Author Archives: Vignesh Eswaramoorthy

Understanding the Importance of Healthcare Effectiveness Data and Information Set (HEDIS) for Healthcare Providers

Healthcare providers often face the challenge of identifying whether their services and interventions are producing the desired outcomes. In this regard, healthcare effectiveness data and information set (HEDIS) is a valuable tool that is used to measure how well healthcare providers are meeting the needs of their patients. HEDIS is widely used by insurers to measure the quality of care delivered by healthcare providers. This blog post will provide an overview of what HEDIS is, its importance, and how healthcare providers can use it to improve patient care.

What is HEDIS?

HEDIS is a set of standardized performance measures that healthcare providers use to assess the quality of care provided to their patients. It was created by the National Committee for Quality Assurance (NCQA) and is used by health plans, employers, and other healthcare organizations to measure performance in different areas of healthcare delivery. Some of the areas that HEDIS measures focus on include preventive care, chronic disease management, behavioral health, and patient safety.

How is HEDIS Used?

HEDIS is used in a variety of ways. Health plans use HEDIS to evaluate the quality of care provided by healthcare providers and to benchmark their performance against other health plans. Employers use HEDIS to assess the overall performance of their health benefits programs. Healthcare providers use HEDIS to identify areas of improvement in their healthcare delivery and to improve their processes, ultimately leading to better patient outcomes.

Why is HEDIS Important?

HEDIS is important because it allows healthcare providers to measure the effectiveness of their healthcare interventions on patient care outcomes. It is a tool that supports measurement-based care, which is essential for improving the quality of care provided to patients. HEDIS provides a standardized framework that enables healthcare providers to compare their performance to other providers and identify areas for improvement. It is also important for healthcare providers to monitor HEDIS measures to meet regulatory requirements.

How Healthcare Providers Can Use HEDIS to Improve Patient Care?

Healthcare providers can use HEDIS to identify areas of care where they may not be meeting the standards of care or may not be doing well compared to their peers. They can then analyze the reasons for the gaps in quality and implement changes to address them. For instance, if HEDIS measures indicate that there is a gap in preventive care interventions, healthcare providers can allocate resources to improve their preventive care programs. By using HEDIS measures to improve their healthcare delivery, healthcare providers can enhance patient outcomes and reduce healthcare costs.

Conclusion

In conclusion, HEDIS is an essential tool for healthcare providers that helps them quantify and measure the quality of care they provide. Understanding and utilizing HEDIS measures can lead to improved processes, better patient outcomes, and cost savings. By leveraging the insights gained from HEDIS, healthcare providers can develop and implement interventions that address gaps in care and ultimately improve their service delivery.

The Benefits of Remote Patient Monitoring for Chronic Disease Management

Chronic diseases such as diabetes, heart disease, and chronic obstructive pulmonary disease (COPD) are major health concerns worldwide. These diseases require long-term medical care and management, which can be challenging for both healthcare providers and patients. However, the advent of remote patient monitoring (RPM) technology has significantly transformed chronic disease management. This technology allows healthcare providers to remotely monitor and manage the health of patients with chronic diseases. In this article, we’ll explore the benefits of RPM for chronic disease management.

Improved Patient Outcomes

Remote patient monitoring improves patient outcomes by providing timely medical intervention and minimizing risks of complications. Healthcare providers can monitor patients’ vital signs and symptoms and take appropriate actions in case of any deterioration. With RPM, healthcare providers can also proactively identify potential health problems before they become severe and take steps to manage them effectively, thereby preventing hospitalization.

Enhanced Patient Engagement

Remote patient monitoring enhances patient engagement and empowerment, improving patients’ quality of life. RPM technology enables patients to actively participate in their own care by monitoring their health progress and sharing data with their healthcare providers. This way, patients can be more involved in their care plan, adhere to medication, and make more informed decisions about their health.

Cost Savings

Remote patient monitoring has proven to be an efficient alternative to traditional in-person care, reducing hospital readmissions, and emergency department visits. RPM technology has been shown to reduce healthcare costs, decrease hospitalization rates and preventable admissions, and lower the overall healthcare costs. In addition, RPM increases the efficiency of healthcare delivery systems by reducing the burden on healthcare providers, freeing up time and resources that can be directed towards other patient needs.

Convenience and Accessibility

Remote patient monitoring provides patients with the convenience and accessibility of receiving care from the convenience of their homes. This technology eliminates the need for patients to travel long distances to visit healthcare providers and saves them time, money, and inconvenience. Moreover, remote patient monitoring enables healthcare providers to monitor patients anytime and communicate in a timely manner with their patients, making it more convenient and accessible to both parties.

Improved Health Equity

Remote patient monitoring contributes towards improving health equity by promoting healthcare quality that is available to all patients regardless of their geographical location or socio-economic status. It bridges the gap between patients living in rural and remote areas and their healthcare providers, enabling individuals in underprivileged communities to receive world-class healthcare remotely. Remote patient monitoring technology promotes access to healthcare that is patient-centered, easily accessible, and high-quality.

Conclusion

Remote patient monitoring is a game-changer for the healthcare industry, helping healthcare providers manage chronic diseases effectively, while improving outcomes, increasing patient engagement, and reducing healthcare costs. RPM technology offers patients with chronic diseases the convenience of receiving care in the comfort of their homes, eliminates the need for travel, and improves healthcare equity. Thus, it should become an integral part of chronic disease management and deliver the best possible healthcare experience to patients while enabling healthcare providers to better manage their resources and improve efficiencies.

Patient Centricity as the Future of Digital Health Management

Digital health is an all-encompassing term that refers to the care provided through eHealth and mHealth through advances in computing sciences.

Challenges or Gaps in Traditional Care

Major technological challenges faced by the healthcare industry have got to do with data processing, cybersecurity, and providing a user-friendly experience. However, advancements in each of these fields have proven to be gainful, and will continue to do so. Our focus here has more to do with the user experience aspect of digital health management.

There are quite a number of digital health care providers, rather, platforms that avail services outside the traditional settings. Consider a regular appointment with the doctor; the patient is examined, tests are probably taken, the prognosis is given, medicines are prescribed, and the doctor sends them on their way after scheduling their next visit. What happens from then to the time of the next visit? Do patients remember to follow their diet plans? Or do they just revert back to their unhealthy lifestyle? The motive behind having health care is to have a better quality of life, and this means strictly following doctors’ instructions!

Where US Healthcare is headed

The most common complaint from American patients is that they have scheduling difficulties. Being in the digital era, and not utilizing resources to make life easier can be frustrating. Say that an appointment is scheduled, but the patient ends up spending less time than they expected. Not only are they dissatisfied, but so are doctors for not getting adequate time with their patients. Then comes the hassle of insurance and billing. Enough said! And this is just the patients’ side of things, there’s still a host of things that need to be managed in the providers’ front.

This is the decade where digital and technological advancements will make providing healthcare efficient, and digital health management is what care organizations need to be looking into. Thankfully, there are now provisions that don’t require patients to walk into a clinic, as this sometimes ends up in no-shows. The reason could be a lack of resources, or an inconvenience to commute, or even that the patient just doesn’t feel like it. It’s no surprise that even a no-show rate of 20% can cause significant revenue loss for healthcare systems.

Need for a Smart Comprehensive Platform

Since the essence of the matter at hand is primarily on the patient experience, here’s what they want. A one stop shop where everything is kept track of – vitals are monitored, real time stats are provided, diet plans are charted out. 97% of American adults now have smartphones, maybe even the wearables that go along with it. Many companies provide such services, few excel at it.

To go the extra mile, a smart, comprehensive platform is exactly what they need. Excellent customer service comes from customization, and personalized should digital health management be!

What can be achieved with a Digital Integrated Platform

Let’s say these amazing, user friendly features are all assembled and ready to go. There needs to be an objective behind each of these features, because, let’s face it, it needs to truly give results to last longer in a challenging market. More than 60% of the patient population require personalized care plans, and a significant portion wants to be able to consult with their provider digitally before going in-person. Pain points such as this need to be addressed.

With a digital integrated platform, providers can now enable that and more. Patients wouldn’t have to worry about not being able to contact their doctor, because with such a platform, there would be more access for all. They wouldn’t have to deal with managing their bills, because the platform would store such information, and all they have to do is view them when required. This platform would also be a digital blessing to providers, for they can manage their organization too. There would be data readily available for patient history, they wouldn’t have to wait until the physical records are brought to them.

On the administrative front, there would be a reduction in the time spent scheduling patients, searching for availability, and even they would be able to take breaks in between. Nurses spend 70% of their time in direct patient care, and with 12-hour shifts, it could be hard.

By transitioning into the digital health space, care organizations can expect better outcomes, higher satisfaction, and find that care management goals can be better regulated. From a monetary perspective, better care equals better profitability. It’s as simple as that, a win-win situation for all parties involved.

HealthViewX Digital Health Management

All said and done, this is where HealthViewX DHM platform comes in. What makes us a candidate worth collaborating with is we’re constantly engaged in providing the best digital experience. Enhancing your practice is just the beginning, so get started and schedule a demo!

Medicare Advantage vs. Traditional Medicare: What’s Best for Seniors?

Traditional Medicare

Traditional Medicare, also known as Original Medicare, has been the foundation of senior healthcare in the U.S. since its inception in 1965. It consists of two parts:

Part A (Hospital Insurance): Covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and home health care.
Part B (Medical Insurance): Covers outpatient care, doctor services, preventive services, and some home health care.

Traditional Medicare operates on a fee-for-service basis, where beneficiaries can visit any healthcare provider that accepts Medicare. However, it does not cover all healthcare costs, leaving gaps such as prescription drugs (covered under Part D), dental, vision, and long-term care.

Medicare Advantage

Medicare Advantage is an alternative to Traditional Medicare. These plans are offered by private insurance companies approved by Medicare and must cover at least what Traditional Medicare covers, but often include additional benefits such as prescription drug coverage, dental, vision, hearing, and wellness programs.

Medicare Advantage plans usually operate as Health Maintenance Organizations (HMOs) or Preferred Provider Organizations (PPOs), which means that beneficiaries may have to use a network of doctors and hospitals and may need referrals to see specialists.

Medicare Advantage Care Management programs are initiatives designed to help Medicare Advantage (MA) plan beneficiaries manage their health, particularly those with chronic conditions or complex health needs. These programs aim to improve patient outcomes, enhance care coordination, and reduce healthcare costs by providing personalized care and support to beneficiaries.

Key Components of Medicare Advantage Care Management Programs

Care Coordination
- Primary Care Provider (PCP) Engagement: Care management programs often assign a primary care provider (PCP) to coordinate all aspects of a patient’s care. This includes managing referrals to specialists, ensuring follow-up appointments, and overseeing overall treatment plans.
- Interdisciplinary Care Teams: These programs may involve a team of healthcare professionals, including doctors, nurses, pharmacists, social workers, and care managers, who work together to provide comprehensive care.
Chronic Care Management
- Disease-Specific Programs: Many care management programs focus on managing chronic conditions like diabetes, heart disease, COPD, and hypertension. These programs provide education, monitoring, and interventions tailored to the specific needs of patients with these conditions.
- Telehealth and Remote Monitoring: MA plans often incorporate telehealth services and remote patient monitoring (RPM) to keep track of patient’s health status in real time, enabling timely interventions and reducing hospitalizations.
Medication Management
- Medication Reconciliation: Care managers review and reconcile medications to ensure patients are taking the right medications at the right times, minimizing the risk of adverse drug interactions.
- Pharmacy Coordination: Programs may include coordination with pharmacies to streamline medication delivery and ensure that patients adhere to their prescribed treatment regimens.
Personalized Care Plans
- Individualized Plans: Each beneficiary receives a personalized care plan based on their specific health needs, preferences, and goals. These plans are regularly updated to reflect changes in the patient’s condition or treatment.
- Patient and Family Engagement: Care management programs actively involve patients and their families in the care planning process, ensuring that the care provided aligns with the patient’s wishes and lifestyle.
Preventive Care and Wellness Programs
- Health Screenings and Vaccinations: MA plans may offer preventive care services, such as regular health screenings and vaccinations, to catch potential health issues early and prevent complications.
- Wellness Programs: Many care management programs include wellness initiatives like fitness classes, nutritional counseling, and smoking cessation programs to promote healthier lifestyles among beneficiaries.
Transition of Care
- Post-Hospitalization Follow-Up: Care management programs often include follow-up care after hospitalizations to ensure that patients transition smoothly back to their homes and adhere to their post-discharge care plans.
- Reducing Readmissions: By closely monitoring patients after discharge and providing necessary support, these programs aim to reduce hospital readmissions, which can be costly and detrimental to patient health.
Home and Community-Based Services
- In-Home Care: Some Medicare Advantage plans provide in-home care services, including home health visits, to support patients with mobility issues or those recovering from surgery.
- Community Resources: Care management programs may connect patients with community resources, such as transportation services, meal delivery, and social support groups, to address social determinants of health.

Benefits of Medicare Advantage Care Management Programs

Improved Health Outcomes: By providing coordinated, comprehensive care, these programs help manage chronic conditions more effectively, leading to better overall health outcomes for beneficiaries.
Enhanced Patient Satisfaction: Personalized care plans and active patient engagement contribute to higher satisfaction rates among Medicare Advantage enrollees.
Cost Savings: Effective care management can reduce the need for emergency room visits and hospitalizations, leading to lower healthcare costs for both beneficiaries and Medicare Advantage plans.
Preventive Care Emphasis: By focusing on preventive care and early intervention, these programs help to identify and address health issues before they become serious, further improving patient outcomes.

Market Data and Statistics: A Comparative Look

Enrollment Trends

Growing Popularity of Medicare Advantage: As of 2024, nearly 50% of all Medicare beneficiaries (around 31 million people) are enrolled in Medicare Advantage plans. This represents a significant increase from 19% in 2007, reflecting a growing preference for the additional benefits and coordinated care that Medicare Advantage offers.
Traditional Medicare Enrollment: Despite the rise of Medicare Advantage, approximately 30 million seniors remain enrolled in Traditional Medicare, valuing its flexibility and extensive provider network.

Costs and Out-of-pocket Expenses

Premiums and Out-of-Pocket Costs: Traditional Medicare beneficiaries typically pay a premium for Part B (around $164.90 per month in 2024) and may purchase supplemental insurance (Medigap) to cover out-of-pocket costs like deductibles, coinsurance, and copayments. Medigap premiums can range widely but often average around $150 per month.
Medicare Advantage Costs: Medicare Advantage plans often have lower or even $0 premiums, but they may come with higher out-of-pocket costs, such as copayments, coinsurance, and deductibles. These plans also have a maximum out-of-pocket limit (averaging around $8,850 in 2024), which Traditional Medicare does not offer.

Access to Care

Provider Networks: One of the primary differences is the provider network. Traditional Medicare allows access to any doctor or hospital that accepts Medicare, which is virtually all providers in the country. In contrast, Medicare Advantage plans typically require beneficiaries to use a network of providers, which can be more restrictive.
Care Coordination: Medicare Advantage plans often include care coordination services, where a primary care physician manages a beneficiary’s care, potentially leading to better health outcomes. Traditional Medicare does not offer this feature, leaving care coordination up to the patient and their providers.

Coverage for Additional Services

Prescription Drugs: Traditional Medicare beneficiaries must enroll in a separate Part D plan to receive prescription drug coverage. Medicare Advantage plans usually include Part D coverage as part of the plan.
Dental, Vision, and Hearing: Medicare Advantage plans often include coverage for dental, vision, and hearing services—benefits not typically covered by Traditional Medicare.
Wellness Programs: Many Medicare Advantage plans offer additional perks, such as gym memberships, transportation services, and wellness programs, which are not available through Traditional Medicare.

Pros and Cons of Medicare Advantage vs. Traditional Medicare

Medicare Advantage: Pros and Cons

Pros:

Comprehensive Coverage: Medicare Advantage plans often include additional benefits such as prescription drugs, dental, vision, and wellness programs.
Lower Premiums: Many Medicare Advantage plans offer lower premiums, with some even offering $0 premium options.
Care Coordination: These plans often provide care coordination services, which can lead to better management of chronic conditions.

Cons:

Network Restrictions: Beneficiaries are typically required to use a network of providers, which can limit access to preferred doctors and hospitals.
Out-of-Pocket Costs: Although premiums may be lower, out-of-pocket costs for services can be higher, especially if care is received outside the network.
Complexity: Medicare Advantage plans can be complex, with varying rules and costs that may change annually.

Traditional Medicare: Pros and Cons

Pros:

Flexibility: Beneficiaries can visit any doctor or hospital that accepts Medicare, providing broad access to care.
Stable Coverage: Traditional Medicare benefits are consistent and do not change based on geographic location or network.
Supplemental Coverage: Medigap policies are available to help cover out-of-pocket costs, reducing financial risk.

Cons:

Higher Premiums: The combination of Part B premiums and Medigap premiums can result in higher overall costs.
No Cap on Out-of-Pocket Spending: Traditional Medicare does not have a maximum out-of-pocket limit, which can expose beneficiaries to high costs in case of serious illness.
Limited Additional Benefits: Traditional Medicare does not cover services like dental, vision, hearing, or wellness programs.

What’s Best for Seniors?

Deciding between Medicare Advantage and Traditional Medicare depends on individual circumstances, including health needs, financial situation, and personal preferences.

Consider Medicare Advantage if:

You prefer a plan with a lower premium that includes additional benefits.
You value the convenience of having all your healthcare needs covered under one plan, including prescription drugs.
You are comfortable using a network of providers and are looking for care coordination services.

Consider Traditional Medicare if:

You want the flexibility to choose any doctor or hospital that accepts Medicare.
You are willing to pay higher premiums for the stability of coverage and the option to purchase a Medigap policy to minimize out-of-pocket costs.
You prefer to avoid the restrictions and complexity of network-based care.

Conclusion

The choice between Medicare Advantage and Traditional Medicare is a significant decision for seniors in the United States. With nearly 50% of Medicare beneficiaries now enrolled in Medicare Advantage plans, it’s clear that the additional benefits and lower premiums are appealing to many. However, Traditional Medicare’s flexibility and stability continue to attract millions of seniors who prioritize broad access to care.

Medicare Advantage Care Management programs play a crucial role in delivering high-quality, personalized care to beneficiaries, particularly those with chronic or complex health needs. Through coordinated care, chronic care management, medication oversight, and preventive services, these programs aim to enhance patient outcomes, reduce healthcare costs, and improve the overall experience for Medicare Advantage enrollees. As these programs continue to evolve, they will likely become even more integral to the success of Medicare Advantage plans in providing value-based care.

Ultimately, the best choice depends on individual needs and circumstances. By carefully considering the pros and cons of each option, along with the latest market data and Medicare statistics, seniors can make an informed decision that best suits their healthcare needs and financial situation.

As the healthcare landscape continues to evolve, it’s crucial for seniors to stay informed about their Medicare options and to re-evaluate their coverage annually during the open enrollment period to ensure it continues to meet their needs.

CMS’s Journey To Value-Based Care

Most people think of CMS (Centers for Medicare & Medicaid Services) as an insurance company that covers individual services provided by physicians, FQHCs, hospitals, and other health care providers. Some people even think of it as a policy-writing agency for Medicare. It is true that CMS reimburses providers for services to millions of individual beneficiaries. However, since the Affordable Care Act came into action in 2010, CMS has been developing focused payment strategies that shift from fee for services to value-based care and a focus on population health.

Today, CMS’s second-highest strategic priority is prevention and population health. To this day, the agency is engaged in numerous activities to promote effective prevention of chronic diseases and not just its treatment.

In 2011, the federal government reported that fewer than half of all adults aged 65+ were regular in checking the core set of recommended preventive services. The Affordable Care Act took a big step towards improving the access to preventive care by eliminating out-of-pocket costs for these preventive services in most insurance markets. This resulted in guaranteed access to preventive services like diabetes screening and cervical cancer screening to almost 137 Million Americans without cost-sharing.

Despite improved access to care, the use of preventive services among seniors with traditional Medicare coverage has not changed significantly. There are several hindrances that inhibit the greater uptake of preventive services. A 2014 survey reveals that only 43% of adults were aware of the new clinical preventive benefits provided by the Affordable Care Act. Of those who were aware of the services, 18% cited cost as a barrier, even though the Affordable Care Act eliminated co-payments for preventive services.

Another obstacle is that many Americans believe that preventive services are not important. Thus, even though many cost barriers have been removed, many Americans still might not perceive preventive services as valuable to their health and well-being. This mindset needs to change.

Shifting the paradigm of preventive care requires CMS and other payers to provide incentives beyond individual services to broader value-based and lifestyle interventions that can change population outcomes. To address this issue, CMMI has developed 2 payment models:

(1) The Million Hearts Cardiovascular Risk Reduction Model:

This model associates payment with population-based risk reduction. It is expected to reach over 3.3 million Medicare fee-for-service beneficiaries and involve nearly 20,000 health care practitioners by December 2021.

(2) The Medicare Diabetes Prevention Program:

This program ties payments to the achievement of weight loss through evidence-based lifestyle intervention.

CMS collaborated with sister agencies such as the Centers for Disease Control and Prevention (CDC) to develop these population health models, and they are good examples of how CMMI is using the Medicare payment structure to improve prevention and population health.

These path-breaking innovations offer an opportunity for CMS to test payment models that emphasize payment for population health outcomes rather than just individual outcomes, with the goal of better care and a healthier population.

References:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5298510/#bibr11-0033354916681508

https://innovation.cms.gov/innovation-models/million-hearts-cvdrrm#:~:text=The%20Million%20Hearts%C2%AE%3A%20CVD%20Risk%20Reduction%20Model%20is%20expected,and%20end%20by%20December%202021

CMS expands Telehealth Services to Deliver Care Safely during COVID-19 and Beyond

During the COVID-19 pandemic, CMS has taken the necessary steps to make it easier to provide quality care through telehealth services. This unprecedented action by CMS has encouraged healthcare providers to adopt and use telehealth as a way to safely provide care to their patients in situations like medication consultation, eye exams, nutrition counseling, behavioral health counseling, and routine health check-ups like annual wellness visits. Past data have shown telehealth to be an effective medium for patients to access healthcare providers especially for managing chronic conditions like diabetes, asthma or to obtain mental health counseling.

Advantages of CMS changes to Telehealth:

Telehealth services made permanent post-COVID-19:

CMS has announced that 60 of the 144 telehealth services that were newly offered during the pandemic will become permanent. This includes services for cognitive assessment, psychological and neuropsychological testing, and custodial care services for established patients.

They have also finalized the decision that direct supervision in telehealth visits can be provided with interactive audio and video technology through the end of the year until December 2021.

CPT Code	Services	Description
77427	Radiation management	It is reported once for every five fractions or treatment sessions regardless of the actual time period in which the services are furnished. The services need not be furnished on consecutive days.
90853	Group psychotherapy	Group psychotherapy including interpersonal interactions and support with several patients; typically 45 to 60 minutes in length.
90953	End-stage renal disease, one visit per month, ages 2 and younger	End-stage renal disease (ESRD) related services monthly, for patients younger than 2 years of age to include monitoring for the adequacy of nutrition, etc.
90959	End-stage renal disease, one visit per month, ages 12-19	End-stage renal disease (ESRD) related services monthly, for patients 12-19 years of age to include monitoring for the adequacy of nutrition, assessment of growth
90962	End-stage renal disease, one visit per month, ages 20 and older	With 1 face-to-face physician visit per month
92057	Speech/hearing therapy	Treatment of speech, language, voice, communication, and/or auditory processing disorder, individual
92521	Evaluation of speech fluency	Evaluation of speech fluency (e.g., stuttering, cluttering)
92522	Evaluation speech production	Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria)
92523	Speech sound language comprehension	Evaluation of speech sound production (e.g., articulation, phonological process, apraxia, dysarthria)
92524	Behavioral quality voice analysis	Behavioral and qualitative analysis of voice and resonance.
96130	Psychological test Evaluation Phys/qhp 1st	Psychological testing evaluation services by a physician or other qualified healthcare professional, including the integration of patient data, interpretation of standardized test results and clinical data
96131	Psychological test evaluation phys/qhp ea	Providers should now use CPT code 96130 to bill for the first hour of psychological testing evaluation services and 96131 for each additional hour
96132	Neuropsychological testing evaluation phys/qhp 1st	Neuropsychological testing evaluation services by physician or other qualified healthcare professional, including integration of patient data, interpretation of standardized test results and clinical data, clinical decision making, treatment planning and report, and interactive feedback to the patient, family member(s) or caregiver(s), when performed; first hour
96133	Neuropsychological testing evaluation phys/qhp ea	The first hour of neuropsychological evaluation is billed using 96132 and each additional hour needed to complete the service is billed with code 96133
96136	Psychological and neurological testing phy/qhp 1s	Psychological or neuropsychological test administration/scoring by physician or other qualified healthcare professional, two or more tests, any method; first 30 minutes
96137	Psychological and neurological testing phy/qhp ea	Similar to 96136. This code is used for each additional hour.
96138	Psychological and neurological tech phy/qhp ea	Psychological or neuropsychological test administration/scoring by technician, two or more tests, any method; first 30 minutes
96139	Psychological and neurological testing tech ea	Similar to 96138.
97110	Therapeutic exercises	Foundational, occupational therapy exercises that are designed to improve a patient’s strength, range of motion, endurance, or flexibility.
97112	Neuromuscular re-education	Specific exercises or activities performed and for what purpose, neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, and/or posture.
97116	Gait training therapy	Therapeutic procedure, one or more areas, each 15 minutes; gait training (includes stair climbing).
97161	Physical therapy evaluation	Physical therapy evaluation of low complexity, 20 min
97162	Physical therapy evaluation	Physical therapy evaluation moderate complexity, 30 min
97163	Physical therapy evaluation	Physical therapy evaluation moderate complexity, 30 min
97164	Physical therapy evaluation	Physical therapy re-evaluation establish plan care
97165	Occupational therapy evaluation	Occupational therapy evaluation low complexity, 30 min
97166	Occupational therapy evaluation	Occupational therapy evaluation moderate complexity, 45 min
97167	Occupational therapy evaluation	Occupational therapy evaluation high complexity, 60 min
97168	Occupational therapy	Occupational therapy re-evaluation establish plan care
97535	Self-care management training	Direct one-on-one supervision and instruction regarding activities of daily living related to the patient’s health and hygiene.
97750	Physical performance test	Physical performance test or measurement (e.g., musculoskeletal, functional capacity), with written report, each 15 minutes.
97755	Assistive technology assessment	This procedure is used by the provider to assess the suitability and benefits of technological interfaces that will help restore, augment, or compensate for existing functional ability in the patient.
97760	Orthotic management and training 1st en	Orthotic(s) management and training (including assessment and fitting when not otherwise reported), upper extremity(ies), lower extremity(ies) and/or trunk, initial orthotic(s) encounter, each 15 minutes.
97761	Prosthetic training 1st enc	Prosthetic training, upper and/or lower extremities, initial prosthetic encounter, each 15 minutes
99217	Observation care discharge	This code is used to report all services provided to a patient discharged from outpatient hospital “observation status” if the discharge is on a date other than the initial date of “observation status
99218	Initial observation care	The first visit of the patient’s admission for outpatient hospital observation care by the Admitting/Supervising Physician or Other Qualified Healthcare Professional. Typically, 30 minutes are spent at the bedside and on the patient’s hospital floor or unit.
99219	Initial observation care	Similar to 99218 but, 50 minutes are spent at the bedside and on the patient’s hospital floor or unit.
99220	Initial observation care	Similar to 99218 but, 70 minutes are spent at the bedside and on the patient’s hospital floor or unit.
99221	Initial hospital care	Office or other outpatient visit for the evaluation and management of an established patient that may not require the presence of a physician.
99222	Initial hospital care	Similar to 99221
99223	Initial hospital care	Similar to 99221
99234	Observation/hospital same date	Observation or inpatient care, are used when the patient is placed in observation status or admitted to inpatient status and then discharged on the same date.
99235	Observation/hospital same date	Observation or inpatient care is used when the patient is placed in observation status or admitted to inpatient status and then discharged on the same date.
99236	Observation/hospital same date	Observation or inpatient care is used when the patient is placed in observation status or admitted to inpatient status and then discharged on the same date.
99238	Hospital discharge day	Used when time spent is less than 30 minutes on the discharge process in face-to-face evaluation.
99239	Hospital discharge day	Used when time spent is greater than 30 minutes on the discharge process in face-to-face evaluation.
99281	Emergency department visit	Requires these 3 key components: A problem-focused history; A problem-focused examination; and Straightforward medical decision-making. Usually, the presenting problem(s) are self-limited or minor.
99282	Emergency department visit	Requires these 3 key components: An expanded problem-focused history; An expanded problem-focused examination; and Medical decision-making of low complexity. Usually, the presenting problem(s) are of low to moderate severity.
99283	Emergency department visit	Requires these 3 key components: An expanded problem-focused history; An expanded problem-focused examination; and Medical decision-making of moderate complexity. Usually, the presenting problem(s) are of moderate severity.
99284	Emergency department visit	Requires these 3 key components: A detailed history; A detailed examination; and Medical decision-making of moderate complexity. Usually, the presenting problem(s) are of high severity, and require urgent evaluation by the physician but do not pose an immediate significant threat to life or physiologic function.
99285	Emergency department visit	Usually, the presenting problem(s) are of high severity, and require urgent evaluation by the physician but do not pose an immediate significant threat to life or physiologic function.
99291	Critical care first hour	It is used to report the services of a physician providing full attention to a critically ill or critically injured patient from 30-74 minutes on a given date
99292	Critical care additional 30 mins	Code 99292 (critical care, each additional 30 minutes) is used to report additional block(s) of time, of up to 30 minutes each beyond the first 74 minutes of critical care.
99304	Nursing facility care initial	The problem(s) requiring admission are of low severity. Typically, 25 minutes are spent at the bedside and on the patient’s facility floor or unit.
99305	Nursing facility care initial	The problem(s) requiring admission are of moderate severity. Typically, 35 minutes are spent at the bedside and on the patient’s facility floor or unit.
99306	Nursing facility care initial	The problem(s) requiring admission are of high severity. Typically, 45 minutes are spent at the bedside and on the patient’s facility floor or unit.
99315	Nursing facility discharge day	99315 is for discharge day management 30 minutes or less
99316	Nursing facility discharge day	This code is for discharge day management over 30 minutes
99327	Domiciliary or rest home visit new patient	Domiciliary or rest home visit for the evaluation and management of a new patient. Usually, the presenting problem(s) are of high severity. Typically, 60 minutes are spent face-to-face with the patient and/or family.
99328	Domiciliary or rest home visit new patient	Code used for Evaluation and Management / Domiciliary, rest home (boarding home) or custodial care services. The general guidance for this code is that it is used for new patient assisted living visits, typically 75 minutes.
99334	Domiciliary or rest home visit established patient	This code 99334 is used to reflect the domiciliary or rest home visit for the E/M of an established patient
99335	Domiciliary or rest home visit established patient	Similar to 99334
99336	Domiciliary or rest home visit established patient	Similar to 99334
99337	Domiciliary or rest home visit established patient	Domiciliary or rest home visit for the evaluation and management of an established patient. Usually, the presenting problem(s) are moderate to high severity. Typically, 60 minutes are spent face-to-face with the patient and/or family
99341	Home visit new patient	Home services are provided in a private residence. A home visit cannot be billed by a physician unless the physician was actually present in the beneficiary’s home. Level 1 new patient home visit.
99342	Home visit new patient	Home services are provided in a private residence. A home visit cannot be billed by a physician unless the physician was actually present in the beneficiary’s home. Level 2 new patient home visit.
99343	Home visit new patient	Home services are provided in a private residence. A home visit cannot be billed by a physician unless the physician was actually present in the beneficiary’s home. Level 3 new patient home visit.
99344	Home visit new patient	Home services are provided in a private residence. A home visit cannot be billed by a physician unless the physician was actually present in the beneficiary’s home. Level 4 new patient home visit.
99345	Home visit new patient	Home services are provided in a private residence. A home visit cannot be billed by a physician unless the physician was actually present in the beneficiary’s home.Level 5 new patient home visit.
99347	Home visit established patient	Home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components. A problem-focused interval history; a problem-focused examination; and straightforward medical decision making. Typically, 15 minutes are spent face-to-face with the patient and/or family.
99348	Home visit established patient	Similar to CPT Code 99348. Typically, 25 minutes are spent face-to-face with the patient and/or family.
99349	Home visit established patient	Similar to CPT Code 99348. Typically, 40 minutes are spent face-to-face with the patient and/or family.
99350	Home visit established patient	Similar to CPT Code 99348. Typically, 60 minutes are spent face-to-face with the patient and/or family.
99468	Neonatal critical care initial	Services of directing the inpatient care of a critically ill neonate or infant 28 days or younger.
99469	Neonatal critical care initial	Services of directing the inpatient care of a critically ill neonate or infant 28 days or younger.
99471	Pediatric critical care initial	Initial inpatient pediatric critical care, per day, for the evaluation and management of a critically ill infant or young child, 29 days through 24 months of age
99472	Pediatric critical care initial	Subsequent inpatient pediatric critical care, per day, for the evaluation and management of a critically ill infant or young child, 29 days through 24 months of age
99473	Self-measurement of blood pressure at home education/training	Code 99473 represents the work of training the patient and calibrating the device,
99475	Pediatric critical care ages 2-5 initial	Initial inpatient pediatric critical care, per day, for the evaluation and management of a critically ill infant or young child, 2 through 5 years of age
99476	Pediatric critical care ages 2-5 subsequent	Subsequent inpatient pediatric critical care, per day, for the evaluation and management of a critically ill infant or young child, 2 through 5 years of age
99477	Initial day of hospital care for neonatal care	Initial hospital care of the neonate (28 days or younger) who is not critically ill but requires intensive observation, frequent interventions, and other intensive care services.
99478	Ic low-birthweight infant	Intensive care, per day, for the evaluation and management of the recovering low or very low birth weight infant( < 1500 gm)
99479	Ic low-birthweight infant < 1500-2500 g subsequent	Intensive care, per day, for the evaluation and management of the recovering low or very low birth weight infant( 1500 gm-2500g)
99480	Ic infant pbw 2501-5000 g subsequent	Intensive care, per day, for the evaluation and management of the recovering low or very low birth weight infant(2501g-5000g)
99483	Assessment and care plan cognitive impairment	Assessment of and care planning for a patient with cognitive impairment, requiring an independent historian, in the office or other outpatient, home or domiciliary or rest home

The ongoing pandemic has resulted in an increased workload for healthcare providers across the country. Incorporating telehealth software into an existing practice can allow providers to virtually connect with patients. This can relieve the strain on practice while introducing an additional revenue stream.

HealthViewX Telehealth/Telemedicine Platform helps health systems to align clinical, financial, and operational goals by providing high-quality remote care and enhancing patient-physician collaborations.

References: https://www.beckershospitalreview.com/telehealth/cms-adds-85-more-medicare-services-covered-under-telehealth.html