In the Coronavirus (COVID-19) pandemic battle, health care providers have been doing their best to treat patients while keeping themselves and their staff protected from exposure. Several temporary changes, waivers and exemptions on the state and federal levels have been helpful in doing so — with one of the safest being the expansion of telehealth.
Telehealth involves using audio/video technology to communicate with patients. This allows doctors, nurses, and other health care providers to help patients in rural areas and shut-ins immediately and without the fear of spreading COVID-19.
This is not a new method of treating patients. Telehealth has been an option long before the Coronavirus outbreak. But in order for health care providers to get Medicare/Medicaid reimbursement, they had to abide by certain requirements. Many of those rules have been relaxed for the time being, as the COVID-19 pandemic is making telehealth one of the most viable solutions in treating patients safely.
Here’s what telehealth is all about and how you can apply it to your health care practice during the COVID-19 Public Health Emergency.
The Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) defines telehealth as the “use of electronic information and telecommunications technologies to support and promote long-distance clinical health care, patient and professional health-related education, and public health and health administration.”
It includes “videoconferencing, the internet, store-and-forward imaging, streaming media, and landline and wireless communications.”
The Notification of Enforcement Discretion issued by the HHS Office for Civil Rights (OCR-HHS) applies to all health care providers that are covered by HIPAA and provide telehealth services during the COVID-19 emergency.
These include “physicians, nurses, clinics, hospitals, home health aides, therapists, other mental health professionals, dentists, pharmacists, laboratories, and any other person or entity that provides health care.”
Before COVID-19, telehealth was limited solely to patients living in rural areas, who needed to travel to a local medical facility in order to get telehealth services from a doctor in a remote location. These patients were not allowed to receive telehealth services from their home.
In addition, telehealth required an established doctor-patient relationship within the past three years.
Simply put, the spread of Coronavirus. Under the 1135 Waiver and the Coronavirus Preparedness and Response Supplemental Appropriations Act of 2020, CMS enacted temporary expansion to telehealth, among other health care compliance measures.
First, the prior relationship requirement. As Andre Perrotta, of Chapman Law Group’s health care compliance practice group, explains in the above video:
“One of the important factors in reading some of the loosening of the strings, so to speak, is that the physician had to have had in the past three years a previous E&M [evaluation and management] service, effectively, with that same patient in order for this to qualify for reimbursement for the provider.”
That condition has been relaxed, as CMS has stated:
“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.”
Second, instead of making patients in rural areas drive out to a health facility, they may receive telehealth services directly from their home, which now qualifies as an “eligible originating site” under the new 1135 waiver.
According to HHS: “All services that a covered health care provider, in their professional judgement, believes can be provided through telehealth in the given circumstances of the current emergency are covered … [including] diagnosis or treatment of COVID-19 related conditions, such as taking a patient’s temperature or other vitals remotely, and diagnosis or treatment of non-COVID-19 related conditions, such as review of physical therapy practices, mental health counseling, or adjustment of prescriptions, among many others.”
But, as Ronald W. Chapman Sr., notes in the above video, health care providers should be aware that telehealth services can only go so far:
“[In] Florida and Michigan, for example, you still have to comply with the standard of care. So I’m wondering when a patient calls and says, ‘Hey I think I might have the Coronavirus I’m a little short of breath,’ what are you going to do? You can’t auscultate the person’s chest, you can’t take a blood pressure, so I don’t know what kind of service you can provide.”
No. CMS calls this “a critical point given the importance of social distancing and other strategies recommended to reduce the risk of COVID-19 transmission, since it will prevent vulnerable beneficiaries from unnecessarily entering a health care facility when their needs can be met remotely.”
As an example, a beneficiary would be able to use a telehealth visit with their doctor before receiving another prescription refill. “However,” CMS notes, “Medicare telehealth services, like all Medicare services, must be reasonable and necessary under section 1862(a) of the Act.”
Health care provider should use a “non-public facing” remote communication platform, which HHS states “allows only the intended parties to participate in the communication.” For video, these include Apple FaceTime, Facebook Messenger video chat, Google Hangouts video, WhatsApp video chat, Zoom or Skype. For text messaging, Signal, Jabber, Facebook Messenger, Google Hangouts, WhatsApp and iMessage may be used.
“Public-facing” platforms like TikTok, Facebook Live, Twitch and the chat room Slack are not acceptable forms of remote communication for telehealth, as they “allow wide or indiscriminate access to the communication.”
The OCR, which serves as the HIPAA-enforcement arm of the HHS, is exercising “enforcement discretion” for telehealth. It has stated that, during COVID-19, it will not impose penalties for noncompliance with regulatory requirements during the “good faith provision of telehealth” services.
OCR does, however, state that doctors and other clinicians should “notify patients that … third-party applications potentially introduce privacy risks” and should “enable all available encryption and privacy modes when using such applications.”
Examples of what OCR may consider bad faith provisions are:
The telehealth waiver will be effective until the Public Health Emergency, which was declared by the Secretary of HHS on January 31, 2020, ends.
Contact the compliance practice attorneys at Chapman Law Group. We are here to guide you through these new telehealth policies, and to answer any questions you may have about what COVID-19 means to your practice.
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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.
The HHS has issued a waiver for certain HIPAA Privacy Rule sanctions for health care facilties, but notes that privacy and disclosure provisions apply even without a waiver in place.
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.
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