►
Description
House Insurance Subcommittee - February 15, 2022 - House Hearing Room 2
A
A
I
just
walked
across
from
the
tennessee
tower
and-
and
I
would
encourage
everyone
after
you
hear
all
of
our
business
here-
to
go
out
and
take
a
breath
of
fresh
air,
so
miss
adams.
Could
you
please
call
the
roll.
A
With
that
said,
we
have
a
calendar
before
us.
We
have
item
number
one
is
house
bill,
2655
that
I
will
be
presenting
so
I'll
hand
the
hand
the
gavel
off
to
dr
kumar.
A
A
What
this
piece
of
legislation
will
do,
we'll
remove
the
sunset
from
the
current
telehealth
procedures
and
just
allow
telehealth
to
continue
in
the
state
of
tennessee.
It's
my
understanding
that
all
folks
are
on
board
and
I
believe
this
keeps
our
our
patients
and
our
medical
providers
in
a
good
place.
So
with
that
brief
explanation,
mr
chairman
and
members.
E
Thank
you,
chairman
hawk.
Thank
you
for
bringing
this.
Certainly,
the
pandemic
was
a
devastating
event
for
of
our
times,
but
it
did
have
some
positive
outcomes,
and
that
was
one
to
realize
that
telemedicine
can
be
very
helpful,
facilitate
patient
care,
make
it
more
convenient,
but
at
the
same
time
avoid
spread
of
infection
as
well
as
having
to
sit
in
a
doctor's
office
to
read
all
magazines.
E
A
A
F
Thank
you,
chairman
and
committee.
This
bill
house
bill
1843
simply
adds
health
care
services
to
current
telemedicine
practices
that
allow
audio
only
for
behavioral
health
services.
Currently
in
the
state,
cms
recognizes
audio
only
health
services,
and
this
bill
would
like
tennessee
up
with
what
cms
is
currently
recognizing,
and
with
that
I
believe
there
are
some
folks
that
may
want
to
testify,
or
I
stand
ready
to
answer
any
questions.
A
A
Forgive
me
chairman
hicks,
you
are
recognized.
Thank
you,
mr
chairman,
and.
F
F
So
the
key
there's
established
patient
parent
or
guardian
not
originating
from
a
related
e
m
service
provided
with
the
within
the
previous
seven
days,
nor
leading
to
an
e
m
service
or
procedure
within
the
next
24
hours
or
soonest
available
appointment,
and
that
that's
the
the
lowest
ones
that
they
have
out
there
for
physicians,
and
it
requires
five
to
ten
minutes
worth
of
medical
discussion.
F
Of
course,
you
document
your
evaluation
of
them
and
your
management
that
you
did
in
order
to
meet
that
criteria.
There's
other
codes
that
are
greater
than
10
between
10
and
20
minutes
is
other
20
to
30
minutes
an
example
that
you
may
have
of
a
a
patient
that
is
currently
under
your
care.
Maybe
somebody's
got
diabetes
and
your
you
follow
them
their
established
patient
and
say
they
have.
F
You
know
you're
always
concerned
about
diabetic
foot
ulcers,
but
say
they
step
on
something
or
they
cut
themselves
and
they
initiate
the
the
call
to
your
office
and
you
during
that
time
evaluate
you
know.
What
did
you
step
on?
Do
you
have
a
tetanus
shot?
F
F
But
if
your
evaluation
management
is
maybe
I
need
to
call
you
in
an
antibiotic,
then
that
would
be
part
of
that
process
so,
and
you
could
bill
for
that,
if
you
don't,
if
they
don't,
follow
up
and
come
into
your
office
and
have
a
conflicting
code
at
that
point
in
time,
so
that
may
be
something
that
a
patient
could
have
I'd
say
something
from
a
personal
standpoint
that
that
has
has
occurred.
F
My
mom
she's
gonna
be
84
this
month,
followed
by
her.
Her
physician
had
coveted
and
had
some
issues.
She
had
not
not
seen
him,
for
that
said,
not
had
a
visit
for
that,
but
she
had
some
issues
with
dehydration
and
confusion,
and
so
she
did.
She
was
not
did
not
have
audio
vid
video
readily
available
to
her,
but
we
were
able
to
get
a
conversation,
get
her
evaluated
and
a
management
taken
at
that
for
her
at
that
point
in
time,
and
we
did
not
have
to
go
back
in
for
something.
C
So
let
me
give
another
example:
another
hypothetical
I've,
my
six-year-old
so
let's
say
she
starts
showing
symptoms
a
cold,
and
so
we
call
her
pediatrician,
and
so
we
talk
to
a
nurse.
Obviously
a
nurse
calls
us
back
at
that
point.
The
nurses
probably
reached
out
to
the
pediatrician
got
guidance,
and
then
they
call
us
back
and
say
here's
what
the
doctor
says
you
should
do.
F
That
may
be
a
great
question
when
we
go
out
of
of
session,
but
from
that
perspective
again
a
greater
than
five
minute
evaluation.
You've
generated
it
to
the
provider.
The
provider
is
speaking
to
you
doing
the
evaluation
you're
the
guardian.
So
this
says
that
the
guardian
could
do
that.
F
So
you'd
be
the
guardian
that
called,
and
if
you
meet
that
criteria,
you've
been
more
than
five
minutes
with
them
in
this
first
code's
five
to
ten
minutes,
then
it
could
potentially
generate
that
if
it,
if
it
doesn't
meet
that
criteria,
then
it
would
not
impact
what
you
did
if
the
nurse
just
said
hey
this
person's
got,
you
know
whatever
you
call
something
in
that,
wouldn't
generate
this
code
and
again,
if,
if
you
don't
meet
the
criteria
for
this
code,
it's
going
to
get
rejected
and
so
understand
that
these
aren't
the
high
paying
codes
or
higher
paying
office
visit
codes
that
are
out
there,
and
so,
if
it
gets
denied-
and
you
haven't-
met
these
criteria,
it's
going
to
cost
you
more
to
go
through
that
process
and
go
through
that
denial
than
it
is
to
meet
all
the
criteria.
F
A
I
do
want
to
go
down
that
that
road,
a
little
bit
with
you,
dr
chair,
if
I
could,
I
think
I
heard
you
mention
within
a
seven
day
time
frame
within
the
previous
seven
days,
and
I
I'll
use
the
example
of
us
traveling
traveling
here
to
nashville
we're
back
home
on
friday,
go
for
xyz
and
drive
down
here
monday,
tuesday.
We
get
a
consultation,
a
phone
call
back.
A
F
Great
question:
what
you're
asking
there
is
essentially
what's
called
a
follow-up
call
and
that's
something
that
we
even
do
in
in
the
operating
room
or
in
the
or
we
will
follow
up.
How
did
your
visit
go?
How
are
you
doing?
That's
not
something
that
would
fall
under
this
this.
What
you're
talking
about
something
that's
generated
by
the
office?
That's
not
what
this
is.
It
would
have
to
be
something
not
related
within
the
previous
seven
days
generated
by
the
patient.
A
Okay
sounds
good,
I
think
that
gets
there.
We
do
have
several
folks
on
the
list
who
would
like
to
testify
and
comment
on
this
piece
of
legislation.
I
will
read
them
off
in
order
that
I
have
them.
We
have
mark
siddig
who's,
a
medical
doctor
with
tennessee
oncology.
We
have
julie
griffin
with
tennessee
medical
association.
A
We
have
lacey
blair
with
the
tennessee
hospital
association
and
joe
birchfield
with
tennessee
hospital
association
I'll.
Let
you
all
duke
it
out
who
wants
to
fight
to
come
up
to
the
podium
on
that
one,
and
we
have
ben
sanders
with
farm
bureau
insurance
for
tennessee,
so
any
questions
at
the
moment
without
any
we
will
go
into
recess
and
dr
sittig,
if
you
are
here
and
forgive
me,
if
I
have
butchered
your
name,
feel
free
to
come
to
the
table
and
yeah,
you
can
bring
julie
with
you.
There.
A
Set
the
parameters
for
for
the
group,
we
would
like
to
keep
testimony
to
three
minutes
and
we
will
have
question
and
answer
as
long
as
we
need
to
go
after
that.
So,
dr
dr
sithik,
you
are
recognized.
G
A
G
Very
much
good
afternoon,
my
name
is
dr
mark
siddig.
I'm
a
board-certified
radiation
oncologist
practicing
with
tennessee
oncology.
Our
practice.
H
G
That's
quite
the
introduction.
Our
practice
provides
care
for
nearly
half
of
cancer
patients
in
the
state
of
tennessee
across
34
clinic
locations
in
both
rural
and
urban
settings.
I'm
also
a
member
of
the
tennessee
medical
association
and
a
treasurer
for
the
tennessee
oncology
practice
society.
A
group
representing
community
oncology,
physicians
across
the
state.
I
appreciate
the
opportunity
to
speak
to
you
today
about
the
importance
of
audio.
G
Only
telehealth
visits
for
our
patients,
like
dr
kumar
mentioned,
there's
been
a
lot
of
changes
during
the
covid19
pandemic,
one
of
the
favorable
ones
in
my
clinical
experience
has
been
the
implementation
of
telehealth,
both
audio
visual
and
audio.
Only
this
has
improved
the
continuity
of
care
between
my
myself
and
my
patients.
G
I'd
like
to
share
with
the
committee
two
cases
that
I
think
exemplify
the
importance
of
this
particular
issue.
The
first
is
a
92
year
old
woman.
I
had
the
pleasure
of
taking
care
of
mrs
h
a
lady
with
renal
failure
on
dialysis,
which
is
a
three
time
a
week
operation
if
you're
not
familiar.
She
came
to
me
with
a
newly
diagnosed
rectal
cancer
with
symptoms
and
needed
a
short
course
of
radiotherapy
to
palliate
her
symptoms
following
the
completion
of
her
treatment.
G
I
needed
to
follow
up
with
her,
but
she
lived
approximately
50
miles
away
and
relied
on
family
members.
Additionally,
due
to
her
medical
comorbidities,
skipping
dialysis
appointments
in
order
to
travel
to
me
for
follow-up
visits,
which
could
be
conducted
appropriately
over
the
telephone
were
not
in
her
best
interest.
So
I
was
able
to
follow
up
with
her
easily
over
the
phone
she's
able
to
give
me
her,
thankfully,
her
lack
of
symptoms
and
her
good
response
to
treatment,
and
I
was
able
to
see
her
in
person
at
a
subsequent
date
and
saved
her
time.
G
The
second
case
is
mr
m,
a
delightful
gentleman
66
years
old,
with
a
low-risk,
prostate
cancer
which
we
follow
with
serial
blood
tests,
called
psa,
he
elected
to
pursue
active
surveillance
instead
of
treatment.
So
as
part
of
his
treatment,
we
were
following
his
blood
values
as
a
small
business
owner.
He
frequently
traveled
about
the
state
and
required
regular
blood
monitoring
in
order
to
follow
up
over
the
telephone.
I
saved
him
time
from
coming
into
the
office.
G
Audio.
Only
telehealth
is
important
in
in
in
comparison
to
audio
vid
video,
because
we
know
in
our
practice
about
half
of
patients
do
not
have
access
to
the
video
component
of
the
technology
that
may
be
due
to
lack
of
broadband
access,
lack
of
smartphone
or
ipad
technology
or
difficulty
with
these
technologies.
G
Additionally,
a
lot
of
my
patients
require
time
to
travel
either
from
loved
ones
or
taking
public
transportation.
So
tell
audio
only
to
health
is
a
great
tool
in
our
repertoire.
A
Thank
you
very
much
doctor.
I
appreciate
that
ready
for
me
julie,
mr
griffin,
please
and
forgive
me
that
sunshine's
fried
my
brain
a
little
bit,
I'm
a
little
off
kilter
today.
So
forgive
me
julie,
miss
griffin!
If
you
could,
please
tell
us
who
you
are
and
who
you're
with
and
begin
your
three
minutes.
H
H
Luckily
I
have
an
ipad
here,
but
they
may
not
have
that.
There's
people
out
there
who
can't
afford
the
technology,
the
smartphones
that
are
you,
know,
a
thousand
dollars
a
pop
we
want
to.
We
want
to
create
an
environment
where,
if
it
would
have
been
appropriate
to
do
it,
audio
video
and
it
can
be
done
at
the
same
standard
of
care
as
it
would
be
done
if
it
was
the
video
component.
Was
there
that's
when
we
want
to
allow
that
patient
that
doesn't
have
access
to
have
the
the
audio
component?
H
H
It
has
to
be
medically
necessary.
You
have
to
document
in
the
charts
that
that
e
m
code,
as
we
call
it
for
evaluation
and
management
code,
has
to
be
medically
necessary
and
meet
the
requirements
of
what's
medically
necessary
according
to
cms
and
according
to
the
the
insurer.
If
it
doesn't
rise
to
that
level,
it
does
not
rise
the
level
of
being
able
to
bill,
and
so
we're
talking
about
a
very
small
number
of
audio
only
calls
that
we're
going
to
be
talking
about.
H
You
know
maybe
one
of
the
the
supporters
of
this
bill,
and
I
probably
shouldn't
speak
on
their
behalf,
but
the
disability
coalition,
when
I've
got
a
copy
of
an
email
from
the
disability
coalition
talking
about
the
visually
impaired,
and
they
can't
necessarily
do
the
the
audio
video.
So
this
is
what
the
this
is.
What
this
bill
is
designed
to
help.
We
are
not
trying
to
do
anything.
That's
going
to
increase
just
when
a
doctor
wants
to
just
bill.
That
is
not
the
intent
and
I
think
the
way
the
bill
is
drafted.
H
It
couldn't
be
done
that
way.
We're
following
we
follow
the
cms
guidelines.
We
have
to
follow
the
rules
of
the
the
payers,
and
I
think
that
it's
just
something
to
add
to
those
patients
who
are
not
as
fortunate
as
I
am
to
have
the
technology
that
I
need,
or
not
as
fortunate
that
I
can
live
in
an
area
where
the
broadband
service
is
available
to
them
and
that's
what
we're
trying
to
do.
A
I
Thank
you
chairman,
and
thank
you,
dr
siddig
and
mrs
griffin.
I
just
want
to
make
sure
that
everyone
understands
in
the
current
code
what
what
you
all
are
doing
is
is
essentially
adding
to
it's
already
a
option
when
someone
has
behavioral
health.
This
is
just
adding
healthcare
services,
but
it
specifically
says
that
when,
when
the
video
component
is
not
available,
so
it's
already
in
code
that
this
is
a
default,
not
a
preferred
method.
I
Is
that
correct,
absolutely,
and
if
I
could,
mr
chairman,
follow
up
if
you
wouldn't
mind
just
to
revisit
that
again
about
the
the
charting,
because
I
think
that
we
want
to
make
sure
that
not
only
is
this
not
a
preferred
method
rather
than
a
default
method,
but
also
that
people
aren't
taking
the
opportunity
to
to
code
up
a
little
bit,
and
I
know
I
know
the
intricacies
of
that-
and
I
know
the
arguments
around
that
I
just
want
it
read
into
the
record
for
the
purpose
of
legislative
intent.
Thank
you,
mr
chairman.
G
That's
a
great
question.
Thank
you.
So
in
my
practice
I
utilize
time-based
billing
for
my
telehealth
encounters.
So
when
I
pick
up
the
phone
to
answer,
a
patient
call
because
the
patient
originated
the
phone
call,
a
timer
is
available
on
the
same
phone.
That
is
probably
in
your
office,
and
it
tells
you
how
long
you're
on
the
phone
call.
I
then
have
to
go
document
that
encounter
for.
G
However,
many
minutes
that
takes
after
we
hang
up
the
phone
and
the
same
documentation
process
that
would
apply
is,
if
I
just
exited
the
clinic
exam
room
and
walked
back
to
my
office.
So
if,
if
there
were
an
unscrupulous
physician
who
were
perhaps
doing
a
number
of
these
encounters
in
order
to
maximize
some
sort
of
charge,
you
would
still
they
would
still
be
held
to
the
same
standard
that
we
are
in
terms
of
the
time
that's
required
and
the
documentation
that
would
be
required
in
the
medical
record
system
and.
H
H
This
is
the
the
follow-up
from
that
I've.
I
think
we're
going
to
have
to
follow
up
with
more
testing
whatever
that
is.
It
has
to
be
documented
everything
that
was
discussed
in
that
encounter
to
rise
to
the
level
of
the
documentation
allowed
for
that
five
to
ten
minute
call
or
ten
to
twenty
and
such.
I
Thank
you
chairman,
and
this
would,
when
you
talk
about
tracking
time,
this
would
be
very
much
applicable
in
the
world
of
attorneys,
whether
they're
riding
down
the
road
or
whether
you're
face
to
face
with
them
in
their
office.
They're
billing
you
for
time,
would
that
be
a
fair
comparison.
G
I
in
my
yeah
as
a
non-attorney.
I
think
that
would
be
fair
yeah,
but
you
know
just
to
re-emphasize:
it's
not
just
the
time
element
as
I
imagine.
An
attorney
would
have
to
demonstrate
their
work
product
that
took
that
hour
or
two
hours.
Similarly,
my
clinical
notes
would
reflect
kind
of
a
discussion
that
lasted
five
minutes
or
10
minutes
or
15
minutes,
and
support
that
that
time
code.
C
Thank
you,
mr
chairman,
miss
griffin.
You
mentioned
that
this
would
be
if
this
bill's
enacted,
then
it
would,
it
would
be
a
rare,
or
at
least
a
seldomly
used
occurrence.
C
What
gives
you
the
the
knowledge
or
the
the
to
to
actually
say
that?
Why
do
you?
Why
do
you
believe
that.
G
This
is
because
there
are
people
that
have
a
limited
symptom
burden
that
do
not
have
symptoms
that
would
benefit
from
being
seen
face
to
face
or
for
a
physical
exam
for
patients
that
do
have
those
issues.
Certainly,
in
my
discretion
I
would
not
want
them
to
be
followed
up
over
the
telephone
and
it
would
rely
on
the
physician's
good
discretion
that
it
was
an
appropriate
audio
only
encounter
again
when
video
wasn't
available.
C
Oncologist:
okay,
okay,
I
would,
I
would
say,
probably
a
large
percentage
of
your
patients
in
in
comparison
with
other
specialists.
Maybe
you
might
have
a
larger
percentage
of
patients
in
need
of
audio
only.
C
Okay,
okay,
then
also
the
in
the
example
of
the
I
think
you
were
answering
chairman
hicks
on
you
know,
talking
about
his
child
and
and
having
colin
and
so
talking
about,
and
he
calls
nurse
answers
which
is
typical,
and
you
goes
to
the
physician
to
ask
the
question
then
comes
back.
What,
if
the
nurse
him
herself
would
make
a
judgment
call
would
that
be
also
covered.
H
H
H
H
H
H
C
H
Advanced
practice,
nurses
would
can
do
telehealth
visits
now
they
work
under
protocols
and
formularies
by
a
physician,
so
they
are
allowed
to
diagnose
and
treat
certain
types
of
conditions
they
can
do
follow-ups
for
for
physicians.
I
know
in
some
of
my
recent
episodes.
I've
had
advanced
practice.
Nurses
follow
up,
none
to
the
point
of
which
I
think
would
rise
to
the
level
of
what
we're
talking
about
here
today.
H
They
don't-
and
I
shouldn't
say
this
with
my
physician
sitting
beside
me,
but
I
don't
think
they
really
love
telehealth,
but
they
know
that
if
it
helps
the
patient
be
more
compliant
helps
the
patient
get
the
care
that
they
need,
because
they
don't
have
access.
That's
why
they
want
to
use
it.
That's
why
we're
here
today?
H
That's
why
we
put
into
the
st
you
know
when
we're
working
with
general
assembly
and
working
with
chairman
or
representative
smith.
While
we
wanted
to
make
sure
that
that
patient
had
a
relationship
with
that
physician
to
even
be
able
to
call
it
telehealth
we
didn't
want.
We
didn't
want
the
teledocs
of
the
world,
which
I
know
some
of
the
insurance
companies
use.
I
think
even
the
farm
bureau
when
those
contests
they
they
encourage
their
folks
to
use
teledoc,
which
is
a
telephone
service.
H
G
With
the
exception
of
a
patient,
who,
I
would
already
know
and
and
would
be
able
to
predict
what
sort
of
clinical
problems
they
may
have,
then
audio
only
may
be
superior
if
it
makes
it
more
likely
that
I'm
going
to
see
that
patient
in
a
timely
manner,
if
it
means
that
their
care
would
be
delayed
two
or
three
weeks
until
a
family
member
could
drive
them
to
clinic.
For
example,
in
that
case,
the
audio
only
may
be
superior.
J
So
excluding
that
example
just
based
off
of
quality
of
care.
We
all
agree
that
we
could
provide
the
best
care
in
face-to-face
in
the
office
scenarios.
The
best
be
able
to
touch
be
able
to
see,
be
able
to
hear
the
patient
and
then
we're
now-
and
I
understand
why
telehealth
came
about
that.
We
we
discounted
the
ability
for
a
doctor
to
be
able
to
touch
their
patients
and
and
and
and
now
it
was
just
audio
and
visual,
and
now
we're
to
the
point
right
now,
where
we're,
in
certain
circumstances,
allowing
just
audio
evaluation.
G
Yes,
and
if
there
was
any
question
I
would
have
them
come
into
my
office
or,
for
example,
when
patients
call-
and
they
present
with
a
number
of
new
symptoms,
if
it's
research,
a
very
low
threshold
that
I'm
concerned
where
they
would
benefit
from
an
in-person
evaluation.
I
always
say
why:
don't
you
come
in
tomorrow?
First
thing
and
I'll
see
you
at
8
a.m.
I
think
physicians
have
been
doing
that
forever.
G
You
know
over
the
phone
after
hours,
type
of
evaluations
or
sending
a
patient
to
an
emergency
department
or
urgent
care
and
that
same
kind
of
thought,
process
and
mechanism
would
be
at
play,
and
I
and
I
I
can
only
speak
for
myself,
but
all
the
physicians
and
I
have
the
privilege
of
practicing
with
that's.
We
all
do
the
same
thing,
which
is
if
it's
of
any
concern
whatsoever,
we
get
that
person
in
it's
only
for
the
very
select
patients
that
would
be
appropriate
for
this
approach.
J
G
It's
a
good
question.
I
think,
when
I
arrange
for
these
fault,
when
I
in
my
own
practice
arranging
for
follow-up
visits
with
patients.
Like
the
two
examples
I've
provided
my
general
phrase
that
I
tell
every
patient
is
it's
up
to
you,
I'm
happy
to
see
you
in
clinic,
or
we
can
do
this
remotely,
but
I
think,
based
on
your
symptoms,
x,
y
and
z,
or
lack
of
symptoms,
I
think
it
would
be
appropriate
it's
up
to
you.
What
is
your
preference.
B
Yeah
doctor,
so
so,
if
a
patient
saying
they've
had
surgery
or
they're,
really
sick
and
they're
put
in
the
hospital,
are
there
different
levels
of
care
in
a
hospital
setting
like
intensive
care?
You
know
so
there's
different
levels
of
care,
correct,
correct!
So
in
this
scenario
the
bottom
line
of
it
is
the
patients
getting
some
care.
A
Yes,
mr
griffin,
before
you
go,
I
want
to
ask
you
a
question
as
well
talk
to
me
a
little
bit
about
the
term
unavailable
in
the
legislative,
the
prior
legislation
in
the
code
section.
If
you
could
talk
to
me
about
that
and
and
where
we
are
with
hipaa
rules
and
regulations
and
and
how
we
essentially
will
define
unavailable
in
this
legislation.
H
We
tried
to
draft
this
language
with
representative,
terry
chairman,
terry,
in
a
in
a
way
in
which
it
was
already
currently
in
statute.
If
you
all
passed
this
language
same
language
last
year
as
for
the
behavioral
health,
so
we
were
trying
to
keep
it
in
line
with
exactly
what
you
all
had
already
passed.
H
That's
the
reason
we
suggested
chairman
terry
drafted
in
that
in
that
manner
I
have
asked
the
payers
for
assistance
in
if
they
needed
more
clarity.
As
to
what
unavailable
was.
I
have
not
gotten
anything.
I
had
a
meeting
with
them
all
of
them
and
they
threw
out
their
concerns,
and
I
listened,
and
I
at
the
end
of
that
conversation,
every
one
of
them
heard
me
say,
bring
me
the
language
that
makes
you
comfortable.
H
It's
not
necessarily
when
the
doctor's
not
doesn't
have
the
availability,
because
the
doctor
by
the
the
st,
if
this
is
passed,
the
doctor
will
have
in
order
to
do
a
telehealth
visit,
will
still
have
to
have
the
complete
medical
record.
You
can't
do
that
on
a
golf
course.
I've
actually
heard
heard
that
that
doctor
might
be
on
the
golf
course
just
making
calls
and
billing
for
them.
That's
not
what
this
bill
would
allow
at
all.
H
H
H
But
again,
if
it's
a,
if
it's
an
audio,
only
encounter
that
patient
is
going
to
have
to
see
and
hear
everything
they
would
have
needed
to
see
and
hear,
which
is
only
here
when
it's
audio
only
from
that
provider.
If
that
patient
was
sitting
in
that
office
across
from
that
provider,
so
there's
no
difference
in
the
standard
of
care
or
it
does
not
rise
to
the
level
of
being
able
to
be
an
audio.
Only
telehealth
encounter.
E
Thank
you,
mr
chairman,
certainly
face
to
face.
It
carries
value,
that's
how
we
connect
with
the
health
care
provider,
and
that
is
what
we
want.
I
asked
a
question
to
some
of
our
insurance
colleagues,
how
I
thought
that
people
would
prefer
and
telemedicine
is
really
going
to
take
off,
and
I
was
told
that
not
really
patients
prefer
seeing
the
doctor,
and
for
that
reason
it's
not
a
big
part
of
the
practice
and
all
doctors
lament
is
that
face
to
face
is
what
we're
talking
about.
E
But
these
days
there
is
a
screen
in
between
the
two
faces
between
the
doctor
and
the
and
the
patient.
But
that's
how
medicine
has
progressed.
Kindly
tell
me:
what
are
the
safeguards
against
overuse,
because
it
is
just
more
convenient
and
do
it
quickly
and
so
on,
so
that
this
method
of
having
an
office
visit
over
the
phone
becomes
more
convenient,
gets
overused.
G
Thank
you
for
the
question.
First
of
all,
I
think
the
utilization
of
this
technology,
as
we've
discussed
really
is
only
applies
in
select
scenarios.
I
could
not
do
much
of
my
profession
over
the
telephone.
I
need
to
evaluate
patients.
I
need
to
physically
examine
them.
I
need
to
assess
them
for
toxicities
after
treatment's
complete.
I
can't
do
that
with
the
majority
of
my
patients
through
an
audio
only
encounter,
so
I
for
my
own
practice
can
never
could
never
switch
to
a
majority
of
telehealth
follow-ups.
H
And-
and
I
would
add
to
that,
if
it's
okay,
mr
chairman,
you
know
these-
these
encounters
will
be
subject
to
the
utility
utilization
review
by
the
payers.
Just
like
every
other
encounter
is
subject
utilization
review.
They
have
the
ability
to
do
audits
of
the
product
providers
to
make
sure
that
they
are
documenting
appropriately
and
if
those
document
those
encounters
are
not
documented
to
the
level
of
which
the
they
have
billed
they.
They
will
recoup
that
money
sure.
E
You
just
a
follow-up:
what
would
the
billing
mechanism
be
from
a
cost
point
of
view
in
the
sense
that
currently
office
visits
are
coded
as
straightforward,
low
complexity,
medium
complexity,
high
complexity,
but
they
are
also
correlate
with
time.
How
much
time
was
spent-
and
here
I
I
guess-
would
that
make
it
not
possible
to
have
a
high
complexity
or
medium
complexity
visit,
because
those
are
20
30
minute
time
spans,
and
I
don't
see
spending
that
much
time
on
the
phone.
G
I
could
probably
count
on
two
hands
how
many
high
complexity
telehealth
visits
I've
had
as
you've
mentioned.
It
takes
a
lot
of
time
to
reach
that
threshold.
Most
of
those
patients
are
not
appropriate.
In
my
opinion,
for
a
telehealth
audio
only
encounter
there'd
be
patients.
I
would
see
in
clinic
whether
I
see
a
patient
in
clinic
or
speak
with
them
on
the
phone.
My
my
billing
practices
through
the
2021
e
m
coding
guidelines,
which
is
by
time
and
so
whether
it's
phone
time
or
face
to
face
in
clinic
time,
plus
the
associated
documentation.
A
Thank
you
any
further
questions
all
right.
Thank
you
all
very
much.
We
appreciate
that
we
will
move
on
to
our
next
presenter,
been
informed
that
t.h.a
the
tennessee
hospital
association
does
not
wish
to
to
speak
on
this
particular
issue.
So
we
will
move
on
to
mr
ben
sanders.
A
D
Thank
you,
mr
chairman.
I'm
benjamin
sanders
with
farm
bureau
health
plans.
Mr
chairman,
I
appreciate
the
opportunity
to
address
the
committee.
I
also
want
to
say
I
appreciate
the
chairman,
terry
and
his
time
over
the
last
week
to
discuss
this
bill
and
hear
our
concerns
at
farm
bureau.
We
write
coverage
for
members
in
all
95
counties.
D
D
I
would
suggest
the
issue
here
with
this:
legislation
is
not
whether
phone
calls
are
an
appropriate
extension
of
medical
practice.
I
would
suggest
it's.
The
question
is
not
whether
doctors
should
or
shouldn't
get
paid
or
how
much
they
get
paid
or
any
of
those
things
that
we've
heard
about
this
bill
over
the
last
week.
D
I
suggest
the
issue
is
whether
there
is
a
discernible
need
of
tennesseans,
that's
not
being
met
that
necessitates
a
new
state
law
representative
smith.
This
might
not
be
strategic
to
remind
the
committee,
but
a
few
years
ago
we
opposed
the
telehealth
legislation,
glad
you
remember
it's
not
because
we
oppose
telehealth.
By
the
time
we
were
discussing
it
here
at
farm
bureau,
we
were
offering
robust,
telehealth
and
telemedicine
coverage
to
all
95
counties.
D
I
would
submit
that
problem
doesn't
exist
with
audio
only
phone
calls.
I
I
say
this
as
respectfully
as
I
can.
This
seems
like
an
excellent
solution.
Looking
for
a
problem
now,
one
step
further,
if
unnecessary
is
one
end
of
the
spectrum,
there's
a
lot
of
unintended
consequences
with
legislation,
especially
when
it
gets
into
medical
billing
situations.
D
Some
of
the
questions
that
have
been
brought
up.
How
does
this
affect
billing
and
cost
share
and
out
of
pocket?
What
does
unavailable
mean?
Does
that
mean
I
don't
have
broadband?
Does
that
mean
I
didn't
pay
for
broadband?
Does
that
mean
I'm
traveling
and
I
don't
have
access
there's
all
these
questions
that
I
think
would
be
better
met
in
the
private
market
and
in
negotiations
with
providers
and
insurers.
D
The
last
thing
I'll
say,
mr
chairman,
is
as
a
reminder
any
law
that
that
mandates
certain
payment
policies
also
restricts
innovation.
I
would
submit
what
we
need
in
health
care
is
more
innovation
and
more
flexibility
that
allows
us
to
deliver
more
health
care
and
reduce
costs.
At
the
same
time.
Thank
you
for
your
time
and
I'm
happy
to
answer
any
questions.
A
Mr
sanders,
if,
if
I
could
tell
me
a
little
bit
about-
and
we
heard
something
about
the
the
cms
guidelines
in
the
in
the
in
the
as
I
wrote
my
notes-
the
the
co-criterion
in
the
the
cpts,
can
you
tell
me
a
little
bit
about
the
functionality
of
that
and
and
would
that
be
affected
by
this
legislation?
Would
it
not
be
affected
if
you
could
address
that,
please
sure.
D
Thing
yes,
sir
chairman
terry
mentioned
earlier,
that
this
would
bring
tennessee
in
line
with
cms.
Now
I
have
heard
I
haven't
seen
any
language
I've
heard
of
a
possible
amendment
that
would
limit
this
to
cpt
codes
that
cms
uses
for
audio.
Only
I'm
not
sure
if
that's
going
to
be
a
posture
of
the
bill,
but
I've
heard
that
and
so
I'll
kind
of
comment
on
all
of
that
at
one
point,
if
that's
okay,
chairman
hogg,
cpt
codes
are
billing
codes
for
every
medical
procedure.
D
D
D
Now,
out
of
those
272,
don't
hold
me
to
that
number
89
of
those
they
approve
for
audio
only
telehealth,
but
I
think
it's
notable,
sir,
that
out
of
those
89
86
of
them
are
for
behavioral
health,
mental
sub
mental
mental
illness
substance
abuse
things
of
that
nature.
There
are
three
codes
that
cms
currently
pays
for,
and
I
believe
this
is
what
chairman
terry
was
referring
to.
D
D
B
So
let's
go
back
to
the
argument
of
telehealth
in
the
first
place,
so
I
I'm
remembering
your
testimony
and
I'm
pretty
sure
you
agreed
that
telehealth
would
save
money
in
the
long
run
by
patients
doing
what
they
needed
to
do.
You
know
keeping
patients
out
of
the
emergency
room,
keeping
patients
from
being
admitted
or
readmitted
it's
kind
of
like
the
cms
code.
You
know
medicare
penalizes
for
for
readmission,
so
wouldn't
the
care
any
type
care
like
my
question.
B
D
Yes,
our
representative,
I
do
agree
with
that.
I
think
the
second
point,
though,
to
that
is,
is
that
not
happening
today?
Everyone,
I've
had
a
conversation
with
about
this
bill
talks
about
the
conversation
that
they've
had
with
their
provider.
My
doctor
calls
me
on
the
phone
he
has
for
ten
years.
I
don't
think
this
would
change
his
practice
on
following
up
with
patients,
so
I
agree
completely
agree
with
you.
More
care
is
always
better.
D
B
And
you
know,
and
going
back
to
the
codes
you
know
there,
there's
many
codes,
usually
usually
cms
is
about
three
years
to
four
years
in
front
of
the
states.
You
know.
Finally,
you
know
cms
will
approve
a
code
and
you
know
the
lobby
fights
and
fights
and
fights
in
states
until
they.
Finally,
you
know
see
the
handwriting
on
the
wall
and-
and
this
is
going
to
go
forward,
so
they
agree-
hey,
let's,
let's
include
this
in
the
coverage
as
well.
B
You
know
why
don't
we
one
time
be
on
the
front
end
of
something
and
try
to
reduce
cost
on
the
front
end,
instead
of
being
forced
to
do
it?
Let's
do
something
it's
kind
of
like
the
telehealth.
We
knew
it
was
going
to
save
money.
We
knew
it
was
going
to
improve
care,
but
we
still
had
to
fight
tooth
and
nail
to
get
it
in
this
state.
Let's
just
do
something
that
gets
care
to
the
patients
like.
B
D
Would
you
like
a
comment?
Representative?
Okay?
Yes,
sir,
that's
an
excellent
point.
I
would
suggest
that
there
are
two
issues
there.
One
is
coverage
of
certain
procedures
if
I
can
use
audio
only
as
a
procedure
and
the
second
is
a
payment
methodology
and
so
a
phone
call
that
is
paid
the
same
as
in
office.
While
it
might
be
good
medical
practice,
it
doesn't
reduce
cost
in
our
book.
D
The
reason
that
we
oppose
the
telehealth
legislation
start
with
no
that's
water
under
the
bridge,
obviously,
is
because
we
wanted
to
see
innovative
models
that
did
both
instead
of
increasing
care
at
the
same
cost
and,
of
course,
there's
the
argument
as
you
well
make,
sir,
about
more
care
reduces
cost
in
the
long
run.
That's
why
we
contract
with
teledoc
at
farm
bureau.
We
have
for
years,
because
we
see
cost
savings
in
other
medical
areas
by
people,
avoiding
er
visits
and
critical
care
visits,
and
that
kind
of
thing,
so
those
two
issues
to
us
are
separate.
E
E
E
I
think
when
you
say
there
are
only
three
codes
but
covered
by
cms
for
this
telephone
or
video
telemedicine.
That
means
that
it's
very
limited
in
in
scope
that
cms
covers,
but
it's
not
limited,
only
the
visits
are
done,
but
the
scope
of
those
visits
with
diagnosis.
They
can
be
very,
very
wide.
E
No
quotes
can
stay
the
same
if
it's
an
office
visit
or
a
telehealth
visit
of
low
complexity.
Right
that
can
mean
a
cold
that
can
mean
a
sprain
that
can
mean
just
simply
blood
pressure
or
medication
adjustment
that
can
mean
variations
in
blood
sugar.
So
those
are
the
diagnosis
codes,
but
the
procedure
code
for
billing
for
an
office
visit
stays
the
same
as
a
matter
of
low
complexity.
E
D
E
I
just
wanted
to
clarify
that
the
fact
that
only
three
codes
of
cpt
codes
are
covered
for
this
does
not
mean
it's
of
limited
use.
The
use
can
be
very
very
wide
because
diagnosis
can
vary,
but
the
amount
of
time
and
effort
involved
in
diagnosing
and
treating
over
the
phone
of
a
low
complexity
situation
stays
the
same.
E
That's
the
point.
I
was
making
fair
point,
but
it
just
came
across
that
it's
a
very,
very
limited
scope,
but
it's
not.
The
codes
are
limited
for
procedures,
but
diagnosis
codes
are
numerous.
That's.
D
An
excellent
point,
sir,
and
I
I
didn't
mean
to
to
insinuate
other
that
it
was
a
simple
issue
by
no
means
the
cms
codes
when
it
deals
with
telehealth
are
much
more
robust.
Those
are
the
only
only
three
for
audio.
Only
is
my
point
on
that.
E
I
I
Is
there
anything
that
prevents
the
insurance
companies
from
reviewing
the
medical
record,
seeing
that
maybe
a
doctor
inadequately
records
that
that
level
of
care
wasn't
delivered
it?
It
there's
nothing
that
that
makes
this
an
automatic
payment.
There's
still
that
back
and
forth
of
making
sure
there's
a
requirement
for
documentation
in
the
medical
record.
Is
that
a
fair
statement.
D
Yes,
all
of
those
would
would
still
be
governed
under
the
the
provider
contract
that
we
have
with
them.
You're
correct.
I
And,
and
just
as
a
follow-up
that
that
is
that's
not
unusual
and
the
reason
I'm
making
this
comment
is
we're
not
really
doing
anything
unusual.
It's
just
that
as
as
more
and
more
technology
allows
people
to
be
cared
for
in
a
home-based
environment,
they're
able
to
watch
their
heart
rate,
they're
able
to
do
their
own
blood
pressure,
they're
able
to
do
their
own
blood
sugar.
I
A
lot
of
this
is
done,
but
they
do
have
to
have
some
sort
of
professional
oversight,
so,
whether
it's
remote
patient
monitoring
or
in
the
case
of
you,
know
the
the
radiology
oncologist
who
was
trying
to
save
a
renal
dialysis
patient
from
missing
one
of
their
sessions.
I
think
there
that
we
can
all
agree
that
there
will
not
be
payment
unless
the
medical
record
establishes
that
certain
level
of
care
is
recorded,
that
matches
the
cpt
code
that
will
trigger
the
payment.
I
D
D
To
elaborate
on
that,
all
of
those
safeguards
that
we
have
in
place
now
would
still
be
in
place
under
this.
I
will
note
this
statute
would
take
away
any
flexibility
to
work
on
additional
payment
methodologies,
because
it
requires
not
just
that
we
cover
even
with
those
safeguards,
it
requires
how
we
have
to
cover
them,
which
is,
as
I
mentioned
earlier,
a
separate
matter
as
well.
A
A
All
right,
I
got
that
right
chairman,
dr
terry
you're,
recognized
for
any
closing
comments
on
your
piece
of
legislation
or
any
questions
from
any
members.
F
F
Currently,
there
are
codes
that
are
for
established
patients
that
are
levels
of
service
that
you
can
do,
one
of
the
the
codes
being
99211,
and
with
that
there
are,
you
have
to
meet
two
of
three
criteria,
and
this
is
what
you
know
is
going
to
go
into
the
chart
two
of
those
three
criteria:
the
history
exam
and
the
medical
decision
making
it's
an
or
it
doesn't
have
to
be
an
and
an
exam,
and
so
in
those
levels
you
can
do
it
without
a
physical
exam
on
that
patient.
F
You
are
getting
that
history,
you
are
making
a
medical
decision,
and
so
that's
already
established
for
inpatient
visits.
This
is
again
for
an
established
patient.
They
have
those
those
codes,
the
three
codes
that
they've
mentioned.
I
would
like
to
to
point
out
that
cms
is
in
the
process
of
making
those
codes
permanent
and
in
the
event
that
they
did
not
it's
my
understanding
that
those
you
know
if
visits
after
this
bill,
hopefully
gets
passed
if
those
codes
go
away
or
if
they
change
or
something
along
those
lines.
F
If
they
go
away,
it
could
be
denied
at
that
point
in
time,
and
so
from
a
physician's
standpoint,
again,
you're
going
to
be
documenting
those
and
if
it's
denied,
because
there's
no
longer
a
code
available,
then
we
will
be
looking
at
something
else
and
as
one
of
the
other
colleagues,
our
colleagues
had
mentioned,
we're
getting
ahead
of
the
game
and
we're
working
as
they
are
working
at
the
federal
level
to
make
these
permanent.
So
with
that,
I
renew
my
motion.
A
Thank
you
for
the
depth
of
conversation,
think
we
are
ready
to
vote
on
the
legislation.
Ladies
and
gentlemen,
we
are
voting
on
house
bill
1843.,
all
those
in
favor
of
house
bill
1843,
please
signify
by
saying
aye.