As California continues to navigate through the pandemic dentists may still wish to consider using telehealth to reduce in-office patient volume.
Telehealth is the mode of delivering health care services and public health through remote communication technologies to facilitate the diagnosis, consultation, treatment, education, care management, and self-management of a patient’s health care while the patient is at the originating site and the health care provider is at a distant site.
From processing insurance claims to Medi-Cal coverage, here are seven things you need to know about utilizing telehealth services during the COVID-19 crisis:
Prior to a telehealth appointment, providers must inform the patient that telehealth may be used, obtain verbal consent from the patient for this use, and document consent in the patient’s record.
CDA has provided a teledentistry consent and notice form that outlines telehealth risks, benefits, confidentiality, and rights for the patient to review and sign before the virtual visit.
The Office for Civil Rights is temporarily waiving penalties for HIPAA Rule violations against covered health care providers who are using remote communication technologies to serve patients during the COVID-19 pandemic. Under the Notification of Enforcement Discretion for Telehealth Remote Communications During the COVID-19 Nationwide Public Health Emergency, dentists may use nonpublic facing platforms, such as Zoom, Skype, Facetime, and Facebook Messenger to virtually examine patients without the risk of being penalized.
The use of public-facing apps, such a Facebook Live, TikTok, and other platforms that are designed to be opened to the public are not covered by the Notification.
Read more about how the notification applies to your practice in “OCR waiving penalties on remote communications during COVID-19 crisis.”
If the service is one that would otherwise have been provided in person but is now being provided via telehealth, the plans should reimburse for that service as if it were provided in person. An issued March 18 by the Department of Managed Health Care (APL 20-009 – Reimbursement for Telehealth Services) states that plans must reimburse a service provided by telephone at the same rate as services provided via video.
Providers may experience delays when calling dental plans with customer service inquiries, particularly since many plans have transitioned some of their staff to remote work environments. To reduce the risk of slow-pay claims from a dental plan, providers are advised to submit claims electronically through the dental plan's online portal.
Dental offices will find that many dental plans’ online portals provide access to their patients’ eligibility, benefits, treatment history, frequencies, remaining maximums, and deductibles. Information about these portals can be found in the provider/dentist section of the dental plan’s website.
Additionally, dental plans offer payment via electronic funds transfer, which allows for expedited payment to dental practices by directly depositing payments into the designated bank account for the dental practice.
If you are using teledentistry to triage patients or offer an evaluation to determine if the situation is urgent or emergent, then the following CDT codes can be used to document and report the services in the patient’s record and to a third-party payer:
If you are providing teledentistry services, one of the following codes would be reported in addition to those cited above:
The Department of Health Care Services is temporarily allowing Medi-Cal Dental providers to submit claims and be reimbursed for patient consultations by telephone or live streaming video during the COVID-19 crisis.
Medi-Cal Dental providers can use the CDT code D9430 for digital consultations with their patients and will receive the Schedule of Maximum Allowances rate of $20 plus an additional supplemental $12 payment through Proposition 56 revenues. This should be billed in conjunction with D9995 (documented per minute of the consultation.)
The temporary teledentistry exception is in effect until further notice. Find more information in the Medi-Cal Dental Provider handbook.
Documentation for services delivered via telehealth should be the same as in-person service. The patient record must include any telehealth appointments, either electronically or by some other means, in addition to the CDT code that reflects the teledentistry service.
Find more information in the dental billing and telehealth D9995 and D9996 — ADA Guide to Understanding and Documenting Teledentistry Events.