On Tuesday March 17, 2020, CMS announced temporary waivers that will broaden access to telehealth services for Medicare beneficiaries. While these new rules seem largely geared toward enabling patients to access care by ambulatory physicians without having to come into the office, they will be useful for hospital medicine practices as well.
Key things you need to know:
- Medicare has waived the requirement that telehealth visits take place at specified sites of service (“telehealth originating sites”); this means patients may access telehealth services from any site, including their home.
- Geographic restrictions on telehealth services have also been waived, so they can now be provided for patients anywhere in the country (not just in designated rural areas).
- Telehealth services can be provided by anyone credentialed to bill Medicare, including physicians, nurse practitioners, physician assistants, and – for certain services – clinical psychologists and social workers, and others.
- Medicare has loosened its definition of the type of interactive audio and video telecommunications system that can be used, to specifically include telephones that have audio and video capabilities (i.e., smartphones).
- CMS will “exercise enforcement discretion and waive penalties for HPAA violations against health care providers that serve patients in good faith through everyday communications technologies, such as FaceTime or Skype” during the current emergency. Be sure to coordinate with your IT experts on this.
- In a separate move, CMS has moved to temporarily waive the requirement that providers be licensed in the state where they are providing services (applicable to Medicare and Medicaid).
What are some of the potential ways you can take advantage of this new flexibility?
- Have hospitalists work from home, seeing patients in your hospital virtually – especially helpful if you have hospitalists who need to self-quarantine due to exposure but who are not sick and/or to protect the health of high-risk members of your existing workforce.
- Increase the efficiency of night shift staffing by having hospitalists at one facility (or at a remote location) cover multiple hospitals at night.
- Provide coverage from your large flagship facility to smaller facilities in your system where clinical staffing may be more compromised.
- Provide remote coverage for local nursing homes, assisted living, LTAC, and other facilities, with the goal of preventing readmissions/transfers into your hospital.
- Provide post-discharge follow-up for patients who might be discharged earlier than would be usual in order to free up beds.
- Take advantage of sub-specialty telemedicine consultations – even from another state – that you may not have been able to take advantage of before.
How the finances work:
- Qualified telehealth services are reimbursed by Medicare at the same rates as in-person services.
- Only selected E&M codes are eligible for Medicare telehealth reimbursement, including follow-up visits for inpatients (99231-99233) and SNF patients (99307-99310), and telehealth consultations (G0425-G0427). Inpatient admissions and discharges, and observation care codes are not included on the approved list of reimbursable telehealth services. This doesn’t mean you can’t provide them via telehealth, but you won’t get reimbursed for them.
- Use Place of Service code 02-Telehealth.
- While normally Medicare coinsurance and deductibles would apply to these services, CMS is now providing flexibility for healthcare providers to reduce or waive such cost-sharing – so you can choose to write off the patient portion of these charges if you want to.
Be aware of potential complications:
- These waivers apply only to Medicare (and in some cases, Medicaid) patients; you’ll need to check with commercial insurers in your region to see if they are following suit.
- While many states have provided an exception to in-state provider licensing during emergencies, not all states have done so, and existing rules are inconsistent from state to state. Be sure to check the requirements in your state and any states you may consider providing telehealth services in.
- Many hospital medical staffs will need to temporarily waive bylaws requirements that patients be seen in person daily by their attending physician if providing subsequent care via telehealth.
CMS has provided a fact sheet regarding these new waivers here and a useful FAQ document here. Please be sure to also monitor SHM’s COVID-19 resource page for updates, and follow the several coronavirus-related threads on the HMX Open Forum.
If you already have meaningful experience providing tele-hospitalist services or have already moved to implement new/expanded tele-hospitalist services under this emergency provision, I’d love to hear about additional thoughts you have. Feel free to post a comment below.
Great information Leslie. Certainly needed. These changes will allow better access for patients, especially now.
Leslie, Have you found information which suggests that Medicare finds it acceptable to refer to physical exams completed by another provider earlier in the day as an alternative to multiple providers visiting the patient daily?
John, I’m not aware on any change in or easing of CPT documentation requirements for history, examination, or medical decision-making, though what your are suggesting makes sense in this current environment. As you probably know, CMS says you don’t need to re-record ROS or PFSH obtained in an earlier encounter or by ancillary staff as long as you provide documentary evidence that you reviewed that information and updated as needed. But there is not currently any similar provision for examination elements. This might be a good thing for SHM government relations folks to advocate for as a temporary measure to preserve PPE? – Leslie
Update: since I wrote this post, CMS has continued to make adjustments to its telehealth policy for the current public health emergency (PHE). For example, CMS now says telehealth services should be billed using the place of service (POS) code that would have been reported had the service been furnished in person (NOT the telehealth POS code 02 as noted above), combined with the CPT telehealth modifier -95. They have also expanded the list of CPT codes that may be billed via telehealth during the PHE. To make sure you are up to speed on these changes, please refer to this document: https://www.cms.gov/files/document/03092020-covid-19-faqs-508.pdf