In the midst of what is normally cold, flu and allergy season, the U.S. is contending with the Coronavirus (COVID-19) pandemic — and health care providers have been feeling its rocky effects.
More people are turning to emergency rooms and hospitals, while fewer are going to their primary care physician or other doctors’ appointments. Meanwhile, physicians, nurses and other practitioners are in the direct line of Coronavirus exposure from patients. Because of this, practitioners are turning to telehealth and telemedicine services, which is becoming a safer service provision option for their patients — and themselves.
Fortunately, the Centers for Medicare and Medicaid services (CMS) has broadened access to Medicare telehealth services so that beneficiaries can still receive treatment from their physician without having to travel to a health care facility. This is a temporary expansion of this CMS benefit that has been passed under the 1135 Waiver and the Coronavirus Preparedness and Response Supplemental Appropriations Act of 2020.
Starting March 6, 2020, Medicare will pay for office, hospital and other visits furnished via telehealth across the U.S., including in the patient’s place of residence. The new provision allows doctors, nurse practitioners, clinical psychologists and licensed clinical social workers to provide in-home care for these patient services.
Previously, the telehealth benefit was strictly limited to patients who lived in rural areas and had to travel to a local medical facility to get telehealth services from a doctor in a remote location. These patients would not be allowed to receive services in their home.
Additionally, on March 17, 2020, the OIG published a policy statement for physicians and other practitioners. It will reduce or waive amounts owed by federal health care program beneficiaries for telehealth services during the Coronavirus outbreak. Under this new policy, physicians and practitioners will not be subject to administrative sanctions and other regulatory requirement related to reducing or waiving any cost-sharing obligations (such as patient co-pays) that federal health care program beneficiaries may owe for telehealth services. It is important to note, however, that these services still must be furnished consistent with the appliable coverage and payment rules.
There are three types of virtual, telehealth services that physicians and other professionals can provide to Medicare beneficiaries, each of which have different requirements:
Provider must use interactive audio and video with real-time communication with the patient, and patients must have a prior established relationship with that particular provider. CMS also stated on its provider fact sheet that, “to the extent the waiver requires that the patient have a prior established relationship with a particular practitioner,” the U.S. Department of Health and Human Services (DHHS) “will not conduct audits to ensure that such a prior relationship existed for claims submitted during this public health emergency.” The codes are:
Brief communication service with practitioners via telephone or video and image initiated by the patient. The patient must have prior established relationship with that particular provider and must verbally consent to receive virtual check-in services. Medicare coinsurance and deductible would generally apply to these services. The codes are:
Non-face-to-face, patient-initiated online evaluation and management conducted via a patient portal. Communication can occur over a seven-day period. Codes are:
HIPAA compliance must be considered when conducting telehealth visits with patients. If possible, communication should be conducted through secure portals.
However, because COVID-19 has become a public health emergency, the DHHS Office for Civil Rights will be using discretion when exercising enforcement. The Office will be waiving penalties for HIPAA violations against health care providers that are serving patients through everyday communication technologies — such as Skype and FaceTime — but this waiver will only apply to communication during this emergency.
As your practice sees more activity during the Coronavirus pandemic, our compliance practice attorneys at Chapman Law Group want to make sure you understand and are following these new telehealth policies and related changes. Contact us today so we may review these guidelines with you.
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Physicians who fail to follow this CMS rule could face credential revocation for up to five years — and a medical career essentially destroyed.
In general, a physician or other licensed healthcare provider is prohibited from making any referral to a person or entity that bills Medicare or Medicaid programs, and with which the physician has a financial interest. And there are hefty penalties for doing so.
Here’s what telehealth is all about and how you can apply it to your health care practice during the Coronavirus (COVID-19) Public Health Emergency.
COVID-19 will become one of the biggest compliance challenges in our lifetime, as new compliance and regulatory measures abound in the health care sector.
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