Telehealth on iPad. Increasing numbers of procedures are covered by Medicare

Telehealth Visits Show Growth in Benefits for Insureds

Telehealth Update – CMS to Start Covering in Home Monitoring

Telehealth update: Health plans are beginning to offer telemedicine services to their insureds that offer 24/7 access to online doctor visits.  For example, BlueCare is a benefit for most insureds of BlueShield of Louisiana.  As a result, online visits are intended to serve members with non-emergency minor illnesses such as colds (ICD-10 code R09.81 – Nasal congestion).  Also, allergies, bladder infections (for example O86.22 – Infection of bladder following delivery), sinus trouble, mild stomach upsets or rashes.  Due to these developments, patients can have an encounter with a physician via mobile device such as an iPhone, iPad, or Android device, over their desktop computer or laptop.

According to the Center for Connected Health Policy, “Telehealth is a collection of means or methods for enhancing health care, public health, and health education delivery and support using telecommunications technologies. Telehealth encompasses a broad variety of technologies and tactics to deliver virtual medical, health, and education services.”

Although BlueCare offers a limited set of services initially, Telemedicine services that are eligible for coverage under Medicare including the following HCPCS and CPT codes:

  • Telehealth consultations, emergency department or initial inpatient (G0425-G0427). Effective Jan. 1, 2010.
  • Follow-up inpatient telehealth consultations (G0425-G0427). Effective Jan. 1, 2009.
  • Office or other outpatient visits (99201-99215).
  • Subsequent hospital care services, with the limitation of one telehealth visit every three days (CPT codes 99231-99233). Effective Jan. 1, 2011.
  • Subsequent nursing facility care services, with the limitation of one telehealth visit every 30 days (99307-99310). Effective Jan. 1, 2011.
  • Pharmacologic management March 1, 2003 – Dec. 31, 2012 (90862). (G0459) Effective Jan. 1, 2013
  • Individual psychotherapy (90804-90809); Psychiatric diagnostic interview examination (90801). Effective March 1, 2003 – Dec. 1, 2013.
  • Individual psychotherapy (90832-90834, 90836-90838) ; Psychiatric diagnostic interview examination (90791-90792) Effective Jan. 1, 2013.
  • Neurobehavioral status exam (96116). Effective Jan. 1, 2008.
  • End Stage Renal Disease (ESRD) related services (90951, 90952, 90954, 90955, 90957, 90958, 90960, and 90961). Effective Jan. 1, 2009.
  • Individual and group medical nutrition therapy (G0270, 97802-97804). Individual effective Jan. 1, 2006. Group effective Jan. 1, 2011.
  • Individual and group health and behavior assessment and intervention (96150-96154). Individual effective Jan. 1, 2010; group effective Jan. 1, 2011.
  • Individual and group kidney disease education (KDE) services (HCPCS codes G0420-G0421). Effective Jan. 1, 2011.
  • Individual and group diabetes self-management training (DSMT) services, with a minimum of 1 hour of in-person instruction to be furnished in the initial year training period to ensure effective injection training (G0108-G0109). Effective Jan. 1, 2011.
  • Smoking Cessation Services (99406-99407 and G0436-G0437). Effective Jan. 1, 2012.
  • Alcohol and/or substance (other than tobacco) abuse structured assessment and intervention services (G0396-G0397) Effective January 1, 2013.
  • Annual alcohol misuse screening (G0442) Effective January 1, 2013.
  • Brief face-to-face behavioral counseling for alcohol misuse (G0443) Effective January 1, 2013.
  • Annual Depression Screening (G0444) Effective January 1, 2013.
  • High-intensity behavioral counseling to prevent sexually transmitted infections (G0445) Effective January 1, 2013.
  • Annual, face-to-face Intensive behavioral therapy for cardiovascular disease (G0446) Effective January 1, 2013.
  • Face-to-face behavioral counseling for obesity (G0447) Effective January 1, 2013.
  • Transitional Care Management Services (99495-99496) Effective January 1, 2014.

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Michael F. Arrigo

Michael Arrigo, an expert witness, and healthcare executive, brings four decades of experience in the software, financial services, and healthcare industries. In 2000, Mr. Arrigo founded No World Borders, a healthcare data, regulations, and economics firm with clients in the pharmaceutical, medical device, hospital, surgical center, physician group, diagnostic imaging, genetic testing, health I.T., and health insurance markets. His expertise spans the federal health programs Medicare and Medicaid and private insurance. He advises Medicare Advantage Organizations that provide health insurance under Part C of the Medicare Act. Mr. Arrigo serves as an expert witness regarding medical coding and billing, fraud damages, and electronic health record software for the U.S. Department of Justice. He has valued well over $1 billion in medical billings in personal injury liens, malpractice, and insurance fraud cases. The U.S. Court of Appeals considered Mr. Arrigo's opinion regarding loss amounts, vacating, and remanding sentencing in a fraud case. Mr. Arrigo provides expertise in the Medicare Secondary Payer Act, Medicare LCDs, anti-trust litigation, medical intellectual property and trade secrets, HIPAA privacy, health care electronic claim data Standards, physician compensation, Anti-Kickback Statute, Stark law, the Affordable Care Act, False Claims Act, and the ARRA HITECH Act. Arrigo advises investors on merger and acquisition (M&A) diligence in the healthcare industry on transactions cumulatively valued at over $1 billion. Mr. Arrigo spent over ten years in Silicon Valley software firms in roles from Product Manager to CEO. He was product manager for a leading-edge database technology joint venture that became commercialized as Microsoft SQL Server, Vice President of Marketing for a software company when it grew from under $2 million in revenue to a $50 million acquisition by a company now merged into Cincom Systems, hired by private equity investors to serve as Vice President of Marketing for a secure email software company until its acquisition and multi $million investor exit by a company now merged into Axway Software S.A. (Euronext: AXW.PA), and CEO of one of the first cloud-based billing software companies, licensing its technology to Citrix Systems (NASDAQ: CTXS). Later, before entering the healthcare industry, he joined Fortune 500 company Fidelity National Financial (NYSE: FNF) as a Vice President, overseeing eCommerce solutions for the mortgage banking industry. While serving as a Vice President at Fortune 500 company First American Financial (NYSE: FAF), he oversaw eCommerce and regulatory compliance technology initiatives for the top ten mortgage banks and led the Sarbanes Oxley Act Section 302 internal controls I.T. audit for the company, supporting Section 404 of the Sarbanes Oxley Act. Mr. Arrigo earned his Bachelor of Science in Business Administration from the University of Southern California. Before that, he studied computer science, statistics, and economics at the University of California, Irvine. His post-graduate studies include biomedical ethics at Harvard Medical School, biomedical informatics at Stanford Medical School, blockchain and crypto-economics at the Massachusetts Institute of Technology, and training as a Certified Professional Medical Auditor (CPMA). Mr. Arrigo is qualified to serve as a director due to his experience in healthcare data, regulations, and economics, his leadership roles in software and financial services public companies, and his healthcare M&A diligence and public company regulatory experience. Mr. Arrigo is quoted in The Wall Street Journal, Fortune Magazine, Kaiser Health News, Consumer Affairs, National Public Radio (NPR), NBC News Houston, USA Today / Milwaukee Journal Sentinel, Medical Economics, Capitol ForumThe Daily Beast, the Lund Report, Inside Higher Ed, New England Psychologist, and other press and media outlets. He authored a peer-reviewed article regarding clinical documentation quality to support accurate medical coding, billing, and good patient care, published by Healthcare Financial Management Association (HFMA) and published in Healthcare I.T. News. Mr. Arrigo serves as a member of the board of directors of a publicly traded company in the healthcare and data analytics industry, where his duties include: member, audit committee; chair, compensation committee; member, special committee.