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CMS Flexes Rules for Telemedicine During COVID-19 Emergency

Physician offices across the country are rescheduling routine care clinic visits in an effort to protect patients, healthcare providers and workforce. The government is working to remove obstacles that would interfere with transitioning these clinic visits to telehealth services. Yesterday (Tuesday, March 17, 2020), Medicare announced that it will reimburse physicians and other certain healthcare providers the same amount as in-person visits regardless of where the patient is located. The rural area and originating site requirements have been lifted. Thus, the beneficiary may be located at home in Memphis during the telehealth visit and qualify for reimbursement. At the same time, the OCR relaxed HIPAA requirements to allow doctors to provide telehealth services with their personal phones using apps such as facetime and Skype. Public-facing apps such as Facebook Live and TikTok are prohibited.

The federal agencies have encouraged private insurers as well as State Medicaid agencies to expand coverage for telehealth.  We are monitoring for state updates along this direction.

Below is a high-level summary of the three primary types of virtual services physicians and other professionals can provide to Medicare patients: Medicare telehealth visits, virtual check-ins, and e-visits and related HIPAA considerations.

Medicare Telehealth Visits:

A Medicare telehealth visit is a remote patient visit with a provider using telecommunication systems rather than a traditional, in-person office visit.

Medicare telehealth visits can be used for new or established patients. Please note that to the extent an established relationship is required, HHS will not conduct audits to ensure that such a prior relationship existed for claims submitted during the public health emergency.

Providers must use an interactive audio and video telecommunications system that permits real-time communication between the distant site and the patient at home.

Distant site practitioners who can furnish and receive payment for covered telehealth services (subject to applicable state law) include physicians, nurse practitioners, physician assistants, nurse midwives, certified nurse anesthetists, clinical psychologists, clinical social workers, registered dietitians, and nutrition professionals.

Virtual Check-Ins:

A virtual check-in is a 5-10 minute check-in with a practitioner via telephone or other telecommunications device to decide whether an office visit or other service is required.

Virtual check-ins are for established patients, but during the public health emergency, CMS will not audit this requirement.

Individual services must be initiated by the patient. Practitioners may educate beneficiaries on the availability of the service prior to patient initiation, however.

Virtual check-ins can be conducted with a broader range of communication methods than Medicare telehealth visits, which require audio and visual capabilities for real-time communication.

The Medicare coinsurance and deductible would generally apply to virtual check-ins, but Medicare is providing flexibility for healthcare providers to reduce or waive cost-sharing for telehealth visits paid by federal healthcare programs.

E-visits:

An e-visit is where patients communicate with doctors via online portals.

E-visits are only for established patients, but CMS will not audit this requirement during the public health emergency.

The patient must generate the initial inquiry and communications can occur over a 7-day period.

The patient must verbally consent to receive virtual check-in services.  This should be documented in the patient’s record at the time of consent.

Practitioners may educate beneficiaries on the availability of the service prior to patient initiation; however, individual services must be initiated by the patient.

The Medicare coinsurance and deductible would generally apply to e-visits, but as stated above, Medicare will grant flexibility with provider’s decision to waive these during the public health emergency.

HIPAA:

Effective immediately, the Office for Civil Rights (“OCR”) will waive penalties for HIPAA violations against health care providers that serve patients in good faith through everyday communications technologies (e.g., FaceTime or Skype) during the COVID-19 nationwide public health emergency, regardless of whether the telehealth service is directly related to COVID-19. We are awaiting further guidance from the OCR regarding how providers can appropriately use remote video communication and offer telehealth to patients.

For reference, please see the Medicare Telemedicine Health Care Provider Fact Sheet and OCR Announces Notification of Enforcement Discretion for Telehealth Remote Communications During the COVID-19 Nationwide Public Health Emergency.