Scheduled, Chargeable Telephone Visits: Quick Reference

PurposeThe intended reference material is provided to MD/APPs rendering services in the Office and Outpatient Clinics in the Ambulatory setting.  Provides a brief overview of requirements and workflow for scheduled Telephone Visits that allow for charging.

Note: Telephone Visit (chargeable) should be utilized by MD/APPs only. Other clinical staff may not have the security to close these encounters and may need to route the encounter to a MD/APP for closing. Telephone Call (no charge) should be utilized by all other clinical staff for scheduled telephone calls.

DefinitionProvider connects directly with patient in real-time via telephone, e.g., with patient at home, to conduct phone visit in lieu of face-to-face.

Patients: Are registered Duke patients with working telephone number(s) Meet clinical criteria for a phone visit (i.e., no hands-on interaction) or would benefit from use of phone

Providers/Clinicians: Will be activated for clinic DEP(s) in which they normally see clinic patients Should conduct telephone visits in private space with limited noise or distractions, compliant w/ HIPAA Ask patients to provide name plus two patient identifiers to verify the patient’s identity (i.e. name, DOB)

Scheduling Non-Video Visit Appointments Use special “TELEPHONE VISIT (CHARGEABLE)” visit type to schedule these calls. (NOTE:

Providers can still continue to use “on-the-fly” Telephone encounters; see Alternate Workflow below.) Providers can designate which patients can be converted to Phone Visits, following clinic-specific

workflow for offering patients this option (e.g., Front Desk calling patients identified by providers)

For clinics that previously scheduled telephone calls (pre-anesthesia surgical screening, et al.), that visit type will still be available and renamed Telephone Call (No Charge).

Version: 2.5 1 Date: March 2020

Day of Appointment The chargeable telephone visit will display on multi-provider schedule and should follow the same

process to have the visit arrived by the front desk staff.o Note the difference between the two different types of scheduled telephone visits

Click on appointment to open encounter; when ready, call patient by phone at the appointed start time. The encounter type will be set as Telemedicine.

Documentation, Dx, Charge Capture, and Closing the Encounter Document encounter as per usual, but include this SmartPhrase to capture verbal consent, patient ID,

privacy check & time-based coding: .TELEPHONEVISITCONSENTPRIVACYIDTIMECODING o This telephone encounter was conducted with the patient's (or proxy's) verbal consent via audio

telecommunications.  o Patient was instructed to have this encounter in a suitably private space; and to only have

persons present to whom they give permission to participate. IIn addition, patient identity was confirmed by use of name plus two identifiers (date of birth and address).

o I spent a total of {Time; 1 min - 3 hour:19605} minutes with the patient, over half of which was spent counseling and/or coordinating care related to {counseling:60259} for the patient's ***.

If entering orders (meds, referrals, labs or imaging), do this as usual (e.g., labs would have to be entered as Future orders); but if there are other after-visit to-dos (e.g., f/up appt scheduling) normally handled by Front Desk on check-out, route these in same way you might if you were out of clinic and responding to a patient message

o After Visit Summary will be available to the patient in MyChart after the encounter is closed Document charges using Charge Capture menu: Telehealth/Non Video

o Patient Initiated – PHONE Eval by MD/APP; can also use Telehealth Easy Button if unsure

NOTE: Normally, in order to close the encounter and route charges, the patient will need to be arrived in the schedule, but this can be done AFTER the visit is completed (within 72 hours). Also note the ‘No Charge’ option and Telehealth Easy Button if you unsure of what code to select.

Version: 2.5 2 Date: March 2020

Additional Tips

You don’t have to wait for patient to “Arrive.” You can still start encounter and documentation by clicking “Start the Visit.” This does NOT arrive visit but still provides the correct navigator and charge capture. The visits must be arrived within 72 hours of the call.

If you cannot close the encounter. Once you complete your documentation and attempt to close the encounter, if you receive an error message “This type of encounter cannot be closed,” go back and a) confirm you have enter a diagnosis, and then b) go to the Virtual Progress Note and set the option to “Sign on saving note” and click Accept. This should force the conversion of your encounter to enable you to sign and close the visit.

When these visits are scheduled in Hospital Outpatient Departments, the encounter type will be Hospital Encounter. These require a level of service (LOS) in order to close the encounter. Clinicians should still select the applicable phone code from the charge preference list but also select a No Charge code for the LOS to meet this requirement.

In the event that a patient does not participate in the scheduled Telephone Visit, the visit should be un-arrived or marked as a No Show. IF the provider has already begun documentation on the encounter, the erroneous smartset should be used to clear the encounter from the patient record.

Version: 2.5 3 Date: March 2020

Incorporating Trainees in Telephone Visits Residents and fellows can also participate in telehealth encounters. These should be scheduled with

individual trainees, documented using the same SmartPhrase, and encounters routed to supervising physicians like in-person visits are (using Send Chart in Follow-up section) for review and closing.

Alternate Workflow For those that do not have Front Desk staff available to schedule and arrive appointments OR for after-

hours use, a Telephone Encounter can still be created “on the fly” and documented. In order to flag these for charging later, the Reason for Call must be updated to include reason “Replace Face to Face” or “COVID-19”; either of these will flag the encounter for review and enable possible manual charge submissions at a later time.

This new report is available in “My Reports Library”, AMB1249A-005. This will allow tracking of unscheduled telephone calls that have used this alternative workflow.

Version: 2.5 4 Date: March 2020