Over the last week, there have been many updates and changes from CMS and HHS that directly affect telehealth delivery and reimbursement, including waivers on the following restrictions:

  • Prior relationship with practitioner
  • Rural and originating site
  • HIPPA compliance of communication technology
  • Amounts owed by beneficiaries for telehealth services

Prior Relationship with Practitioner Requirement

“To the extent the waiver (section 1135(g)(3)) requires that the patient have a prior established relationship with a particular practitioner, HHS will not conduct audits to ensure that such a prior relationship existed for claims submitted during this public health emergency.”

What does this mean for HRS customers?

This means that practitioners can deliver telehealth to patients regardless of whether a previous relationship exists. Practitioners can see patients for the first time via telehealth.

More information from CMS on practitioner/patient prior relationship requirement.

Rural and Originating Site Restrictions

With the implementation of the emergency waiver CMS has waived the Medicare’s rural and originating site restrictions relating to reimbursement of telehealth services for Medicare recipients. Healthcare providers including physicians, nurse practitioners, clinical psychologists, and licensed clinical social workers for telehealth visits involving evaluation and management visits (common office visits), mental health counseling and preventive health screenings to patients in their homes or form any other originating site. These visits will be reimbursed at the same rate as an in-office visit.

What does this mean for HRS customers?

Limitations on where Medicare patients are eligible for telehealth will be removed. Patients outside of rural areas and patients in their homes are eligible for telehealth services. The waiver temporarily allows Medicare to pay for telehealth services when beneficiaries are in their homes or any other setting of care.

More information from CMS on rural and originating site restrictions.

Office for Civil Rights: Notification of Enforcement Discretion for Telehealth Remote Communications

On March 17 the Office for Civil Rights (OCR) at the US Department of Health and Human Services (HHS) announced that it will exercise enforcement discretion and will waive potential penalties for HIPAA violations against healthcare providers that serve patients through everyday communication technologies.

This exercise of discretion applies to widely available communication apps, when used in good faith for any treatment or diagnostic purpose, regardless of whether the telehealth service is directly related to COVID-19

Effectively, this means, physicians can use audio and video technology to consult with patients, even if that technology is not HIPAA compliant. Physicians will at this time, not be penalized for using these applications that are not HIPAA compliant.

What does this mean for HRS customers?

Video communication with patients on the HRS platform is done through Zoom for Healthcare, a HIPAA compliant application. Zoom for Healthcare ensures physicians can effectively hold consultations with their patients, while keeping patient privacy at the forefront.

Additionally, this will allow for doctors to have HIPAA compliant solutions in place when the OCR announces they will again be exercising enforcement and HIPAA privacy is no longer waived for telehealth communication.

HRS customers will be able to allow qualified healthcare providers (i.e. MD’s, NP’s, etc.) access to video call patients through the HRS platform and those providers will be able to bill for those encounters.

More information from HHS on HIPAA compliance of communication technology.

Waive Amounts Owed by Beneficiaries for Telehealth Services During the COVID-19 Outbreak

The OIG will not enforce the statue if providers choose to reduce or waive cost-sharing for telehealth visits and would not be in violation of the Federal anti-kickback statute, the civil monetary penalty and exclusion laws related to kickback, and the civil monetary penalty law prohibition on inducements to beneficiaries, during the COVID-19 public health emergency, which the HHS Secretary determined exits and has existed since January 27, 2020.

What does this mean for HRS customers?

Medicare beneficiaries can obtain services by telehealth instead of going to their doctor or NP. Their physician or other practitioner is not required to charge any cost-sharing, such as a co-payment.

More information from HHS on waiver of amount owed by beneficiaries for telehealth services.

The HRS team will continue to update this blog as more updates are released. If you have any questions please reach out to reimbursement@healthrecoverysolutions.com or visit out website.