Tag: Telehealth
TMB FAQs on telemedicine
Texas Medical Board announcement regarding telemedicine http://www.tmb.state.tx.us/page/coronavirus
To view the FAQs
Summary of telehealth restrictions lifted
| See the below for a summary of all the documents POET has been posting the last 2 days. The MGMA does a nice job. Remember you can view our posts for more details. SOURCE: MGMA GovChat Digest March 17,2020 Today, the Centers for Medicare & Medicaid Services (CMS) issued guidance on Secretary Azar’s waiver authority that broadens access to Medicare telehealth services. Effective March 6, 2020 and for the duration of the COVID-19 Public Health Emergency, CMS will: —Waive geographic restrictions, meaning patients can receive telehealth services in non-rural areas; —Waive originating site restrictions, meaning patients can receive telehealth services in their home; — Allow use of telephones that have audio and video capabilities; —Allow reimbursement for any telehealth covered code, even if unrelated to COVID-19 diagnosis, screening, or treatment; and —Not enforce the established relationship requirement that a patient see a provider within the last three years. The Medicare telemedicine healthcare provider fact sheet can be found here. You can access the Medicare FAQ on these telehealth waivers here. The Enforcement Discretion for telehealth remote communications during the COVID-19 notice can be found here. This announcement follows MGMA efforts to encourage CMS to expeditiously expand telehealth coverage in response to the public health emergency. Visit the MGMA COVID-19 Action Center for the latest developments impacting medical practices. —————————— Drew Voytal Associate Director MGMA Government Affairs Washington, DC —————————— |
OIG issues a policy statement
OIG issues a policy statement and a factsheet regarding telehealth cost-sharing during the COVID-19 outbreak.
This is an important piece of the puzzle since the OIG needed to be on the same page with CMS on regulations to keep physicians out of hot water if they choose to waive patient portion for telemedicine.
A report and four enforcement actions are also posted. As always, you can use the links provided to go directly to the new material.
Policy Statement:
- Waiving Telehealth Cost-Sharing During COVID-19 Outbreak https://go.usa.gov/xdtXC
- Telehealth Factsheet https://go.usa.gov/xdtXT
From CMS MLN Connects
From CMS MLN Connects, two resources for telehealth see links below
Key take aways:
Question: Is any specialized equipment needed to furnish Medicare telehealth services under the new law?
Answer: Currently, CMS allows for use of telecommunications technology that have audio and video capabilities that are used for two-way, real-time interactive communication. For example, to the extent that many mobile computing devices have audio and video capabilities that may be used for two-way, real-time interactive communication they qualify as acceptable technology. The new waiver in Section 1135(b) of the Social Security Act explicitly allows the Secretary to authorize use of telephones that have audio and video capabilities for the furnishing of Medicare telehealth services during the COVID-19 PHE. In addition, effective immediately, the HHS Office for Civil Rights (OCR) will exercise enforcement discretion and waive penalties for HIPAA violations against health care providers that serve patients in good faith through everyday communications technologies, such as FaceTime or Skype, during the COVID-19 nationwide public health emergency.
Q: How does a qualified provider bill for telehealth services?
A: Medicare telehealth services are generally billed as if the service had been furnished in-person. For Medicare telehealth services, the claim should reflect the designated Place of Service (POS) code 02-Telehealth, to indicate the billed service was furnished as a professional telehealth service from a distant site.
Q: How much does Medicare pay for telehealth services?
A: Medicare pays the same amount for telehealth services as it would if the service were furnished in person. For services that have different rates in the office versus the facility (the site of service payment differential), Medicare uses the facility payment rate when services are furnished via telehealth.
Q: Are there beneficiary out of pocket costs for telehealth services?
A: The use of telehealth does not change the out of pocket costs for beneficiaries with Original Medicare. Beneficiaries are generally liable for their deductible and coinsurance; however, the HHS Office of Inspector General (OIG) is providing flexibility for healthcare providers to reduce or waive cost-sharing for telehealth visits paid by federal healthcare programs.
https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet
https://edit.cms.gov/files/document/medicare-telehealth-frequently-asked-questions-faqs-31720.pdf
Coronavirus (COVID-19): new telehealth rules and procedure codes for testing
From American Academy of Family Practice
Getting Paid – A Blog from FPM Journal
Tuesday
Mar 10, 2020
Coronavirus
(COVID-19): new telehealth rules and procedure codes for testing
Last
week, Congress passed the Coronavirus Preparedness and Response Supplemental AppropriationsAct.(www.congress.gov)
The legislation will allow physicians and other health care professionals to
bill Medicare fee-for-service for patient care delivered by telehealth during
the current coronavirus public health emergency.
In
particular, the legislation gives the U.S. Department of Health and Human
Services (HHS) secretary the authority to waive or modify certain telehealth
Medicare requirements when the President has declared a National Emergency, or
the HHS Secretary has declared a Public Health Emergency, as Sec. Alex Azar did in January(www.phe.gov).
For instance, the legislation gives the HHS secretary the authority to
waive the originating site requirement(www.cchpca.org) for
telehealth services provided by a qualified provider to Medicare beneficiaries(www.cms.gov) in
any identified emergency area during emergency periods. The legislation also
allows telehealth services to be provided to Medicare beneficiaries by phone,
but only if the phone allows for audio-video interaction between the qualified
provider and the beneficiary. This expansion is limited to qualified providers
who have furnished Medicare services to the individual in the three years prior
to the telehealth service (or another qualified provider under the same tax
identification number that has provided services within three years). The
patient must initiate the service and give consent to be treated virtually, and
the consent must be documented in the medical record before initiation of the
service.
As noted,
the waiver of the originating site requirement and expansion of telemedicine
modalities is limited to emergency areas identified by the President and HHS
Secretary during emergency periods. Accordingly, as a practical matter, this
expansion of payment is very limited. Further, health care providers must still
comply with state telehealth laws and regulations, including professional
licensure, scope of practice, standard of care, patient consent(www.cchpca.org),
as well as other payment requirements for non-Medicare beneficiaries.
The codes
that will be billed for what Medicare actually defines as Medicare “telehealth
services” will typically be evaluation and management (E/M) codes (for example,
99213, 99214) along with a telehealth Place of Service (POS) code(www.cchpca.org) and
potentially a modifier (if required by commercial payer). However, there are
additional services available for payment that are not ever restricted by
originating site and other Medicare telehealth regulations. The Medicare “communications-based technology” codes(www.cchpca.org) (e.g.
G2012) are not deemed by the Centers for Medicare & Medicaid Services (CMS)
to be Medicare “telehealth services,” which means they are not subject to the
statutory restrictions regarding originating site and rural geography. These
services can be furnished even when patient are in their homes, regardless of a
national emergency declaration. There are also time-based, online digital E/M
codes (99421, 99422, 99423) for established patients. Similar codes (G2061,
G2062, G2063) are available for online patient-initiated assessments provided
by qualified non-physician health care professionals.
Last week
CMS also announced that Medicare Part B would cover a test to determine if
beneficiaries have coronavirus for dates of service on or after Feb. 4, 2020.
But providers of the test will have to wait until after April 1, 2020, to
submit a claim to Medicare for the test. Most physician offices will not have
access to the test to perform it themselves, but may be ordering it for their
patients or collecting specimens (e.g. nasal swab or sputum) for testing. In
general, if the patient is in the office for an E/M service, the specimen
collection is bundled in that service. Otherwise, many contracts don’t include
specimen collection. You will need to check with the payers in your area on
this point.
CMS has
created two Healthcare Common Procedure Coding System (HCPCS) codes to report
testing for coronavirus. Labs that test patients for the new coronavirus using
the Centers for Disease Control and Prevention (CDC) 2019 Novel Coronavirus
Real Time RT-PCR Diagnostic Test Panel may bill for that test using the new
HCPCS code (U0001). This code is used specifically for CDC testing laboratories
to test patients for SARS-CoV-2. The second HCPCS billing code (U0002) allows
laboratories to bill for non-CDC laboratory tests for SARS-CoV-2/2019-nCoV
(COVID-19). On Feb. 29, 2020, the Food and Drug Administration (FDA) issued a
new, streamlined policy for certain laboratories to develop their own validated
COVID-19 tests. This second HCPCS code may be used for tests developed by these
additional laboratories when submitting claims to Medicare or health
insurers. Diagnosis coding for coronavirus is also
available.
What is
happening in the private health insurance sector remains unclear and may vary
from payer to payer. An industry trade group, America’s Health Insurance Plans, issued its own
statement last week(www.ahip.org). CMS also
issued a fact sheet on “Information Related to COVID–19 Individual
and Small Group Market Insurance Coverage.”(www.cms.gov)
For more
information, please see CMS’s frequently asked questions(www.cms.gov) for
health care providers regarding Medicare payment for laboratory tests and other
services related to the 2019 novel coronavirus. CMS has also provided related
fact sheets pertaining to Medicare(www.cms.gov) and Medicaid and the Children’s Health Insurance Program(www.cms.gov).
Coverage,
payment, and other aspects of getting paid for services related to the
coronavirus are continuously evolving. Stay tuned to the “Getting Paid” blog
for further updates. AAFP has more information about how to prepare for
COVID-19 here: https://www.aafp.org/patient-care/emergency/2019-coronavirus.html
— Kent
Moore, AAFP Senior Strategist for Physician Payment
Posted
at 04:30PM Mar 10, 2020 by Kent Moore
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