Recommended Telehealth Workflows in NextGen Office Cloud Based EHR

Deliver High Quality Healthcare Anytime, Anywhere, and on any device: desktop, laptop, phone, iPad, Android, Mac etc. using the your NextGen Office patient portal and the built-in, secure Telemedicine feature.

Virtual visits are critical to maintain care continuity during the coronavirus pandemic. Beyond the crisis, patients will not only expect the convenience and autonomy they've grown accustomed to, but will want additional options to engage with their healthcare.

Given this new normal, a telemedicine solution that is part of and built into your EHR and PM is essential. When you add virtual visits to your existing workflow, you optimize your time and enhance efficiency, safety, and convenience for patients.

The NextGen Office cloud based EHR has long had a robust and secure telemedicine option (called E-Visits in NextGen Office) coupled with an intuitive and easy to use patient portal called YourHealthFile.com.

COVID-19 Pandemic Considerations

The COVID-19 pandemic has increased the demand for secure, easy to use telehealth services. While you can use this recommended workflow to document telemedicine in general, this post provides tips to help practices document Coronavirus (COVID-19) cases.

The information in this article is current as of April 1, 2020 and may change as health policy surrounding COVID-19 evolves. Medicare, Medicaid, commercial payers, and states have all taken action to remove policy barriers to telehealth utilization to address this public health emergency.

Telemedicine Process from Start to Finish

1. Schedule the E-Visit (telemed visit)
2. Check the patient in
3. Begin the E-Visit
4. Document the E-Visit in the NextGen Office EHR
5. Bill for the E-Visit in the NextGen Office PM

1. Schedule the E-visit Appointment

Before you can schedule a telemedicine session you need to add E-visit as an Appointment Type in NextGen Office. If you're not familiar how and where to do that click here for a short how-to. Add E-visit Appointment Types

Option 1: The practice schedules the E-visit for the patient

1. Hover over the Schedule menu and select Calendar > Day View.
2. Click the time.
3. Select the E-VISIT appointment type.
4. Search and select the patient's name.
5. Complete the relevant fields and options.
6. Click Save Appointment.

Option 2: Patients can request a telemedicine appointment from their portal. This requires you to enable the patient appointment request option in set up. Once you do you can publish on the portal days and times that are available.

2. Appointment Check-in in Patient Portal

Patient logs in to their patient portal account at YourHealthFile.org

1. On the home page, patients click the Appointment Check-in tile. In this example we see the patient has an appointment at 11:30 AM on 03/03/2020

Once patients are logged in they can complete intake information before joining an e-visit. The intake information is easily customizable by you and can be customized by appointment type. For example, if this is a new patient telemedicine visit the patient can be prompted to complete new patient intake forms as well as enter pertinent medical information. If this is a follow up visit for an established patient you may decide to collect less information upfront from the patient thereby streamlining the intake process.

Some examples::

• Patients can enter HPI and the provider can modify the HPI during the SOAP workflow.
• Patients can enter exposure history and the provider can modify as part of the reason for visit.
• Patients can complete Review of Systems information and the provider can modify during the visit.

Patients can use the navigation menu at the top of the page to review and fill out each form. They can also click a check-in process form link.

To learn more about the NextGen Office cloud based patient portal see this blog post

Clicking NEXT at the top of the page moves the patient through the check-in process. Patients can also use the navigation menu on the left side to select a form to fill out.

Patients can use the check-in process to share information with the provider. This information gets pulled into the Subjective section of the encounter summary in EHR.

In our example, we're showing a customized a Coronavirus (COVID-19) form based on the Respiratory > Cough Chief Complaint Form. Each practice can create as many custom processes/intake forms as they like.

Once the patient is done completing the intake they click Complete Check-in Process. Once they do the e-Visit window automatically opens and the patient is in the telemedicine visit waiting for the provider to join. On the practice side the provider simply clicks the appointment time in the Patient Tracker and the telemedicine visit begins, both the patient and provider can see each other and talk live via a secure connection.

Provider's View of a NextGen Office Telemedicine Visit

Provider can see, chat or talk to the patient and be in the EHR encounter at the same time.

Document an E-visit in EHR

E-visits are documented in EHR using the same templates and tools as an in-person visit.

Subjective

Scroll down to the Subjective section, where you see all of the intake responses that the patient entered during the Patient Portal check-in process. You should enter all information that the patient shares with you about themselves in the Subjective section. You can edit this section as necessary during the encounter.

Objective

The provider enters Objective, Assessment, and Plan information.

Physical Exam

Even though the physical exam is limited to what you can observe over video, you can document any patient-reported vital signs as a SOAP note.

Example: The patient shares that they have been checking their temperature daily and says the highest it has been today is 102.5. You would add this patient-reported observation as a free-text SOAP note (either type or dictate) to Physical Exam. Other vitals can also be documented in this way such as height, weight, and blood pressure. If the patient can show you the thermometer on camera that shows the reading, you could add that reading to Vital Signs in the Objective section.

Other visual exam findings include:

• Constitutional
• Respiratory effort
• Skin pallor or rash
• Psychiatric evaluation (oriented to person, place, or time)
• Other (varies by reason for visit)

You can also use blueprints (templates) or body systems and phrases available in Physical Exam.

Disclaimer

This article provides workflow suggestions for e-visits (telehealth visits) and is not intended to provide clinical, legal, healthcare coding, or billing advice. Clients should verify that the information presented here is still applicable and valid. Additionally, practices should check with their malpractice carrier to verify liability coverage for offering telehealth services.

Diagnosis Coding

There are suggested codes based on the Chief Complaint Form. You can create a custom diagnosis panel in Administration: Diagnosis Panels. We created a custom panel for COVID-19. For a list of ICD-10 codes that you can use for COVID-19, refer to ICD-10 Codes Related to COVID-19.

Plan

In the plan section of your encounter note you'd prescribe medications (in Prescribe) and order labs or tests (in Orders) as you normally would.

Care Plan

You can create a custom care plan in Administration: Care Plans or click Create New. We created a custom care plan for COVID-19.

Patient Instructions

There are built-in patient instructions and patient education by Elsevier, patient instructions are suggested based on diagnosis you choose in the encounter note. The patient instructions are posted to the patient's Patient Portal account in Patient Summary.

Procedure Coding

• There are telehealth parity laws in most states, but they differ from state to state. Check with your commercial payers regarding coverage for telehealth services.
• Use the same E&M codes that you used before and document at the same level. If the code is time-based, evidence of time must be documented.
• Medicare requires modifier 95, indicating that the service rendered was actually performed via telehealth. Check with your commercial payers to determine which modifier they require.
• For COVID-19 testing codes, refer to CPT and HCPCS Codes for COVID-19 Testing.

For a more complete list of Medicare Telemedicine Services please click here

Effective March 6, 2020 and until the public health emergency is over, telehealth visits are considered the same as in-person visits and Medicare pays at the same rate as regular, in-person visits. Check with your commercial payers regarding coverage for telehealth services.

When billing professional claims for nontraditional telehealth services with dates of services on or after March 1, 2020 and for the duration of the public health emergency, Medicare requires:

• Place of Service (POS) equal to what it would have been had the service been furnished in-person (use 11 for Office)
• Modifier 95, indicating that the service rendered was actually performed via telehealth

Check with your commercial payers to determine which modifier they require.

Claims that were already submitted in accordance with the previously published guidance (that required POS = 02) must be corrected and resubmitted by providers. Claims billed with a POS of 02 will be paid at the facility rate.

Pro Tip:  Use Blueprints as a Timesaver

NextGen Office has a time saving tool called Blueprints that will allow a busy healthcare provider to conduct and document patient visits efficiently and quickly. You can use this feature for any encounter. Once you've created your standard or typical note for a particular type of complaint you can save it as a Blueprint and then apply that Blueprint or part of that Blueprint to any patient or encounter. 

As an example, this article presented a typical COVID-19 e-visit and can be saved as a COVID-19 e-visit blueprint for reuse, freeing up time to see more patients. You would probably want not reuse the Subjective information since that will vary greatly patient to patient. But other areas such as the Review and Physical Exam may mostly normal and can be applied to other encounters, allowing you to just document the pertinent positives.

Here's how to Create a Blueprint

1. Click the Encounter # within the current encounter.
2. Below Manage the Encounter Content, click Save as Blueprint.

1. Deselect whichever SOAP sections or notes that you do not want to reuse.
2. Select a Body System (for this example, we select Respiratory).
3. In the Create a New Blueprint field, enter the name of the blueprint (we use COVID-19) and Description.
4. Click Create.

Use a Blueprint

1. Within the new encounter, click Grand Central (where all blueprints are).
2. In the Blueprints section, click the body system (our example uses Respiratory).
3. Click the blueprint name (our example uses COVID-19).
4. Click Import.
5. Click Preview Encounter.

Summary:

NextGen Office cloud based EHR offers a patient portal and telemedicine solution that is easy to use for both patients and providers alike. You can be confident that you're meeting your patients expectations and needs by providing a useful tool that allows them to participate in their care. 

If you have questions about how to use your existing NextGen Office telemedicine solution please contact our support team by sending an email to support1@avsmedical.com or call 877-975-9160 and choose option 2

If you're looking to add a telemedicine and patient portal solution please click the button below to learn more!

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