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COVID-19 Telehealth Expansion

Craneware® Insights Regulatory Updates – CWI1212 (19 March 2020)


Topic

COVID-19 – Telehealth Expansion

On March 17, 2020, CMS posted a “CMS NEWS” article in which information regarding an expansion to telehealth coverage is announced.

Provider Types Affected

Critical Access Hospitals
Provider-Based FQHC
Provider-Based Rural Health Clinics
Physicians

Departments/Areas Affected

Business Office
Compliance / Revenue Integrity
Finance
HIM/Medical Records

What You Need to Know

On March 13, 2020, President Trump issued an emergency declaration under the Stafford Act and the National Emergencies Act in response to the coronavirus disease 2019 (COVID-19) outbreak. In response to President Trump’s announcement, CMS is expanding the Medicare telehealth benefits under the 1135 waiver authority and the Coronavirus Preparedness and Response Supplemental Appropriations Act.

Currently, payment for  telehealth services is limited to clinicians for services such as routine visits in certain circumstances. For example, the beneficiary receiving the telehealth services must live in a rural area and travel to a local medical facility to get telehealth services from a doctor in a remote location. Generally, the beneficiary was not allowed to receive telehealth services in their home.

Over the past two years, the telehealth benefit was expanded to allow clinicians to have brief “virtual check-ins” with their patients through phone, video chat, and online patient portals. This expansion allowed beneficiaries to remain in their home rather than risk exposure of illness to others.

The expansion under the Coronavirus Preparedness and Response Supplemental Appropriations Act will allow Medicare beneficiaries to receive additional telehealth services including common office visits, mental health counseling, and preventive health screenings from their home, regardless of the diagnosis in all areas of the country and in all settings. This change prevents beneficiaries from unnecessarily entering a healthcare facility when their needs can be met remotely. This also allows healthcare facilities and doctor offices additional availability to deal with more urgent cases and reduce the risk of additional infections.

Clinicians may bill Medicare for the expanded telehealth services for dates of service on and after March 6, 2020. The range of providers who will be able to offer telehealth services include doctors, nurse practitioners, clinical psychologists, and licensed clinical social workers. Telehealth services are paid under the Physician Fee Schedule at the same amount as in-person services. The Medicare coinsurance and deductible amounts still apply for these services. 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.

We have provided links under the “Background” section of this Insights article to a Fact Sheet and a Frequently Asked Questions document on the Telehealth expansion.

CMS provided a table of telehealth services that includes the type of service, the description of the service, applicable HCPCS/CPT® codes, and the relationship between the patient and the provider:

Type of Service

Description of Service

HCPCS/CPT® Code

Patient Relationship with Provider

Medicare Telehealth Visits

A visit with a provider that uses telecommunication systems between a provider and a patient.

Common telehealth services include:

  • 99201-99215 (Office or other outpatient visits)
  • G0425-G0427 (Telehealth consultations, emergency department or initial inpatient)
  • G0406-G0408 (Follow-up inpatient telehealth consultations furnished to beneficiaries in hospitals or SNFs)

For a complete list:

https://www.cms.gov/Medicare/Medicare-General-Information/Telehealth/Telehealth-Codes

For new* or established patients.

*To the extent the 1135 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-in

A brief (5-10 minutes) check in with your practitioner via telephone or other telecommunications device to decide whether an office visit or other service is needed. A remote evaluation of recorded video and/or images submitted by an established patient.

  • G2012 (Brief communication technology-based service…)
  • G2010 (Remote evaluation of recorded video and/or images submitted by an established patient)

For established patients

E-Visits

A communication between a patient and their provider through an online patient portal

  • 99421 (Online digital E/M Svc, 5-10 min)
  • 99422 (Online digital E/M Svc, 11-20 min)
  • 99423 (Online digital E/M Svc, 21+ min)
  • G2061 (Qualified nonphysician online assessment, est. patient, 5-10 min)
  • G2062 (Qualified nonphysician online assessment, est. patient, 11-20 min)
  • G0263 (Qualified nonphysician online assessment, est. patient, 21+  min)

For established patients

Action Needed

Hospitals and physician offices should read the CMS documentation pertaining to the expansion of coverage for telemedicine services. Ensure that the telemedicine G-codes have been added to the facility/office chargemaster and charge capture tools. Communicate the expansion of telemedicine guidelines to key stakeholders. Lastly, include information about the availability of telemedicine, in your office (if applicable), in any mass communication tools used for patients. 

Effective Date

06 March 2020

Background

Telemedicine Health Care Fact Sheet:

https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet

Medicare Telehealth Frequently Asked Questions (FAQs), March 17, 2020:

https://edit.cms.gov/files/document/medicare-telehealth-frequently-asked-questions-faqs-31720.pdf 

Reference

https://www.cms.gov/newsroom

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NOTICE: This document contains confidential or proprietary information which may be legally privileged. It is intended only for the named recipient(s) and not to be shared with other facilities or vendors outside of Craneware. Craneware Inc, 3340 Peachtree Road, N.E., Suite 850, Atlanta, GA 30326, Tel: 404-364-2032 email: info@craneware.com