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.