Fact vs. Fiction: Addressing the Confusion Over Current Telehealth Guidelines
CMarch 18, 2020 – Today, the number of active cases and related deaths from the COVID-19 virus in the United States continues to rise. It has spread to all 50 states and all territories. There is a lot of confusion and many questions surrounding the use of telehealth during this Public Health Emergency (PHE) for COVID-19.
For those of you who watched yesterday’s update by President Trump, conflicting information on telehealth guidelines was heard from our experts. In order to help with this confusion, the following updates are from the United States’ official resource on Medicare and Medicaid services, the Centers for Medicare and Medicaid Services (CMS).
Under President Trump’s leadership, CMS has expanded access to Medicare telehealth services so that beneficiaries can receive a broader range of services from their doctors, without having to travel to a healthcare facility.
The purpose of this expanded access is to prevent patients from having to travel. Many of the regulations do not apply to those already in a facility. It is important to note that healthcare facilities must still follow their regulations.
Did CMS waive the rural requirement for telehealth services?
A: Yes. Starting March 6, 2020 and for the duration of the COVID-19 Public Health Emergency, Medicare will make payment for professional services furnished to beneficiaries in all areas of the country in all settings. Additionally, Medicare will make payment for Medicare telehealth services furnished to beneficiaries in any healthcare facility and in their home.
How do I bill for services?
A: It depends upon which type of services you are providing. There are currently 3 different types of services each requiring different codes: Medicare telehealth visits, virtual check-ins and e-visits. See links below for more information.
Did CMS waive the established relationship requirement for Telehealth?
A: No. CMS will not conduct audits of claims to ensure that a prior provider-patient relationship existed for the medical services rendered and submitted on claims, during the Public Health Emergency (PHE). It is important to note that the referral must come from the patient. Skilled Nursing Facilities and Assisted Living Facilities must continue to meet regulations regarding physician notification.
Did CMS waive HIPAA for telehealth visits?
A: No. Effective immediately, the Health and Human Services (HHS) Office for Civil Rights (OCR) WILL EXERCISE ENFORCEMENT DISCRETION AND WAIVE PENALTIES FOR HIPAA VIOLATIONS against healthcare providers that serve patients in good faith through everyday communications technologies.
A covered healthcare provider that wants to use audio or video communication technology to provide telehealth to patients during the COVID-19 nationwide public health emergency can use any NON-PUBLIC facing remote communication product that is available to communicate with patients. This is designed to connect with patients who may not have HIPAA compliant video capabilities on their personal devices. Facilities must still comply with all HIPAA regulations. THERE HAS BEEN NO RELAXATION OF PENALTIES FOR ASYNCHRONOUS OR STORE AND FORWARD OR PATIENT PORTAL COMMUNICATIONS THAT DO NOT COMPLY WITH HIPAA.
For more details, visit HHS website: Emergency Situations: Preparedness, Planning, and Response or Notification of Enforcement Discretion for Telehealth Remote Communications During the COVID-19 Nationwide Public Health Emergency
Did CMS waive co-pays for telehealth visits?
A: No. The HHS Office of Inspector General (OIG) is providing flexibility for healthcare providers to reduce or waive cost-sharing for telehealth visits paid by federal healthcare programs. It is at the discretion of providers
Did CMS waive the frequency limitations for telehealth visits in nursing facilities?
A: No. CMS did not waive the restriction that limits the billing of CPTs 99307-99310 one time in 30 days per patient. It is important to note that CPT 99306 (Initial nursing facility care) is not a Medicare approved telehealth code. In order to bill for this service, the provider must see the patient in the facility.
External Links for more information
Medicare Telemedicine Health Care Provider Fact Sheet
Covid-19 Frequently Asked Questions (FAQs) on Medicare Fee-For-Service (FFS) Billing
CMS Press Release: Telehealth Benefits for Medicare Beneficiaries During COVID-19 Outbreak
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