L&I Claim and Remote Medical Exam Telehealth Service
It’s important that injured workers and medical providers know that telehealth is a valid option for keeping your L&I claim moving forward. Telehealth also allow you to limit exposure for at-risk individuals while respecting social distancing guidelines.
What is Telehealth?
Telehealth allows a person with a work injury to get medical care remotely through a secure high-speed internet connection. On top, Telehealth lets people remain in their local community at an “origination site”. This service gives work injury claimants more access to medical care while avoiding long waits or travel distances. In some circumstances, it also reduces the amount of time that people need to miss from work.
If a workers’ compensation claim and the related medical condition meet certain requirements, then medical providers use telehealth for consultations, follow-up visits and psychotherapy. Moreover, attending physicians can use telehealth for end stage renal disease services or office or other outpatient services. Also, providers can use it for psychiatric intake and assessment, medical management and care team conferences. However, providers cannot use telehealth for a hands-on physical examination such as the report of accident or completing a provider’s initial report. Similarly, they can’t use it to complete an activity prescriptions form (APF).
Getting started with telehealth for your L&I claim
The requirements for authorization of telehealth in a workers’ comp claim are relatively straightforward:
(1) The referring doctor, as well as the telehealth provider, has to have a license to practice medicine and surgery (MD), or chiropractic (DC), or advanced registered nurse practitioner (ARNP). Other acceptable licenses include dentistry (DDS or DMD) osteopathic medicine and surgery (DO), or clinical psychology (PhD, PsyD – cannot refer). Furthermore, licenses such as or naturopathic physician (ND), optometry (OD), or physician assistant (PA) work as well.
(2) The work injury claimant must be able to go to an authorized "origination site". That’s where the telehealth visit will take place. Here, these sites include hospitals, physician offices, petitioner offices, and clinics. They also include nursing facilities, dialysis centers and others.
(3) Throughout the examination, the telehealth provider must control the entire examination.
(4) There must be communication, in real-time, between the provider and the injured worker. The communication can be done over the internet and must have audio and video services.
(5) After the exam, the telehealth provider must submit a written report to summarize the exam. The report includes a statement that says that the provider used telehealth to perform the exam. The report must be sent to the referring provider. The provider also needs to forward a copy Department of Labor and Industries (L&I) or to the third-party administrator (TPA) for a self-insured work injury claim.
L&I claim policy change for telehealth
This week L&I made a temporary change to the telehealth policy in response to the COVID-19 outbreak. L&I is temporarily allowing home to be a valid origination site for telehealth services. The CPT billing codes for this service are 99211, 99212, and 99213. L&I indicated this temporary policy will remain in effect through July 30, 2020 and will update the policy as needed.
Telehealth services do not necessarily require pre-authorization. However, for certain services such as mental health services, for example, you still need to get authorization. I believe that if the L&I informs its workers compensation claim managers regarding telehealth services, then there won’t be many authorization related issues.
Paying for telehealth
When it comes to reimbursement for the telehealth services, both the telehealth provider and the origination site can bill L&I and the TPA. The payment to providers is the same as face-to-face services. The origination site bills services under HCPCS code Q3014. However, they should submit their documents separately from the telehealth providers documentation.
Will this affect my workers’ compensation claim?
Finally, it is very important to note that L&I gave every L&I claim manager instructions to NOT automatically stop time-loss benefits if the restrictions on an APF expire. This change happened because work injury claimants can’t travel and visit their medical providers in person due to COVID-19 precautions. L&I is instructing its claim managers to assess each case individually or consult with supervisors to determine how best to manage the claim during this unusual time. While this applies specifically to telehealth policies, it suggests to me that L&I is trying to enact policies that will help protect work injury victims impacted by the COVID-19 outbreak.