There’s a temptation with routine eyecare restarting around the nation to put any utilization of telemedicine back on the shelf in optometry. But are there ways to continue to provide remote care for patients to meet their needs for safety and convenience, even as offices are reopen? Our expert guests for this conversation are Dr. Michael Samuels, owner of NC Eye Associates in Apex, North Carolina and founder of MedPhoto Manager, and Dr. Chad Morgan Third Party Committee Member and CAC Leader for the State of North Carolina and the founder of AskTheDoc.Live, a telemedicine platform where patients can be personally triaged by a doctor and educated if they need to seek in person care.
- Dr. Morgan and Dr. Samuels are both strong believers that telemedicine has a place in traditional eyecare going forward. In their practices, they share that they are using telehealth in several different patient situations:
- Triaging red eyes (if a phone call results in the need for a patient to come to the office to be seen, the telemedicine visit cannot be billed if the patient is seen within 24 hours). Dr. Morgan specifically shares his offices’ “Pink Eye Policy” that is in place due to the correlation of red eyes as a symptom of active COVID-19. All red eyes in his practice are triaged via telemedicine first, and if the patient has a fever and a concurrent red eye, they are referred for COVID-19 testing instead of being seen in the office and exposing staff and other patients to potential viral risk.
- Medical follow-up visits to connect with a patient about improvement in their condition after a treatment that had been prescribed for red eyes or styes.
- Contact Lens Checks for routine patients with no complaints or complications to make sure they are happy with comfort and vision, and have no questions about care or insertion/removal.
Several telemedicine platforms exist, and each has their own pros and cons. Dr. Morgan and Dr. Samuels both use Unified Imaging and Dr. Lyerly is utilizing Doxy.me. Dr. Samuels shares that in his practice ease of use is king, and he needed a platform that was simple for his staff and his patients that didn’t require extra downloads or apps. Dr. Morgan put together many of the pros and cons of the most popular available services on the market below:
Payment for telemedicine examinations has been a major concern across the country, but Dr. Morgan and Dr. Samuels both share that their office has had great success with billing and coding visits when following AOA guidelines. Both doctors are utilizing 992XX medical codes with -11 POS (Place of Service) and -95 modifiers for telehealth. As a Third Party Committee Member for North Carolina optometry, Dr. Morgan shares that each insurance is handling telehealth and optometry differently. To ensure payment, he encourages doctors to utilize telemedicine for existing patients to meet the requirements for most insurances (though CMS has stated that for Medicare telemedicine could be billed for new and established patients). In his experience, the virtual check in codes (G2012 and G2010) or the 9944X telephone check codes are creating more issues with payment, and when doctors are using them instead of 992XX codes they are more likely to state that payment for services is not sufficient since these codes only reimburse between $10-15. Another key to payment for your services is to make sure that patients are educated prior to any telemedicine visit about associated costs and applicable copays. Sometimes patients assume if they are talking to the doctor and not in the office, it is not a true doctor’s visit. However, if you are assessing, diagnosing, and prescribing treatment do not undervalue your services and make sure patients are educated about the fees associated with these visits.
Unified Imaging: This free service is simple to use, HIPPA compliant, provides an available summary for download (for reporting purposes in your EHR), and has photo-sharing capabilities.
Doxy.Me: This service is free at its’ basic level but certain extra features (like billing and photo sharing abilities) cost money. It is simple to use and HIPPA compliant and also provides a summary for download.
Eyecare Pro Live: While this service does cost money to utilize, it has several features above and beyond free platforms. It integrates into your EHR, has several tests integrated into the platform including visual acuity testing and a SPEED questionnaire, and has billing and scheduling capabilities inside the platform. It can also be used to instant message patients directly and send medication reminders. The potential con of this platform is that it does require patients to download an app and create an account which for some patients who are not as adept with technology may limit their ability to use this service.
VSee: This service costs $49/month and does integrate into your EHR and includes billing and scheduling functionalities into the platform, in addition to direct patient messaging. Patients do have to download software for this service, however.
Want to learn more? Follow Dr. Samuels at @huddle.health to learn more about the power of anterior segment photography in patient education, and Dr. Chad Morgan at @askthedoc.live to learn more about this new telehealth triaging platform directly connecting patients to optometrists.