers; and» Hospital-Based or Critical Access Hospital (CAH)-

Based Renal Dialysis Centers (includingsatellites).4

If a beneficiary receives telehealth services while at his or her home, those telehealth services are not covered by Medicare.5 Many patients choose telehealth services for the convenience and access it offers as an alternative to driving to a practitioner’s office and sitting in the waiting room. Accordingly, many telehealth offerings are built around making the services available to patients “on-demand” at their home, workplace, or in the evenings. These services would not be covered by Medicare because a beneficiary located at home is not at one of the eight qualifying originating sites.

Note, effective January 1, 2017, providers must now use POS code 02 on Medicare claims to designate the service was delivered via telehealth. This code is required in addition to the GT modifier, and the beneficiary must still be located in a qualifying rural area and at a qualifying originating site.6

3. Eligible Distant Site PractitionersEven if the first two requirements are met, and the beneficiary is located at an eligible rural area and a qualifying originating site, the services themselves must be provided by a qualified distant site practitioner eligible to furnish and receive Medicare payment for telehealth services. Eligible distant site practitioners are:

» Physicians;» Nurse practitioners (NPs);» Physician assistants (PAs);» Nurse-midwives;» Clinical nurse specialists (CNSs);» Certified registered nurse anesthetists;

4 See CMS’ MLN “Telehealth Services” for CY 2016 (Dec 2015). 5 Id.; see also, e.g., Noridian Telehealth Services Q&A No. 6 (rev. May

29, 2015) (noting that POS Code 12: home is ineligible for payment).

6 See MLN Matters MM9726; Change Request 9726 (Aug 12, 2016)

» Clinical psychologists (CPs) and clinical socialworkers (CSWs) (although CPs and CSWs cannotbill for psychiatric diagnostic interviewexaminations with medical services or medicalevaluation and management services underMedicare); and

» Registered dietitians or nutrition professionals.7

This list of ten eligible practitioners is defined by statute.8 If a beneficiary receives telehealth services from a practitioner other than those listed above, the service is not covered by Medicare. Many patients enjoy telehealth services from other practitioners or specialty providers (e.g., RNs, occupational therapists, physical therapists). Currently, services provided by such professionals would not be covered by Medicare because that distant site practitioner is not among the ten listed types.

4. Eligible Telecommunications TechnologyThe Medicare coverage rules require the beneficiary and distant site practitioner to communicate via an interactive audio and video telecommunications system that permits real-time communication between the beneficiary and the distant site provider.9 This means the practitioner may not use audio-only, store and forward, or other message-based communications if the services are to be covered by Medicare. There is a minor exception allowing asynchronous store and forward technology in Federal telehealth demonstration programs in Alaska or Hawaii.

5. Eligible CPT/HCPCS CodesFinally, the service itself must be listed among the eligible CPT/HCPCS codes CMS publishes each year as covered telehealth services. In CY 2016, there were approximately 37 covered services (with approximately 50 associated codes). Unless a service is listed among the approved service codes for telehealth services, Medicare will not cover the service if provided via telehealth.10

The result of Medicare’s restrictive telehealth law has been narrow coverage and few claims submitted. For

7 See CMS’ MLN “Telehealth Services” for CY 2016 (Dec 2015). 8 See Section 1834(m)(4)(E) of the Social Security Act. 9 See 42 CFR 410.78(a)(3). 10 See Section 1834(m)(4)(F) of the Social Security Act; 42 CFR

410.78(f); CMS Pub. 100-02, Medicare Benefit Policy Manual, Ch. 15 section 270.2; Medicare Claims Processing Manual, Ch. 12 section 190.3.


example, in CY 2015, Medicare paid a total of $17.6 million for telehealth service claims, compared to an overall $600 billion Medicare program budget. At the same time, patient demand for the convenience and access to care offered by telehealth services has created a willingness for patients (including Medicare beneficiaries) to self-pay out of pocket to enjoy the benefits of these new technologies.11

11 Note: coverage rules for Medicare Advantage plans and Medicaid Managed Care organizations are notably more flexible than traditional Medicare. These plans are encouraged to develop new and innovative ways to provide care, and are generally subject to fewer restrictions on coverage of telehealth services.


DEPARTMENT OF HEALTH AND HUMAN SERVICESCenters for Medicare & Medicaid Services

Telehealth ServicesRURAL HEALTH SERIES

ICN 901705 December 2015

To Print a Text-Only VersionTo Print a Text-Only Version

Please note: The information in this publication appliesonly to the Medicare Fee-For-Service Program (also known as Original Medicare).

This publication provides the following information on calendar year (CY) 2016 Medicare telehealth services:

�Originating sites;�Distant site practitioners;�Telehealth services;�Billing and payment for professional services

furnished via telehealth;�Billing and payment for the originating site facility fee;�Resources; and� Lists of helpful websites and Regional Office Rural

Health Coordinators.

When “you” is used in this publication, we are referring to physicians or practitioners at the distant site.

Medicare pays for a limited number of Part B servicesfurnished by a physician or practitioner to an eligiblebeneficiary via a telecommunications system. Foreligible telehealth services, the use of a telecommunications system substitutes for an in-person encounter.

CPT only copyright 2015 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association. Applicable FARS\DFARS Restrictions Apply to Government Use. Feeschedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

ORIGINATING SITESAn originating site is the location of an eligible Medicarebeneficiary at the time the service furnished via atelecommunications system occurs. Medicare beneficiaries are eligible for telehealth services only if they are presented from an originating site located in:

�A rural Health Professional Shortage Area (HPSA)located either outside of a Metropolitan StatisticalArea (MSA) or in a rural census tract; or

�A county outside of a MSA.


2 Telehealth Services

The Health Resources and Services Administration (HRSA) determines HPSAs, and the United States (U.S.) Census Bureau determines MSAs. You can access HRSA’s Medicare Telehealth Payment Eligibility Analyzer to determine a potential originating site’s eligibility for Medicare telehealth payment at http://datawarehouse.hrsa.gov/telehealthAdvisor/telehealthEligibility.aspx on the HRSA website.

Entities that participate in a Federal telemedicine demonstration project approved by (or receiving fundingfrom) the Secretary of the U.S. Department of Health & Human Services as of December 31, 2000, qualify as originating sites regardless of geographic location.

Each CY, the geographic eligibility of an originating siteis established based on the status of the area as ofDecember 31st of the prior CY. Such eligibility continuesfor the full CY.

The originating sites authorized by law are:

�The offices of physicians or practitioners;�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); and�Community Mental Health Centers (CMHCs).

Note: Independent Renal Dialysis Facilities are noteligible originating sites.

DISTANT SITE PRACTITIONERSPractitioners at the distant site who may furnish and receive payment for covered telehealth services (subject to State law) are:

�Physicians;�Nurse practitioners (NPs);�Physician assistants (PAs);�Nurse-midwives;�Clinical nurse specialists (CNSs);�Certified registered nurse anesthetists;

�Clinical psychologists (CPs) and clinical socialworkers (CSWs). CPs and CSWs cannot bill forpsychiatric diagnostic interview examinations withmedical services or medical evaluation andmanagement services under Medicare. Thesepractitioners may not bill or receive payment forCurrent Procedural Terminology (CPT) codes90792, 90833, 90836, and 90838; and

�Registered dietitians or nutrition professionals.

TELEHEALTH SERVICESAs a condition of payment, you must use an interactiveaudio and video telecommunications system that permitsreal-time communication between you, at the distant site, and the beneficiary, at the originating site. Asynchronous “store and forward” technology is permittedonly in Federal telemedicine demonstration programs in Alaska or Hawaii.

The chart on pages 3–4 provides the CY 2016 list of Medicare telehealth services.

CPT only copyright 2015 American Medical Association. All rights reserved.



CY 2016 Medicare Telehealth Services

Service Healthcare Common Procedure Coding System (HCPCS)/CPT Code

Telehealth consultations, emergency department or initial inpatient HCPCS codes G0425–G0427

Follow-up inpatient telehealth consultations furnished to beneficiaries in hospitals or SNFs

HCPCS codes G0406–G0408

Office or other outpatient visits CPT codes 99201–99215

Subsequent hospital care services, with the limitation of 1 telehealth visit every 3 days

CPT codes 99231–99233

Subsequent nursing facility care services, with the limitation of 1 telehealth visit every 30 days

CPT codes 99307–99310

Individual and group kidney disease education services HCPCS codes G0420 and G0421

Individual and group diabetes self-management training services, with a minimum of 1 hour of in-person instruction to be furnished in the initialyear training period to ensure effective injection training

HCPCS codes G0108 and G0109

Individual and group health and behavior assessment and intervention CPT codes 96150–96154

Individual psychotherapy CPT codes 90832–90834 and 90836–90838

Telehealth Pharmacologic Management HCPCS code G0459

Psychiatric diagnostic interview examination CPT codes 90791 and 90792

End-Stage Renal Disease (ESRD)-related services included in the monthly capitation payment

CPT codes 90951, 90952, 90954, 90955, 90957, 90958, 90960, and 90961

End-Stage Renal Disease (ESRD)-related services for home dialysis per full month, for patients younger than 2 years of age to includemonitoring for the adequacy of nutrition, assessment of growth anddevelopment, and counseling of parents (effective for services furnished on and after January 1, 2016)

CPT code 90963

End-Stage Renal Disease (ESRD)-related services for home dialysis per full month, for patients 2-11 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents (effective for services furnished on and after January 1, 2016)

CPT code 90964

End-Stage Renal Disease (ESRD)-related services for home dialysis per full month, for patients 12-19 years of age to include monitoring for the adequacy of nutrition, assessment of growth and development, and counseling of parents (effective for services furnished on and after January 1, 2016)

CPT code 90965

End-Stage Renal Disease (ESRD)-related services for home dialysis per full month, for patients 20 years of age and older (effective for services furnished on and after January 1, 2016)

CPT code 90966

Individual and group medical nutrition therapy HCPCS code G0270 and CPT codes 97802–97804

Neurobehavioral status examination CPT code 96116

Smoking cessation services HCPCS codes G0436 and G0437 and CPT codes 99406 and 99407

Alcohol and/or substance (other than tobacco) abuse structured assessment and intervention services

HCPCS codes G0396 and G0397

Annual alcohol misuse screening, 15 minutes HCPCS code G0442

Brief face-to-face behavioral counseling for alcohol misuse, 15 minutes HCPCS code G0443



Telehealth Services4

CY 2016 Medicare Telehealth Services (cont.)

Service Healthcare Common Procedure Coding System (HCPCS)/CPT Code

Annual depression screening, 15 minutes HCPCS code G0444

High-intensity behavioral counseling to prevent sexually transmitted infection; face-to-face, individual, includes: education, skills training and guidance on how to change sexual behavior; performed semi-annually, 30 minutes

HCPCS code G0445

Annual, face-to-face intensive behavioral therapy for cardiovascular disease, individual, 15 minutes

HCPCS code G0446

Face-to-face behavioral counseling for obesity, 15 minutes HCPCS code G0447

Transitional care management services with moderate medical decision complexity (face-to-face visit within 14 days of discharge)

CPT code 99495

Transitional care management services with high medical decision complexity (face-to-face visit within 7 days of discharge)

CPT code 99496

Psychoanalysis CPT codes 90845

Family psychotherapy (without the patient present) CPT code 90846

Family psychotherapy (conjoint psychotherapy) (with patient present) CPT code 90847

Prolonged service in the office or other outpatient setting requiring direct patient contact beyond the usual service; first hour

CPT code 99354

Prolonged service in the office or other outpatient setting requiring direct patient contact beyond the usual service; each additional 30 minutes

CPT code 99355

Prolonged service in the inpatient or observation setting requiring unit/floor time beyond the usual service; first hour (list separately in addition to code for inpatient evaluation and management service) (effective for services furnished on and after January 1, 2016)

CPT code 99356

Prolonged service in the inpatient or observation setting requiring unit/floor time beyond the usual service; each additional 30 minutes (list separately in addition to code for prolonged service) (effective for services furnished on and after January 1, 2016)

CPT code 99357

Annual Wellness Visit, includes a personalized prevention plan of service (PPPS) first visit

HCPCS code G0438

Annual Wellness Visit, includes a personalized prevention plan of service (PPPS) subsequent visit

HCPCS code G0439

For ESRD-related services, a physician, NP, PA, or CNS must furnish at least one “hands on” visit (not telehealth)each month to examine the vascular access site.

BILLING AND PAYMENT FOR PROFESSIONAL SERVICES FURNISHED VIA TELEHEALTHSubmit claims for telehealth services using the appropriate CPT or HCPCS code for the professional service along with the telehealth modifier GT, “via interactive audio and video telecommunications systems” (for example,99201 GT). By coding and billing the GT modifier with a covered telehealth procedure code, you are certifying that the beneficiary was present at an eligible originating site when you furnished the telehealth service. By codingand billing the GT modifier with a covered ESRD-related service telehealth code, you are certifying that you furnished one “hands on” visit per month to examine the vascular access site.



Telehealth Services5

For Federal telemedicine demonstration programs in Alaska or Hawaii, submit claims using the appropriate CPT or HCPCS code for the professional service along with the telehealth modifier GQ if you performed telehealth services “via an asynchronous telecommunications system” (for example, 99201 GQ). By coding and billing the GQ modifier, you are certifying that the asynchronous medical file was collected and transmitted to you at the distant site from a Federal telemedicine demonstration project conducted in Alaska or Hawaii.

You should bill the Medicare Administrative Contractor (MAC) for covered telehealth services. Medicare pays you the appropriate amount under the Medicare Physician Fee Schedule (PFS) for telehealth services. When you are located in a CAH and reassigned your billing rights to a CAH that elected the Optional Payment Method, the CAH bills the MAC for telehealth services and the payment amount is 80 percent of the Medicare PFS for telehealth services.

BILLING AND PAYMENT FOR THE ORIGINATING SITE FACILITY FEEOriginating sites are paid an originating site facility fee for telehealth services as described by HCPCS code Q3014.Bill the MAC for the originating site facility fee, which is a separately billable Part B payment.

Note: When a CMHC serves as an originating site, the originating site facility fee does not count toward the number of services used to determine payment for partial hospitalization services.

RESOURCESThe chart below provides telehealth services resource information.

Telehealth Services Resources

For More Information About… Resource

Telehealth Services https://www.cms.gov/Medicare/Medicare-General-Information/Telehealth on the Centers for Medicare & Medicaid Services (CMS) website

Chapter 15 of the “Medicare Benefit Policy Manual” (Publication 100-02) on the CMS website

Chapter 12 of the “Medicare Claims Processing Manual” (Publication 100-04) on the CMS website

Health Professional Shortage Areas Medicare Learning Network® (MLN) publication titled “Health Professional Shortage Area (HPSA) Physician Bonus, HPSA Surgical Incentive Payment, and Primary Care Incentive Payment Programs” on the CMS website

All Available MLN Products “MLN Catalog” on the CMS website

Provider-Specific Medicare Information MLN publication titled “MLN Guided Pathways: Provider Specific Medicare Resources” on the CMS website

Medicare Information for Beneficiaries https://www.medicare.gov on the CMS website




HELPFUL WEBSITESAmerican Hospital Association Rural Health Carehttp://www.aha.org/advocacy-issues/rural

Critical Access Hospitals Centerhttps://www.cms.gov/Center/Provider-Type/Critical-Access-Hospitals-Center.html

Disproportionate Share Hospitalshttps://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/dsh.html

Federally Qualified Health Centers Centerhttps://www.cms.gov/Center/Provider-Type/Federally-Qualified-Health-Centers-FQHC-Center.html

Health Resources and Services Administrationhttp://www.hrsa.gov

Hospital Centerhttps://www.cms.gov/Center/Provider-Type/Hospital-Center.html

Medicare Learning Network®http://go.cms.gov/MLNGenInfo

National Association of Community Health Centershttp://www.nachc.org

National Association of Rural Health Clinicshttp://narhc.org

National Rural Health Associationhttp://www.ruralhealthweb.org

Rural Health Clinics Centerhttps://www.cms.gov/Center/Provider-Type/Rural-Health-Clinics-Center.html

Rural Health Information Hubhttps://www.ruralhealthinfo.org

Swing Bed Providershttps://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/SNFPPS/SwingBed.html

Telehealthhttps://www.cms.gov/Medicare/Medicare-General-Information/Telehealth

U.S. Census Bureauhttp://www.census.gov

REGIONAL OFFICE RURAL HEALTH COORDINATORSTo find contact information for CMS Regional Office Rural Health Coordinators who provide technical, policy, and operational assistance on rural health issues, refer to https://www.cms.gov/Outreach-and-Education/Outreach/Open DoorForums/Downloads/CMSRuralHealthCoordinators.pdf on the CMS website.

The Medicare Learning Network® Disclaimers are available at http://go.cms.gov/Disclaimer-MLN-Product on the CMS website.

The Medicare Learning Network®, MLN Connects®, and MLN Matters® are registered trademarks of the U.S. Department of Health & Human Services (HHS).

Check out CMS on:


1/612017 Medicare Payments for Telehealth Increased 25% in 2015: What You Need to Know I Health Care Law Today

:FOLEY FOLEY&. LARDNt:R LLP

Health Care Law Today

https://www.healthcarelawtoday.com

Medicare Payments for Telehealth Increased 25% in

2015: What You Need to Know

POSTED BY NATHANIEL M. LACKTMAN ON 3 MARCH 2016

POSTED IN REIMBURSEMENTS; TELEMEDICINE

More good news on the telehealth

reimbursement front: CMS reported its total

2015 payments for telehealth services under

the Medicare program and it was a 25%

increase over last year. This reflects how

providers are successfully integrating

telehealth services into their traditional health

care delivery approaches, and are better

realizing payment opportunities both within the

Medicare FFS program and in other sources of

revenue. We have written and advocated

extensively on ways providers can (and

should) look beyond solely Medicare to drive the financial growth of their telehealth

offerings. It is encouraging to see more providers taking the time to understand the

reimbursement opportunities and submit covered claims for payment.

Let's break down the numbers. In CY 2015, Medicare paid a total of $17,601,996 for

telehealth services, spread across a total of 271,877 claims. This includes payments to

distant site providers and originating site payments. Compare this to last year, in which

Medicare paid a total of $13,934,430 for telehealth services, spread across a total of

214,346 claims. The result: 2015 saw a 27% increase in the number of Medicare FFS

telehealth services claims submitted and a 25% increase in total payments. And this

uptick in total payments is not attributable to reimbursement increases, but rather to more

providers using telehealth services with their traditional Medicare FFS beneficiaries. This is

particularly true with claims for professional services by distant site providers, which has

seen the largest uptick in claims volume.

. ,


Code Short Descriptor Code Short Descriptor

90791 Psych diagnostic evaluation 90791 Psych diagnostic evaluation

90792 Psych diag eval w/med srvcs 90792 Psych diag eval w/med srvcs

90832 Psytx pt&/family 30 minutes 90832 Psytx pt&/family 30 minutes

90833 Psytx pt&/fam w/e&m 30 min 90833 Psytx pt&/fam w/e&m 30 min





90845 Psychoanalysis 90845 Psychoanalysis

90846 Family psytx w/o patient 90846 Family psytx w/o patient

90847 Family psytx w/patient 90847 Family psytx w/patient

90951 Esrd serv 4 visits p mo <2yr 90951 Esrd serv 4 visits p mo <2yr

90952 Esrd serv 2-3 vsts p mo <2yr 90952 Esrd serv 2-3 vsts p mo <2yr

90954 Esrd serv 4 vsts p mo 2-11 90954 Esrd serv 4 vsts p mo 2-11

90955 Esrd srv 2-3 vsts p mo 2-11 90955 Esrd srv 2-3 vsts p mo 2-11

90957 Esrd srv 4 vsts p mo 12-19 90957 Esrd srv 4 vsts p mo 12-19

90958 Esrd srv 2-3 vsts p mo 12-19 90958 Esrd srv 2-3 vsts p mo 12-19

90960 Esrd srv 4 visits p mo 20+ 90960 Esrd srv 4 visits p mo 20+

90961 Esrd srv 2-3 vsts p mo 20+ 90961 Esrd srv 2-3 vsts p mo 20+

90963 Esrd home pt serv p mo <2yrs 90963 Esrd home pt serv p mo <2yrs

90964 Esrd home pt serv p mo 2-11 90964 Esrd home pt serv p mo 2-11

90965 Esrd home pt serv p mo 12-19 90965 Esrd home pt serv p mo 12-19

90966 Esrd home pt serv p mo 20+ 90966 Esrd home pt serv p mo 20+

96116 Neurobehavioral status exam 90967 Esrd home pt serv p day <2

96150 Assess hlth/behave init 90968 Esrd home pt serv p day 2-11

96151 Assess hlth/behave subseq 90969 Esrd home pt serv p day 12-19

96152 Intervene hlth/behave indiv 90970 Esrd home pt serv p day 20+

96153 Intervene hlth/behave group 96116 Neurobehavioral status exam

96154 Interv hlth/behav fam w/pt 96150 Assess hlth/behave init

97802 Medical nutrition indiv in 96151 Assess hlth/behave subseq

97803 Med nutrition indiv subseq 96152 Intervene hlth/behave indiv

CY 2016

COVERED TELEHEALTH SERVICES

CY 2017

COVERED TELEHEALTH SERVICES


97804 Medical nutrition group 96153 Intervene hlth/behave group

99201 Office/outpatient visit new 96154 Interv hlth/behav fam w/pt

99202 Office/outpatient visit new 97802 Medical nutrition indiv in

99203 Office/outpatient visit new 97803 Med nutrition indiv subseq

99204 Office/outpatient visit new 97804 Medical nutrition group

99205 Office/outpatient visit new 99201 Office/outpatient visit new

99211 Office/outpatient visit est 99202 Office/outpatient visit new




99215 Office/outpatient visit est 99211 Office/outpatient visit est

99231 Subsequent hospital care 99212 Office/outpatient visit est



99307 Nursing fac care subseq 99215 Office/outpatient visit est

99308 Nursing fac care subseq 99231 Subsequent hospital care



99354 Prolonged service office 99307 Nursing fac care subseq

99355 Prolonged service office 99308 Nursing fac care subseq

99356 Prolonged service inpatient 99309 Nursing fac care subseq

99357 Prolonged service inpatient 99310 Nursing fac care subseq

99406 Behav chng smoking 3-10 min 99354 Prolonged service office

99407 Behav chng smoking > 10 min 99355 Prolonged service office

99495 Trans care mgmt 14 day disch 99356 Prolonged service inpatient

99496 Trans care mgmt 7 day disch 99357 Prolonged service inpatient

G0108 Diab manage trn per indiv 99406 Behav chng smoking 3-10 min

G0109 Diab manage trn ind/group 99407 Behav chng smoking > 10 min

G0270 Mnt subs tx for change dx 99495 Trans care mgmt 14 day disch

G0396 Alcohol/subs interv 15-30mn 99496 Trans care mgmt 7 day disch

G0397 Alcohol/subs interv >30 min 99497 Advncd care plan 30 min

G0406 Inpt/tele follow up 15 99498 Advncd are plan addl 30 min

G0407 Inpt/tele follow up 25 G0108 Diab manage trn per indiv

G0408 Inpt/tele follow up 35 G0109 Diab manage trn ind/group


G0420 Ed svc ckd ind per session G0270 Mnt subs tx for change dx

G0421 Ed svc ckd grp per session G0396 Alcohol/subs interv 15-30mn

G0425 Inpt/ed teleconsult30 G0397 Alcohol/subs interv >30 min

G0426 Inpt/ed teleconsult50 G0406 Inpt/tele follow up 15

G0427 Inpt/ed teleconsult70 G0407 Inpt/tele follow up 25

G0436 Tobacco-use counsel 3-10 min G0408 Inpt/tele follow up 35

G0437 Tobacco-use counsel>10min G0420 Ed svc ckd ind per session

G0438 Ppps, initial visit G0421 Ed svc ckd grp per session

G0439 Ppps, subseq visit G0425 Inpt/ed teleconsult30

G0442 Annual alcohol screen 15 min G0426 Inpt/ed teleconsult50

G0443 Brief alcohol misuse counsel G0427 Inpt/ed teleconsult70

G0444 Depression screen annual G0438 Ppps, initial visit

G0445 High inten beh couns std 30m G0439 Ppps, subseq visit

G0446 Intens behave ther cardio dx G0442 Annual alcohol screen 15 min

G0447 Behavior counsel obesity 15m G0443 Brief alcohol misuse counsel

G0459 Telehealth inpt pharm mgmt G0444 Depression screen annual

G0445 High inten beh couns std 30m

G0446 Intens behave ther cardio dx

G0447 Behavior counsel obesity 15m

G0459 Telehealth inpt pharm mgmt

G0508 Telehealt con initial ccare

G0509 Telehealt con subseq ccare


DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services

MLN Matters® Number: MM9726 Related Change Request (CR) #: CR 9726

Effective Date: January 1, 2017 - Under the Health Insurance Portability and Accountability Act of 1996

Related CR Release Date: August 12, 2016 (HIPAA), the effective date for nonmedical data code sets, of which the POS code set is one, is the code set in effect the date the transaction is initiated. It is not date of service.

Related CR Transmittal #: R3586CP Implementation Date: January 3, 2017

New Place of Service (POS) Code for Telehealth and Distant Site Payment Policy

Provider Types Affected

This MLN Matters® Article is intended for physicians, other practitioners, and suppliers submitting claims to Medicare Administrative Contractors (MACs) for services provided to Medicare beneficiaries.

Provider Action Needed

CR 9726 updates the Place of Service (POS) code set by creating a new code (POS 02) for Telehealth services, effective January 1, 2017. You should ensure that your billing staffs are aware of this new POS code.

Background

As an entity covered under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), Medicare must comply with standards, and their implementation guides, adopted by regulation under this statute. The currently adopted professional implementation guide for the ASC X12N 837 standard requires that each electronic claim transaction include a Place of Service (POS) code from the POS code set that the Centers for Medicare & Medicaid Services (CMS) maintains. The POS code set provides setting information necessary to appropriately pay Medicare and Medicaid claims.


As a payer, Medicare must be able to recognize, as valid, any valid code from the POS code set that appears on the HIPAA standard claim transaction. Further, unless prohibited by national policy to the contrary, Medicare not only recognizes such codes, but also adjudicates claims that contain these codes. At times, Medicaid has had a greater need for code specificity than has Medicare; and many of the new codes, over the past few years, have been developed to meet Medicaid’s needs. While Medicare does not always need this greater specificity in order to appropriately pay claims, it nevertheless adjudicates claims with the new codes to ease coordination of benefits and to give Medicaid and other payers the setting information they require. Effective January 1, 2017, CMS is creating a new POS code 02 for use by the physician or practitioner furnishing telehealth services from a distant site. CR 9726 updates the current POS code set by adding this new code (POS 02: Telehealth), with a descriptor of “The location where health services and health related services are provided or received, through telecommunication technology.” Medicare will pay for these services using the Medicare Physician Fee Schedule (MPFS), including the use of the MPFS facility rate for Method II Critical Access Hospitals billing on type of bill 85x. This Telehealth POS code would not apply to originating site facilities billing a facility fee.

Remember that under HIPAA, the effective date for nonmedical data code sets, of which the POS code set is one, is the code set in effect the date the transaction is initiated. It is not date of service. Modifiers GT (via interactive audio and video telecommunications systems) and GQ (via an asynchronous telecommunications system) are still required when billing for Medicare Telehealth services. If you bill for Telehealth services with POS code 02, but without the GT or GQ modifier, your MAC will deny the service with the following messages:

• Group Code CO• Claim Adjustment Reason Code (CARC) 4 (The procedure code is inconsistent with

the modifier used or a required modifier is missing. Note: Refer to the 835Healthcare Policy Identification Segment (loop 2110 Service Payment InformationREF), if present)

• Remittance Advice Remarks Code (RARC) MA130 (Your claim containsincomplete and/or invalid information, and no appeal rights are afforded because theclaim is unprocessable. Please submit a new claim with the complete/correctinformation)

Conversely, if you bill for Telehealth services with modifiers GT or GQ, but without POS code 02, your MAC will deny the service with the following messages:

• Group Code CO


• CARC 5 (The procedure code/bill type is inconsistent with the place of service.Note: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 ServicePayment Information REF), if present)

• RARC M77 (Missing/incomplete/invalid/inappropriate place of service)

Additional Information

The official instruction, CR9726, issued to your MAC regarding this change is available at https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/R3586CP.pdf. If you have any questions, please contact your MAC at their toll-free number. That number is available at https://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/Review-Contractor-Directory-Interactive-Map/.

Disclaimer This article was prepared as a service to the public and is not intended to grant rights or impose obligations. This article may contain references or links to statutes, regulations, or other policy materials. The information provided is only intended to be a general summary. It is not intended to take the place of either the written law or regulations. We encourage readers to review the specific statutes, regulations and other interpretive materials for a full and accurate statement of their contents. CPT only copyright 2015 American Medical Association. All rights reserved.


©2015 Foley & Lardner LLP • Attorney Advertising • Prior results do not guarantee a similar outcome • Models used are not clients but may be representative of clients • 321 N. Clark Street, Suite 2800, Chicago, IL 60654 • 312.832.4500

Florida Telehealth Advisory Council

Medicare Coverage of Telehealth Services


©2015 Foley & Lardner LLP

Five Conditions for Coverage

■ Patient in a qualifying rural area■ Patient at one of eight qualifying facilities (“originating

site”)■ Service provided by one of ten eligible professionals

(“distant site practitioner”)■ Technology is real-time audio-video (interactive audio and

video telecommunications system that permits real-timecommunication between the beneficiary and the distantsite provider)

■ The service is among the list of CPT/HCPCS codes coveredby Medicare



Telehealth Has Not Been a “Budget Buster”

■ In 2001, the Congressional Budget Office estimated itwould cost the Medicare program $150 million ($30million a year) to cover telehealth services from 2001through 2005

■ Reality, during those first five years, Medicare paid a totalof $3,103,912 for telehealth services

■ CY 2014: Medicare paid a total of $13,934,430 fortelehealth services (214,346 claims)

■ CY 2015: Medicare paid a total of $17,601,996 fortelehealth services (271,877 claims)

■ Total Medicare telehealth payments to date (2001-2015):$75,460,785

■ Medicare annual budget: $600 BillionPresentation to Florida Telehealth Advisory Council (Page 22)


Continued Bipartisan Federal Efforts to Expand Telehealth Coverage

■ Medicare Telehealth Parity Act■ Telehealth Enhancement Act■ Telehealth Modernization Act■ Telehealth Innovation and Improvement Act■ CONNECT for Health Act■ 21st Century Cures Act



Nathaniel Lacktman Foley & Lardner LLP 813.225.4127 [email protected] www.foley.com/nlacktman

News & Resources www.foley.com/telemedicine www.healthcarelawtoday.com

@Lacktman

Speaker Contact


PARTNER

[email protected]

813.225.4127 100 NORTH TAMPA STREET SUITE 2700 TAMPA, FL 33602-5810

Nathaniel (Nate) Lacktman is a partner and health care lawyer with Foley & Lardner LLP. His practice focuses on health care compliance and strategic counseling, with a particular emphasis on telemedicine and telehealth. Mr. Lacktman is listed in 2013, 2014 and 2015 Chambers USA: America’s Leading Business Lawyers, which says,

Clients are effusive in their praise, with one saying, 'I would describe Nate as the regulatory guidance expert.'

He is the chief legal counsel to the Telehealth Association of Florida and co-chairs the Telemedicine and eHealth Affinity Group of the American Health Lawyers Association. A true believer in health innovation, he is a frequent author and speaker on telehealth thought leadership, and is an active member of the American Telemedicine Association. Mr. Lacktman is a Certified Compliance & Ethics Professional (CCEP).

Telemedicine, Telehealth, Virtual Care Mr. Lacktman advises a number of clients – including hospitals, health systems, clinics, pharmacies, physician groups, and start-ups – on the emerging opportunities and regulatory issues presented by telemedicine and telehealth. He has advised clients on the following representative telemedicine matters:

» Strategic counsel for multistate licensure and scopeof practice issues for direct-to-patient, peer-to-peer,and remote monitoring telemedicine businessmodels. Issues include cross-border compliance,patient consent, practitioner licensure, use ofphysician extenders, application of telemedicine toconsultation exception and call/coveragearrangements, ability to provide telemedicineconsults without a prior in-person examination, abilityto issue prescriptions following telemedicine consults(controlled substances vs. other prescriptions), andassociated recordkeeping requirements.

Nathaniel M. Lacktman


Nathaniel M. Lacktman

» Multistate statutes, pending legislation, and strategicadvocacy regarding commercial payor coverage oftelemedicine services, including any limitations onscope and reimbursement rates.

» Corporate practice of medicine analysis andcompliance considerations for virtual care physicianservices across the country.

» Internet pharmacies and federal and staterequirements for remote prescribing.

» E-prescribing practices and application of e-prescribing to telemedicine consults.

» Teleradiology and telepathology arrangements andassociated licensure and Medicaid reimbursementissues.

» Contracts regarding virtual care wellness clinic,hormone replacement therapy clinic, and integrativemedicine clinic.

» DTC online urgent care services by physicians.

» Telehealth payment and reimbursement issues,including Medicare billing requirements andcoverage, modifiers, state Medicaid coverage,teleradiology overreads and second reads underMedicaid billing, states with commercial telehealthpayment statutes, patient self-pay, employer-payarrangements, insurance benefit issues, andcharging Medicare and Medicaid beneficiaries out-of-pocket for telehealth services.

» Virtual care terms of service, provider terms of use,notice of privacy practices, consent forms,authorization forms, patient authentication andverification documents, e-signatures, paymentacknowledgements, employment agreements,independent contractor agreements, and themultitude of operational documents associated withtelehealth practices.

» Telemedicine service lines, including internationaltelemedicine arrangements, for several differentchildren’s hospitals.

» Strategy and contracting for internationaltelemedicine arrangements between U.S.-basedproviders and entities across the Globe.

» Compliance counseling and fraud and abuseguidance for telemedicine companies with multi-state footprints, including Anti-Kickback Statutes,physician self-referral laws, fee splitting rules,healthcare marketing, and corporate practice ofmedicine.

» Represent provider group before Florida Departmentof Health on petition for declaratory statementregarding telemedicine arrangement.

Health Care Compliance and Counseling Mr. Lacktman advises a variety of other health care entities on a range of business, legal and regulatory issues affecting the industry. He handles matters involving contracting fraud and abuse compliance, Medicare and Medicaid reimbursement, self-disclosures and overpayments, the Anti-Kickback Statute, physician self-referrals (the Stark Law), health care marketing rules, HIPAA, corporate compliance programs, licensing, contracting, change of ownership, confidentiality and information sharing, and policies and procedures.

Thought Leadership Mr. Lacktman speaks and writes frequently on issues at the forefront of telehealth and is often quoted for his insight about legal and business developments in this area. He has helped write telemedicine policy letters and position statements with such organizations as the ATA and the American Heart Association. He has provided comments and policy input on telehealth to lawmakers, the Drug Enforcement Agency, the Congressional Research Service, state Medicaid Agencies, and state boards of medicine across several states. He has appeared in publications such as Inside


Nathaniel M. Lacktman Counsel, Buzzfeed, Politico, Modern Healthcare, Forbes, Fox News, Bloomberg, Reuters, and Information Week, among others.

Health Care Enforcement and Litigation In the health care litigation and enforcement context, Mr. Lacktman has focused experience in matters involving enforcement actions by state and federal regulators, qui tam actions and the False Claims Act, internal investigations, ALJ hearings and reimbursement disputes, surveys and deficiencies, medical staff peer review, and long-term care. He has represented health care clients in state, federal and appellate courts, administrative hearings, mediations and arbitrations, including the following representative matters:

» Internal investigations for DMEPOS suppliers andskilled nursing facilities regarding potential Medicareand Medicaid overpayments and self-disclosures.

» Representation of suppliers in Medicare andMedicaid ALJ hearings and reimbursement appeals.

» Representation of hospitals, providers, and suppliersin defense of False Claims Act whistleblower suits.

Education and Accolades Prior to joining Foley & Lardner, Mr. Lacktman was a judicial extern for the Honorable Ronald S.W. Lew of the United States District Court for the Central District of California. He was selected for inclusion to the Florida Super Lawyers® - Rising Stars lists (2013 - 2015).

Mr. Lacktman received his law degree from the University of Southern California School of Law, where he was an editor for the Hale Moot Court Honors Program. He is a graduate of the University of Florida (B.A., with honors), where he was a University of Florida Scholar, member of Golden Key National Honor Society, and a member of Sigma Phi Epsilon fraternity.

Community Involvement, Pro Bono and Professional Memberships Mr. Lacktman is active in the community and is a member of the firm's Tampa pro bono committee. He is a board member of the Gulf Ridge Council Boy Scouts of America. He serves as a volunteer judge in the Teen Court juvenile diversion program through the Hillsborough County Courts, having first volunteered with the Sarasota Teen Court program over 20 years ago.

He is a member of the American Health Lawyers Association (AHLA), the Health Care Compliance Association (HCCA), the Health Law Section of the Florida Bar, Health Law Litigation Committee of the American Bar Association (ABA), and the American Telemedicine Association. Mr. Lacktman is admitted to practice in Florida and California, including the U.S. Court of Appeals for the 9th and 11th Circuits.


©2016 Foley & Lardner LLP • Attorney Advertisement • Prior results do not guarantee a similar outcome • 321 North Clark Street, Chicago, IL 60654 • 312.832.4500

Presentations and Media» “Legal & Regulatory: How to Create a Multi-State

Telehealth Clinic,” MedTech Impact Expo &Conference 2016 (December 9-10, 2016)

» “Telehealth Business Arrangements andContracting,” Cambridge Healthtech Institute’sBusiness of Telemedicine Symposium (August 26,2016)

» “Hot Topics in Telemedicine 2016: Payment Policy,Prescribing, and Practice Standards,” AmericanHealth Lawyer’s Association (AHLA) Annual Meeting(June 28, 2016)

» “Advanced Telehealth Contracting and NetworkDevelopment,” American Health Lawyer’s Association(AHLA) In-House Counsel Program (June 26, 2016)

» “Telehealth Coverage and Parity Laws: Trends,Challenges and Opportunities,” 2016 Telemedicine& Telehealth Service Providers Showcase (June 21-22, 2016)

» “Using Telehealth and Informatics Under NewPayment Models,” Workgroup for Electronic DataInterchange (WEDI) 25th Annual National Conference(May 24-26, 2016)

» “From the East Coast to the Far East: Building U.S. toChina International Telemedicine Arrangements,”American Telemedicine Association (ATA) AnnualInternational Meeting and Expo (May 15-17, 2016)

» Melding Worlds of Established and EmergingTelehealth Models,” American TelemedicineAssociation (ATA) Annual International Meeting andExpo (May 15-17, 2016)

» Telemedicine Start-Ups: What Entrepreneurs Need toKnow,” American Telemedicine Association (ATA)

Annual International Meeting and Expo (May 15-17, 2016)

» “Advanced Discussion on Telemedicine Legal Issues,Institutional Contracting, and Network Development,”American Telemedicine Association (ATA) AnnualInternational Meeting and Expo (May 15-17, 2016)

» “Telemedicine in Florida: Practice and Payment,”Florida Bar Health Law Section Web Conference (May10, 2016)

» “The Use of Telemedicine in the EmergencyDepartment,” Emergency Department PracticeManagement Association (EDPMA) 2016 SolutionsSummit (May 1-4, 2016)

» “Telemedicine Legal & Compliance Issues forAcademic Medical Centers," Vizient 2016 AcademicMedical Center Networks Meeting (April 20-21,2016)

» “Improving Telehealth Care Through LegislativeInitiatives: Understanding the Politics andProcesses,” Mid-Atlantic Telehealth Resource Center(MATRC) 2016 Annual Summit (April 10-12, 2016)

» “The Patient Will See You Now: Understanding andNavigating the Direct to Consumer Evolution inHealthcare,” Mid-Atlantic Telehealth Resource Center(MATRC) 2016 Annual Summit (April 10-12, 2016)

» “Where Do We Go From Here?” Mid-AtlanticTelehealth Resource Center (MATRC) 2016 AnnualSummit (April 10-12, 2016)

» “Building Telemedicine Contracts for Hospitals &Health Systems,” ACI Conference on Implementing,Advancing and Exploring Telemedicine Programs andServices for Hospitals and Health Systems (April 6-8,2016)

Selected Telemedicine and Telehealth Publications & Speaking Engagements


» “Georgia Telehealth Laws: 2016 and Beyond," 7thAnnual Georgia Partnership for TelehealthConference (March 2-4, 2016)

» Panelist, “The Business of Telemedicine Part 4: TheLegal and Legislative Hurdles on IntegratingTelemedicine into Healthcare Delivery,” AmericanTelemedicine Association Web Conference (February24, 2016)

» Panelist, “Telemedicine – Covering the business,legal, and policy issues affecting telemedicineinnovation today,” 13th Annual ABA WashingtonHealth Law Summit in Washington, DC (December 7-8, 2015)

» Conference Chair and Speaker, Florida HospitalAssociation’s 2015 Telehealth Summit (September18, 2015)

» Moderator, “Telehealth Data Privacy and Security:Strategies and Solutions for Providers,” Foley &Lardner LLP Telehealth Data Privacy and SecurityWeb Conference (September 16, 2015)

» “Telehealth Policy in Motion in the Private BusinessSector,” Florida TaxWatch’s Telehealth CornerstoneConference 2015 (September 10, 2015)

» “Telehealth Business Models and ContractualArrangements,” Association of Corporate Counsel(ACC) Health Law Committee (September 1, 2015)

» Quoted, “Texas, Alabama Respond Differently toSCOTUS Case,” Politico (August 21, 2015)

» Quoted, “DEA medical record case could impact useof telemedicine to prescribe meds: United States v.Zadeh centers on prescribing laws for controlledsubstances,” FierceHealthIT (August 12, 2015)

» “If skeptical on telemedicine, 'don't give in to thefearmongering',” Clinical Innovation + Technology(July 22, 2015)

» “Exploring Reimbursement and Financing ofConnected Health Programs,” mHealth + TelehealthWorld Congress 2015 (July 20-22, 2015)

» Quoted, “Telemedicine Faces the Employee/Not anEmployee Diagnosis,” Inside Counsel (July 13, 2015)

» Quoted, “Delaware’s telehealth parity bill becomeslaw as Congress re-floats nationwide version,”MobiHealthNews (July 8, 2015)

» Quoted, “Reimbursement Misconceptions Trendingin Telehealth Services,” mHealth Intelligence (June30, 2015)

» Quoted, “Think Outside Medicare Box for TelehealthRevenue, Compliance,” Report on MedicareCompliance (June 29, 2015)

» Quoted, “Tele Vision for Health Care,” Workforce(June 21, 2015)

» Quoted, “Iowa High Court Says TelemedicineAbortions Are OK,” Law360 (June 19, 2015)

» Quoted, “Iowa ruling could lead to tele-abortion inother states,” Politico Pro (June 19, 2015)

» Quoted, “Webcam Abortions Legal, Iowa SupremeCourt Rules,” BuzzFeed News (June 19, 2015)

» Quoted, “Iowa Supreme Court ruling on abortionscould lift telemedicine,” Modern Healthcare (June19, 2015)

» “Clinically Integrated Networks and Virtual Care:Taking Hospital Population Health to the Next Level,”Florida Hospital Association 2015 Health CareCorporate Compliance Education Retreat (June 18-19, 2015)

» Quoted, “Women May Soon Lose The Ability To GetAn Abortion Via Webcam,” BuzzFeed News (June 10,2015)

» Chair and Presenter, AHLA 4-part Webinar Series onTelemedicine (June-July, 2015)

» “Telemedicine Payment and Reimbursement –Embracing Opportunities to Fuel Real Growth,”American Health Lawyers Association (June 9, 2015)

» “Telemedicine – Strong Business Models fromStrong Business Leaders,” American Health LawyersAssociation (June 1, 2015)


» “Telehealth Legal & Compliance Issues forUniversities and Academic Medical Centers,”University HealthSystem Consortium (UHC) 2015Joint Council Meeting (May 13-15, 2015)

» “Legal Issues in Telemedicine Business Models,”American Telemedicine Association AnnualInternational Meeting and Expo (May 3, 2015)

» “Telehealth: Legal and Compliance Issues,” HCCA’s2015 Compliance Institute (April 19-22, 2015)

» “Unpack! Connecting Canadian Telehealth andHealthcare Robotics,” Consulate General of Canadaand the Canadian Technology Accelerator (March 17-18, 2015)

» Quoted, “Abortion Legislation Could RestrictTelehealth Services,” mHealth Intelligence (March17, 2015)

» Quoted, “Iowa abortion case could impacttelemedicine,” Healthcare Dive: IT (March 12, 2015)

» “Technology in Health Care: A Weapon or a Tool?”Florida Health Care Affordability Summit (February 8-10, 2015)

» "Florida Telemedicine: No Time Like the Present,"Hillsborough County Bar Association Health CareSection’s CLE Luncheon (December 3, 2014)

» “Addressing Issues of Non-Consensus & NationalGuidance,” Florida TaxWatch’s TelehealthCornerstone Conference (November 19, 2014)

» Florida Hospital Association’s General ComplianceRoundtable (November 13, 2014)

» Florida Bar Health Care Regulatory & ComplianceSeminar (November 7, 2014)

» “Telemedicine: Doing Business in China,” WebConference (October 6, 2014)

» “Telemedicine and Chronic Care Management: LegalIssues,” American Telemedicine Association FallForum, Palm Desert (September 9, 2014)

» “Building a Chronic Care Management Program –Perspectives on State-Specific Legal Considerations,”American Telemedicine Association 2014 Fall Forum,Palm Desert (September 7-9, 2014)

» “Navigating Telemedicine Requirements forLicensing, Scope of Practice and Reimbursement,”Strafford Publishing Web conference (July 9, 2014)

» “Telehealth Legal Issues in Florida,” Florida HospitalAssociation (June 18, 2014)

» “Telehealth Legal & Regulatory Issues Part 1: ExpertLessons from Legal and Health System Leaders,”American Telemedicine Association AnnualInternational Meeting and Expo, Baltimore (May2014)

» Quoted, “mHealth13: Technology knowledge key totelehealth deployment,” FierceHealthIT (December12, 2013)

» Quoted, “6 Regulatory and Procedural Hurdles forMultistate Telemedicine,” mobihealthnews(December 12, 2013)

» Quoted, “As mHealth Outpaces Regulations, LegalQuestions Arise,” mHealth Regulatory Landscape(November 14, 2013)

» “Telehealth and the Virtualization of Healthcare,”HIMMS 5th Annual mHealth Summit. Washington,DC (Dec 2013).

» “Bring Your Own Device: Overcoming PhysicianLiability Concerns in the Practice of Telemedicineand mHealth,” mHealth and Wireless MedicalTechnology Conference, Washington, DC (April2013)

Publications» “Arkansas New Proposed Rules Allow Telemedicine

Exams,” Health Care Law Today (May 10, 2016)

» “Virginia Telehealth Law: What You Need to Know,”Health Care Law Today April 12, 2016

» “West Virginia's New Telemedicine PracticeStandards & Remote Prescribing Laws,” Health CareLaw Today (April 4, 2016)


» “Key Takeaways From Indiana's New TelemedicineLaw,” Health Care Law Today (March 28, 2016)

» “Louisiana Telemedicine Practice Rules: WhatProviders Need to Know,” Health Care Law Today(March 21, 2016)

» “DC Proposes New Telemedicine Rules: What YouNeed to Know,” Health Care Law Today (March 16,2016)

» “Florida Passes New Telehealth Bill: Focus isReimbursement,” Health Care Law Today (March 14,2016)

» “Medicare Payments for Telehealth Increased 25% in2015: What You Need to Know,” Health Care LawToday (March 3, 2016)

» “Illinois Telemedicine Rules: Licensing, Practice,Payment,” Health Care Law Today (February 25,2016)

» “Florida Expands Telemedicine Controlled SubstancePrescribing,” Health Care Law Today (February 22,2016)

» “Arkansas Prepares New Telemedicine PracticeRules,” Health Care Law Today (February 16, 2016)

» “8 Tips for Navigating New Wisconsin TelemedicineRules,” Health Care Law Today (January 26, 2016)

» “2016 Forecast: What to Expect from Telemedicine,”MiraMed Focus (January 6, 2016)

» “Will New Hampshire Offer Medicaid TelehealthCoverage?” Health Care Law Today (December 21,2015)

» “2016 Will Be the Year of Telemedicine and ACOs,”Health Care Law Today (December 15, 2015)

» “Consumerism Drives Employer & Retail Clinics’Telemedicine Adoption in 2016,” Health Care LawToday (December 10, 2015)

» “State Lawmakers Pushing Telemedicine Coverage in2016,” Health Care Law Today (December 8, 2015)

» “China Expands Telemedicine Programs toProvinces,” Health Care Law Today (December 3,2015)

» “Telemedicine Going Global in 2016,” Health CareLaw Today (December 1, 2015)

» “Payers Embracing Telemedicine Cost Savings,Ramping Up Reimbursement in 2016,” Health CareLaw Today (November 23, 2015)

» “Florida Proposes Telemedicine Medicaid Rules,”Health Care Law Today (November 19, 2015)

» “Five Telemedicine Trends Transforming Health Carein 2016,” Health Care Law Today (November 16,2015)

» “Five Takeaways From North Dakota’s ProposedTelemedicine Rules,” Health Care Law Today(November 9, 2015)

» “Top Three Reasons ACOs Should Use Telehealthand Telemedicine,” Health Care Law Today(November 2, 2015)

» “Six Ways to Take Advantage of New Hampshire’sNew Telemedicine Law,” Health Care Law Today(October 26, 2015)

» “Changes to New York Telehealth Coverage ComingSoon,” Health Care Law Today (October 20, 2015)

» “Telehealth and Consumer Subscription Models,”Health Care Law Today (October 5, 2015)

» “U.S. to China Health Care Arrangements: New Rulesfor Medical Institution and Service Advertisements,”Health Care Law Today (September 28, 2015)

» “Recent Enforcement Shows the Importance ofEncrypting Mobile Devices Containing ProtectedHealth Information,” Health Care Law Today(September 18, 2015)

» “Medicare Telehealth Services in Puerto Rico,”Health Care Law Today (September 14, 2015)

» “Telehealth Reimbursement Under the Microscope,”Managed Healthcare Executive (September 8, 2015)


» “Will the TELE-MED Act of 2015 Really ChangeLicensure Rules?” Health Care Law Today (August26, 2015)

» “Can My Hospital Bill Medicare for TelehealthChronic Care Management?,” Health Care Law Today(July 15, 2015); republished by TeleHealth NewsNetwork (August 26, 2015)

» “The Telehealth ‘Top Ten’ for 2015,” ACC LegalResources (August 24, 2016)

» “Up, up and away (safely): How the airline industrycould use telehealth,” Health Care Law Today(August 24, 2015)

» “Telemedicine Prescribers Should Read This Case:U.S. vs. Zadeh,” Health Care Law Today (August 11,2015); republished by TeleHealth News Network(August 19, 2015)

» “Examining Payment Parity in Telehealth Laws,”Health Care Law Today (August 13, 2015)

» “Maine Welcomes Telemedicine with New BoardGuidelines,” Health Care Law Today (August 3,2015)

» “Does Delaware's New Telemedicine LawForeshadow Broader Payment Parity?” BloombergBNA Health Law Reporter (July 23, 2015)

» “Colorado Proposes New Telehealth Rules,” HealthCare Law Today (July 16, 2015)

» “Congress Wows with Medicare Telehealth Parity Actof 2015, But Will It Succeed?,” Health Care LawToday (July 15, 2015)

» “Is My Telehealth App Subject to HIPAA?,” HealthCare Law Today (July 15, 2015)

» “Telemedicine Practice and Remote Prescribing inDelaware,” Health Care Law Today (July 10, 2015)

» “Delaware Enacts Telehealth Commercial InsuranceParity Law,” Health Care Law Today (July 8, 2015)

» “Telemedicine Providers: Are My Doctors Employeesor Independent Contractors?,” Health Care LawToday (July 6, 2015)

» “Telemedicine Business Opportunities and the “DocFix” Bill,” Health Care Law Today (June 1, 2015)

» “Can My U.S. Company Offer Online Second Opinionsin China?,” Health Care Law Today (April 29, 2015)

» “Does the “Doc Fix” Bill Help Telemedicine andTelehealth?,” Health Care Law Today (April 20,2015)

» “China Telemedicine Tackles Long Term Care:Business Opportunities and Government Guidance,”Health Care Law Today (March 16, 2015)

» “DME Suppliers, Get More Information on YourMedicare Appeals,” Health Care Law Today (March11, 2015)

» “Telemedicine Flourishes Despite Hurdles,”Executive Insight (March 2015)

» “Telemedicine in Massachusetts: What ProvidersNeed to Know,” Health Law Reporter (March 2015)

» “Do You Really Know Your China TelemedicinePartners? China Anti-Corruption Effort Focuses onMajor Medical Institutions,” Health Care Law Today(February 24, 2015)

» “Florida Still Needs Work on Telemedicine Rules,”Miami Daily Business Review (February 2015)

» “China Unveils Plans for National TelemedicineNetwork,” Health Care Law Today (February 16,2015)

» “Texas Torches Telemedicine? Board IssuesEmergency Rule,” Health Care Law Today (January22, 2015)

» “Look at What New York Did with Telemedicine toBring in the New Year,” Health Care Law Today(January 9, 2015)

» “Ten Things That Health Care Lawyers Should beThinking About,” Association of Corporate Counsel(December 16, 2014)


» “Three Key Components to Physician Buy-In forTelemedicine,” Health Care Law Today (December 8,2014)

» “Florida, No Grants For You!,” Health Care Law Today(December 3, 2014)

» “Does Telemedicine Matter? Yes!,” Health Care LawToday (November 25, 2014)

» “Telemedicine Technology: Tackling Rural HealthCare Challenges,” Health Care Law Today (November20, 2014)

» “Will the Mid-Term Elections Help TelemedicineReimbursement?,” Health Care Law Today(November 17, 2014)

» “2014 Telemedicine Survey Executive Summary,”(November 2014)

» “Foley Survey Finds Health Care Executives PursuingTelemedicine Despite Hurdles,” Health Care LawToday (November 11, 2014)

» “Realizing the Potential of Telemedicine in China,Part 2: Data Privacy and Security,” Health Care LawToday (November 5, 2014)

» “Does the Medicare Telehealth Parity Act of 2014Stand a Chance?,” Health Care Law Today (October9, 2014)

» “Realizing the Potential of Telemedicine in China,Part 1: Protecting Your IP,” Health Care Law Today(September 30, 2014)

» “Telemedicine and the Interstate Medical LicensureCompact is Here: Will it Succeed?,” Health Care LawToday (September 25, 2014)

» “China Issues New Telemedicine Opinions for Chinaand Foreign-Based Providers,” Health Care LawToday (September 16, 2014)

» “Georgia Composite Medical Board Issues NewTelemedicine Rules,” Health Care Law Today (August20, 2014

» “ATA Issues Final Clinical Guidelines forTelepathology,” Health Care Law Today (August 13,2014)

» “AMA Adopts Telemedicine Policy for Coverage andPayment of Telemedicine Services,” Health Care LawToday (June 24, 2014)

» “Draft Guidelines for Telepathology Released,”Health Care Law Today (June 19, 2014)

» “Practice Guidelines for Real-time, Direct-to-PatientPrimary Urgent Care Telemedicine Released,” HealthCare Law Today (June 19, 2014)

» “Florida Board of Medicine Issues TelemedicineRegulations,” Health Care Law Today (May 15,2014)

» “Tennessee Enacts Telehealth Parity Legislation,”Health Care Law Today (April 16, 2014)

» “Health Care Law: Telemedicine LegalConsiderations for Florida Providers,” HCBA LawyerMagazine (April 2014)

» “Draft Guidelines for TeleICU Operations Released,”Health Care Law Today (April 3, 2014)

» “Telehealth Opportunities Arise as South KoreaOpens Door to Telemedicine,” Health Care LawToday (April 2, 2014)

» “Telemedicine Legal Considerations for FloridaProviders,” Lawyer Magazine, Hillsborough CountyBar Association Health Law Section (April 2014)


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