By Mitzi R. Norris, Ph.D., and Elizabeth G. Franklin, Ph.D., CHCP, University of Mississippi Medical Center
In over half of Mississippi’s 82 counties, patients must drive more than 40 minutes to receive specialty healthcare. Without access to quality care, any state would find itself falling short of national health standards. The Center for Telehealth at the University of Mississippi Medical Center in Jackson, Mississippi, has been the bridge to improve the availability of medical services in our state.
Using online video technology, UMMC provides remote medical care, health education and public health services through telehealth. The Center for Telehealth offers telemedicine, wellness care, disaster response, workforce development, business development, research and education to people in all parts of our state. Since the telehealth program began in 2003, more than half a million rural Mississippians have received the treatment they need. Telehealth services now include over 30 different medical specialties, including adult and pediatric specialties, and extend to more than 100 clinical sites.
Providing citizens of a largely rural state improved emergency medical services and specialty healthcare through telemedicine technology, UMMC’s Center for Telehealth is eliminating barriers to quality health care for Mississippians. However, even though telehealth is eliminating barriers to healthcare, there remain barriers and gaps that quality continuing education for health professions can address.
When the Division of Continuing Health Professional Education (CHPE) discussed ways to assist telehealth efforts across our state, we were told that many rural clinics and potential sites are hesitant to contract with UMMC because they do not understand the reimbursement model. In 2013, the Mississippi state legislature unanimously passed SB 2209 to reimburse for telemedicine at the same rate as in-person care. The legislature followed up in 2014, voting unanimously again this time in SB 2646 to cover Remote Patient Monitoring and Store & Forward telehealth. Mississippi is one of 29 states that has legislation mandating telehealth reimbursement from private payors at the same rate as in-person care and one of 48 states that has some level of Medicaid coverage for telemedicine. Mississippi’s laws requiring telemedicine parity by both private and public payors have been nationally recognized, receiving a grade of “A” from the American Telemedicine Association (ATA): https://www.mstelehealth.org/policy.
Since knowledge gaps in coding for telehealth reimbursements existed, the telehealth experts wanted potential or existing clinical sites to know how supportive Mississippi law is for telehealth reimbursement. The premise was that if sites knew the proper coding procedures for reimbursement, the sites would be more likely to contract with the state’s only academic medical center for telehealth services. Provision of this information would eliminate barriers and more rural sites would participate in the telehealth program. As a result, healthcare and education would reach more of the rural population.
CHPE agreed to plan and make available this educational reimbursement information but considered the question, “What educational format should we use?”
CHPE knew it was imperative to adhere to principles of andragogy, specifically that adult learners are most interested in subjects that have immediate relevance and impact to their job or personal life (https://elearningindustry.com/the-adult-learning-theory-andragogy-of-malcolm-knowles).
An animated handwashing educational video had been used in the hospital to encourage handwashing. After use of the video, the clinical quality report card indicated substantial improvements in handwashing. Therefore, animation was explored as an option to deliver the educational content.
CHPE collaborated with Media Services Department, telehealth staff, revenue cycle and coding personnel to write a script with accurate content and brought the information to life using animation and voiceover. The modules were divided into three to four minute animated videos. The objectives for the sessions were:
- Discuss MS SB 2209 and Telehealth Reimbursement Mandates.
- Differentiate between Telemedicine and Telehealth.
- Discuss Medicare restrictions for TH services.
- List the four steps to check for reimbursement eligibility.
- Compare each site’s responsibility to bill services with regard to telehealth services.
- Interpret remittance advice messages after a denial.
- Utilize proper codes for reimbursement.
Initial feedback of the modules revealed high satisfaction with the content and the format but, more importantly, 60 percent of participants reported they could perform the objectives “Extremely Well” and 35 percent reported they could perform them “Well.” Only 2 percent reported “moderate” and none reported “minimal or not at all.” See Figure 1.
Comments and responses also revealed a high degree of intent to utilize the information.
Examples are listed below.
1. How do you plan to use the information from the Telehealth Reimbursement Modules in your present position?
- Increase staff understanding of telehealth reimbursement
- Increase services provided
- Increase revenue collected
2. Do you plan to change any of your current practices after viewing?
- Yes—Resulting in more services offered and more revenue collected—both by the rural site and for UMMC as well.
- Yes! I can share this information with new site users in the onboarding process; it is a great resource! Thank you!
3. Comments were:
- Two thumbs up—Simple and comprehensive
- Good resource for facility billers
- Well-presented and reasonable length
Examples from Telehealth Reimbursement Coding Animated Educational Module
Institutions with fewer resources may not have access to an animation expert or media team. To overcome this barrier, animation software platforms were reviewed. Some options allow utilizing animation in education with little more difficulty than creating a PowerPoint slide. Several options were examined by our team, but the one we chose was PowToon (PowToon.com).
Though several provide a free version for trial runs, we chose the education tier pricing for PowToon, which seemed the most user friendly and provided several useful template and “just in time” hints while building the module. Participants in our session at the 2017 Alliance Annual Meeting suggested this format be used, not only for continuing education, but also for housekeeping announcements at events, for providing credit information, disclosures and other essential pieces, which are often read or printed without much attention from the audience. Starting the day with a unique platform for information delivery might increase audience engagement throughout the event.
Examples of Other Use in CPD Activities
"Policy." Mississippi Telehealth Association. N.p., n.d. Web. 25 Apr. 2017.
Pappas, Christopher. “The Adult Learning Theory - Andragogy - of Malcolm Knowles.”
E-Learning Industry, 9 May 2003. Web. 25 April 2017. https://elearningindustry.com/the-adult-learning-theory-andragogy-of-malcolm-knowles