COVID-19 Policy Updates - CMS' Sweeping Regulatory Changes

By Gerald Buggs, MSJ

Over the past few weeks, there have been many CMS updates and changes to expand access to telehealth services. CMS is making changes to allow for “hospitals without walls.”

CMS acknowledges the importance of keeping patients, regardless of a COVID-19 positive diagnosis or not, at home. CMS states that “RPM services support the CDC’s goal of reducing human exposure to the novel coronavirus while also increasing access to care and improving patient outcomes.

As we understand it, the following changes have occurred to widen access to telehealth for Medicare beneficiaries:

  • CMS allows for more than 80 additional services to be furnished via telehealth (a full list of covered telehealth services can be found here)
    • Telehealth visits can now include emergency department visits, initial nursing and discharge visits, home visits, therapy visits – these visits must be provided by a clinician that can provide telehealth, i.e. a MD or NP
  • Throughout the pandemic, patients can use interactive apps with audio and video capabilities to visit with their clinician for a broader range of services
  • Providers can evaluate beneficiaries who have audio phones only - this change is temporary and will ensure patients have access to their primary care provider and other providers while remaining safely at home

  • MDs and NPs can bill for telehealth visits at the same rate as in person visits

  • New as well as established patients now may stay at home and have telehealth visits with their MD or NP

  • Telehealth can fulfill many face-to-face visit requirements for clinicians to see their patients in inpatient rehabilitation facilities, hospice and home health. This ruling allows telehealth, virtual check-ins, e-visits, and telephone E/M services to be provided to any patient new or established within the patient’s home. Consent must be obtained and may be obtained either before or at the time of services

  • Clinicians can provide remote patient monitoring services to patients with acute and chronic conditions and for patients with only one disease (i.e., not just to COVID-19 positive patients). The guidelines for general supervision of an MD or NP are still enforced for the remote patient monitoring
    • Example: remote monitoring can be used to monitor a patient’s oxygen saturation levels using pulse oximetry
  • For services requiring direct supervision, supervision may be provided virtually using real-time audio/video technology
    • Physicians must use their best judgement in determining when supervision is and is not appropriate via technology – there are cases where supervision via technology may not be appropriate

  • Home health agencies can provide services to beneficiaries using telehealth, as long as the telehealth is part of the patient’s plan of care as determined by the patient’s MD or NP, and does not replace needed in-person visits as ordered
    • Home health agencies can report the costs of technology during PHE as allowable administrative and general costs
      • There is no direct reimbursement to Home Health agencies for telehealth or remote patient monitoring services at this time

    • Home Health agencies who do not meet CMS general supervision guidelines can enter into a Private Pay Agreement with Physician Practices, Hospital Systems, ACO and IPAs for remote patient monitoring services. The HHC can charge a flat rate per patient, list the services the HHC will provide including RPM to the referring group. The Physician Practice would pay the HHC for each patient referred and the HHC will provide patient progress notes to the referring group

  • Hospice can provide services to a Medicare patient receiving routine home care via telehealth if it is feasible and appropriate to do so in response to palliative and management of the patient’s terminal illness
    • The use of technology must be included in the patient’s plan of care
    • The face-to-face visit provided for the purpose of hospice care certification may be provided via telehealth through audio and video communications

Read CMS’ Fact Sheet on March 30th, 2020 sweeping regulatory changes

Billing for Professional Telehealth Services during the COVID-19 Pandemic

When billing professional claims for non-traditional telehealth services with dates of service on or after March 1, 2020 and for the duration of the Public Health Emergency (PHE), bill with the Place of Service equal to what it would have been in the absence of a PHE, along with a modifier 95, indicating the service rendered was actually performed via telehealth.
  • CMS is not requiring the “CR” modifier on telehealth services

  • Consistent with current rules for traditional telehealth services, there are two scenarios where modifiers are required on Medicare telehealth professional claims:
    • GQ modifier is used when furnished as part of a federal telemedicine demonstration in Alaska and Hawaii using asynchronous (store and forward) technology
    • G0 modifier when furnished for diagnosis and treatment of an acute stroke

  • Traditional Medicare Telehealth services professional claims should reflect the designated POS code of 02, to indicate the billed service was furnished as a professional telehealth service from a distant site.

  • Claims submitted with POS code 02 will continue to pay at the facility rate

  • There are no billing changes for institutional claims, critical access hospital method II claims should continue to bill with a modifier of GT

Read Medicare Learning Network March 31, 2020 Edition

Our reimbursement team will continue to provide updates as CMS’ rules change and evolve. If you have any questions, please reach out to reimbursement@healthrecoverysolutions.com.

Tags: reimbursement, COVID-19

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