Sweeping Expansion of Telehealth Coverage for All Medicare Beneficiaries

CMS published new a Fact Sheet and FAQ today detailing changes in telehealth requirements due to the COVID-19 outbreak. These new telehealth waivers date back to March 6th, when President Trump signed an Emergency Coronavirus spending package. With the new waivers extending to Medicare, providers have flexibility on who can receive telehealth services and where they can occur. CMS is encouraging telehealth services to be increasingly utilized to limit providers exposure to COVID-19. Qualified providers may now let patients know directly that healthcare is available via telehealth. Advis has summarized the information from CMS below.

Who Can Receive Telehealth Services Now

  • Telehealth coverage is now available across the country from anywhere for all Medicare beneficiaries.
    • This waiver is not solely limited to patients with COVID-19.

Where Can Telehealth Services be Provided

  • Patients can receive services in any healthcare facility as well as their homes.

What Type of Technology is Required

  • Due to the related relaxation of HIPAA violations and penalties during this crisis, telehealth communication can now be done over everyday communication devices with audio and/or visual capabilities (e.g., phone calls, FaceTime, Skype, etc.).
  • The Office of Civil Rights will also waive HIPAA penalties for providers that “serve patients in good faith through everyday communication technologies.”

Billing and Co-Payments for Telehealth Services

  • Payments for these services are retroactive to 3/6/20, and are at the same MPFS rate as an in-person visit.
  • Medicare coinsurance and deductible amounts will still apply; yet the OIG is “providing flexibility for healthcare providers to reduce or waive cost-sharing for telehealth visits paid by federal healthcare programs.”
  • Providers bill with POS 02 on the CMS 1500. CMS is not requiring new modifiers to indicate telehealth services.
  • When the patient is present at the facility during a telehealth session, Health facilities may bill for the originating site fee via HCPCS code Q3014.

Who Can Provide Telehealth Services

  • Provider eligibility remains unchanged:
    • Physicians and certain non-physician practitioners, such as nurse practitioners, physician assistants, and certified nurse midwives remain eligible.
    • Other practitioners, such as certified nurse anesthetists, licensed clinical social workers, clinical psychologists, and registered dietitians or nutrition professionals may also furnish services within their scope of practice, consistent with the Medicare benefit rules that apply to all services.
  • 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.

CMS also made clear that States have broad flexibility to cover telehealth services through Medicaid. States do not need approval for State Medicaid programs to reimburse providers for telehealth services in the same manner or at the same rate that states pay for face-to-face services. These waivers allow providers to immediately start billing for telehealth services retroactive to March 6th as the date of service. The waivers will be effective until HHA Secretary Alex Azar’s public health emergency has ended.

In addition to Medicare telehealth waivers, commercial payers are implementing their own telehealth waivers as well. We encourage providers to reach out to payers and confirm eligibility during this national emergency. Please find some examples of policies below:

  • BCBS of IL
    • Press release here.
    • Effective March 10, 2020, BCBSIL began covering telehealth “virtual” visits with in-network Illinois providers for eligible BCBSIL PPO and Blue Choice members.
    • This means qualified members whose own provider offers telehealth service will now have that service covered as a regular office visit.
    • This coverage benefit is in addition to the telehealth benefits currently being offered to eligible members by MDLIVE.
    • Covered telehealth visits currently include two-way, live interactive telephone communication and digital video consultations.
  • Aetna
    • Press release here.
    • Nationally, Aetna will offer zero-pay telemedicine visits until June 4th for any reason.
    • Aetna is waiving cost sharing for all telemedicine visits through in-network providers delivering live telemedicine care.
    • Aetna Medicare Advantage brief virtual check-in and remote evaluation benefits will also be offered to all Aetna commercial members with the co-pay waived.

Advis is striving to help healthcare providers understand these changes so they can provide care to people in need right now without risking exposure to COVID-19. Please contact us today at 708-478-7030 if you need additional assistance.

Published: March 17, 2020