Temporary Guidance on Telehealth for Workers’ Compensation

Wednesday, April 01, 2020 | 11:22am

Is telehealth allowed in workers' compensation in Tennessee?

During this period, in accordance with the national emergency, telehealth visits may be used by all providers to provide appropriate care continuation and to improve functional considerations for established patients.  For initial visits or new patients, appropriate care can be rendered via telehealth as well.  The Bureau follows CMS, DEA, CDC and OCR recommendations. As there are very frequent changes, please check the CMS announcement at least daily for now: https://www.cms.gov/files/document/covid19-emergency-declaration-health-care-providers-fact-sheet.pdf.

How do the patient and the provider utilize telehealth?

As a result of the current emergency relaxation of certain HIPAA regulations, visits may be by telephone only or by unsecure or secure video/audio links with the express agreement/permission of the patient and the provider.

What are the requirements for the provider?

Although recommended to have the appropriate Tennessee license(s), certain requirements have been waived by the national agencies for certain qualified providers.   If care is being rendered by a practitioner without a Tennessee license to a Tennessee claimant, please refer to the applicable state licensing boards.  Scope of practice requirements remain in effect for any provider rendering care to a claimant under the Tennessee Workers’ Compensation Law.

What are the requirements for the injured worker/patient?

A satisfactory telephone or telehealth link can be established, and the patient must acknowledge this to the provider.  See: https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet.

What about Privacy?

Certain telecommunications applications not previously allowed may be used during this period, such as Skype, Facetime, etc.  It is anticipated that the provider will still make all good faith efforts to protect patient privacy.  All persons who are present or can hear during a telehealth visits should be disclosed and acceptable to both the patient and the provider.  The specific enforcement discretion from the Office of Civil Rights may be found at: https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet.

What are the record keeping requirements for the provider?

Records should be kept as if the visit were in-person, reviewing pertinent information and documenting all interactions and recommendations/orders.  It is anticipated that demographic data on new patients will require extended time.  See CMS coding guidance for different types of visits. Appropriate consent for the type of communications must be documented.

How does the provider bill the payer?

The providers may bill using the standard appropriate billing forms in accordance with CMS guidance. The applicable codes for CPT® recognized procedures are available at: https://www.ama-assn.org/system/files/2020-03/cpt-reporting-covid-19-testing.pdf

Further information specifically for physicians may be found at: https://www.ama-assn.org/system/files/2020-03/covid-19-coding-advice.pdf.

A modifier should be added to the appropriate CPT® code and a location code. Since these have not been standardized by different insurers, check the CMS website for guidance for each particular type of communications.

How should the payer reimburse providers?

Once the bill and supporting documents have been received, coverage verified and care accepted as payable, the bill should be paid at the Medicare rate in effect for that date of service by applying the current Tennessee Workers’ Compensation Medical Fee Schedule conversion percentages found in  Chapters 0800-02-17, 0800-02-18 and 0800-02-19, https://publications.tnsosfiles.com/rules/0800/0800.htm.

Other payment rules remain in effect.  It is anticipated that payment for properly billed services will be made without undue delay.   Payment for services rendered under these emergency circumstances should include “telephone-only” services.  All codes recognized and payable by CMS in accordance with the current CPT® descriptors should be paid.

In accordance with T.C.A. §50-6-215, the Bureau will investigate complaints concerning discounts taken in violation of this statute.

Other questions?

Please e-mail WCCompliance@tn.gov or the Medical Director at robert.b.snyder@tn.gov.