April 2020

Access to Medicare Telehealth Services Broadened Temporarily

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With the emergence of the virus causing the disease known as coronavirus disease 2019 (COVID-19), there is an urgency to expand the use of technology to help people who need routine care, and keep vulnerable beneficiaries and beneficiaries with mild symptoms in their homes while maintaining access to the care they need. Limiting community spread of the virus, as well as limiting the exposure to other patients and staff members will slow viral spread. To this end, the Centers for Medicare & Medicaid Services (CMS) has broadened access to Medicare telehealth services so beneficiaries can receive a wider range of services from their doctors without having to travel to a healthcare facility.

These policy changes build on the regulatory flexibilities granted under President Trump’s emergency declaration regarding the virus. CMS is expanding the access to Medicare telehealth services on a temporary and emergency basis pursuant to the waiver authority under section 1135(b)(8) of the Social Security Act and the Coronavirus Preparedness and Response Supplemental Appropriations Act. This benefit is part of the broader effort by CMS and the White House Task Force to ensure that all Americans—particularly those at high risk of complications from the virus—are aware of easy-to-use, accessible benefits that can help keep them healthy while helping to contain the community spread of this virus.

There are 3 main types of virtual services physicians and other healthcare professionals can provide to Medicare beneficiaries: Medicare telehealth visits, virtual check-ins, and e-visits.

Medicare Telehealth Visits:

  • Starting March 6, 2020 and for the duration of the COVID-19 Public Health Emergency, Medicare will make payment for Medicare telehealth services furnished to patients in broader circumstances. These visits are considered the same as in-person visits and are paid at the same rate as regular, in-person visits.
  • Starting March 6, 2020 and for the duration of the COVID-19 Public Health Emergency, Medicare will make payment for professional services furnished to beneficiaries in all areas of the country in all settings and for Medicare telehealth services furnished to beneficiaries in any healthcare facility and in their home.
  • The Medicare coinsurance and deductible would generally apply to these services. However, the US Department of Health and Human Services (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.
  • To the extent the waiver requires an established relationship, HHS will not conduct audits to ensure that such a prior relationship existed for claims submitted during this public health emergency.

Virtual Check-ins:

  • Medicare will pay for virtual check-in services for established Medicare patients when the billing practice has an established relationship with the patient and where the communication is not related to a medical visit within the previous 7 days and does not lead to a medical visit within the next 24 hours (or soonest appointment available). The Medicare coinsurance and deductible would generally apply to these services.
  • This is not limited to only rural settings or certain locations.
  • The patient must verbally consent to receive virtual check-in services; however, practitioners may educate beneficiaries on the availability of the service prior to patient agreement.
  • Virtual check-ins can be conducted with a broader range of communication methods (e.g., telephone discussion, text, email, patient portal, or video chat), unlike Medicare telehealth visits, which require audio and visual capabilities for real-time communication.

E-visits:

  • Medicare will pay for established Medicare patients to have non-face-to-face patient-initiated communications with their doctors without going to the doctor’s office by using online patient portals. These services can only be reported when the billing practice has an established relationship with the patient, and the Medicare coinsurance and deductible would generally apply to these services.
  • This is not limited to only rural settings. There are no geographic or location restrictions for these visits.
  • The patient must generate the initial inquiry and communications can occur over a 7-day period; however, practitioners may educate beneficiaries on the availability of the service prior to patient initiation.

Furthermore, effective immediately, the HHS Office for Civil Rights will exercise enforcement discretion and waive penalties for HIPAA violations against healthcare providers who serve patients in good faith through everyday communications technologies, such as FaceTime or Skype, during the COVID-19 nationwide public health emergency.

For more information regarding this CMS announcement, including affected healthcare practitioners and appropriate billing codes, visit www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet. For more information regarding COVID-19 and HIPAA, visit www.hhs.gov/hipaa/for-professionals/special-topics/emergency-preparedness/index.html

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