Description
Telehealth is the use of interactive audio, video or other telecommunications technology used by a health care provider or health care facility at a distant site to deliver health services at an originating site; and that is delivered over a secure connection that complies with the requirements of state and federal laws.
Telehealth enables providers to extend their reach and improve their efficiency and effectiveness while still maintaining high quality care and attention to individual safety. The benefits and limitations of care delivery via telehealth is the responsibility of the provider. A provider using telehealth technologies in the provision of services to an individual must provide care of the individual consistent with traditional standards of care for the individual presentation.
An examination or evaluation may be performed entirely through telehealth if the examination or evaluation is equivalent to an in-person examination. An examination that utilizes appropriate diagnostic testing and use of peripherals that would be deemed necessary in a like in-person examination or evaluation would meet this standard, as would an examination conducted with an appropriately licensed intervening health care provider, practicing within the scope of their profession, providing necessary physical findings to the licensee.
Definitions:
1. Synchronous Telehealth - Synchronous Telehealth means care delivery that occurs in real time between an individual at an originating site and a health care provider at a distant site, connected by video technology.
Types of synchronous telehealth include:
a. Originating/Distant Site Telehealth– Forms of synchronous telehealth delivery.
i. Originating site (Location of Patient)– Site where patient is physically present would be considered the originating site location, such as a clinic or facility setting. Originating site location where the patient is participating with a distant site practitioner will not be covered if it is the patient’s home, community setting, or other non-provider owned location.
ii. Distant site (Location of Practitioner)– Site where the patient is present at an originating site and the visit allow for a face-to-face encounter. The patient is at home using a consumer device via telehealth platforms such as mobile health apps, kiosks, or web-based video available through an electronic health record (HER) portal to obtain a patient and practitioner face-to-face telehealth services.
b. Digital Online Visit– Digital synchronous communication initiated by the member to a provider through the provider’s online patient portal. Member is not located at a clinic or facility site. This is a low complexity interactive individual encounter performed through a consumer device via telehealth platforms such as mobile health apps, kiosks, or web-based video available through an electronic health record portal.
i. Audiovisual (face-to-face) real time online communication
ii. The individual initiates the encounter
iii. A low complexity, straight forward decision-making encounter that addresses urgent but not emergent clinical conditions
iv. It is not anticipated that a follow-up encounter is required
2. Asynchronous Telehealth (also called store-and-forward) – Electronic medical information, imaging, or communication that is transferred, recorded, or otherwise stored to be reviewed at a distant site at a later time by a health care provider or health care facility without the individual present in real time.
Types of asynchronous telehealth include:
a. Teleradiology - The practice of a radiologist interpreting radiologic images of internal body parts while not physically present in the location where the images are generated.
b. Remote Physiological Monitoring (Telehome monitoring) -The use of electronic remote monitoring devices for purposes such as blood pressure checks, weight checks via a telescale as well as other remote medical intervention and assessment tools from the convenience of the individual's place of residence. Please see below for link to Remote Physiological Monitoring Medical Policy.
c. Interprofessional Electronic Record Referral- a form of asynchronous telehealth online electronic medical evaluation that is non-face-to-face using Internet resources in response to an individual (or an individual's representative's) on-line inquiry typically through email or by completion of a questionnaire that enables health providers to interact with individuals through a secured electronic channel.
3. Consultation– An evaluation of an individual and resulting opinion or recommendation from a physician or licensed independent practitioner. Consultation evaluation is performed upon the request of a treating provider of record because the consultant has expertise in a specific clinical area beyond the requesting provider’s knowledge. If, after completion of a consultation, the consultant assumes responsibility for management of an individual’s condition, subsequent care codes should be used and not follow-up consultation codes.
4. Provider of record (or attending provider) - the principal provider who oversees an individual’s care. The provider of record provides primary and routine care, or oversees hospital care, and coordinates other specialized care for an individual.
5. Virtual Check-In - A brief communication via telephone or other telecommunication device to decide whether an office visit or other service is needed. A remote evaluation of recorded video and/or images submitted by an established patient.
6. Telehealth Visit - Visit with a provider that uses a telecommunication system connecting the patient with the provider
Please see BCBSND Corporate Medical Policy for Telehome Monitoring (Remote Physiological Monitoring).
https://www.bcbsnd.com/providers/policies-precertification/medical-policy/telehome-telemonitoring-for-congestive-heart-failure-and_or-chronic-obstructive-pulmonary-disease
Members must consult their applicable benefit plans or contact a Member Services representative for specific coverage information.
BCBSND allows industry standard ancillary asynchronous teleradiology.
