Use of Telemedicine During a Public Health Emergency
DISCLAIMER
This information and compliance guidance has been gathered and interpreted by No World Borders from various resources, including CMS, and Medicare Administrative Contractors (MACs) and is provided for informational purposes. This should not be viewed as an official policy of CMS or the MACs. The provider is always responsible for determining and complying with applicable CMS, MAC and other payer requirements.
- The federal government declared a Section 1135 waiver which granted increased flexibility for the use of telehealth. The Coronavirus Aid, Relief, and Economic Security Act (CARES Act) broadened the waiver authority under section 1135 of the Social Security Act; the Secretary has authorized additional telehealth waivers. CMS is waiving the requirements of section 1834(m)(4)(E) of the Act and 42 CFR § 410.78 (b)(2), which specify the types of practitioners that may bill for their services when furnished as Medicare telehealth services from the distant site. The waiver of these requirements expanded the types of health care professionals who can furnish distant-site telehealth services to include all those who are eligible to bill Medicare for their professional services. This allows healthcare professionals who were previously ineligible to furnish and bill for Medicare telehealth services, including physical therapists, occupational therapists, speech-language pathologists, and others, to receive payment for Medicare telehealth services. This waiver will end 151 days after the conclusion of the PHE.
- 418.204(d) Special coverage requirements provide,
(d) Use of technology in furnishing services during a Public Health Emergency. When a patient is receiving routine home care during a Public Health Emergency as defined in § 400.200 of this chapter, hospices may provide services via a telecommunications system if it is feasible and appropriate to do so to ensure that Medicare patients can continue receiving services that are reasonable and necessary for the palliation and management of a patient’s terminal illness and related conditions.
The use of such technology in furnishing services must be included in the plan of care, meet the requirements at § 418.56, and must be tied to the patient-specific needs as identified in the comprehensive assessment , and the plan of care must include a description of how the use of such technology will help to achieve the goals outlined on the plan of care.
Indeed, earlier in 2020 CMS issued a notice pursuant to the public health emergency [“Public Health Emergency (PHE) means the Public Health Emergency determined to exist nationwide as of January 27, 2020, by the Secretary pursuant to section 319 of the Public Health Security Act on January 31, 2020, as a result of confirmed cases of COVID-19, including any subsequent renewals.”]
“This interim final rule with comment period (IFC) gives individuals and entities that provide services to Medicare beneficiaries needed flexibilities to respond effectively to the serious public health threats posed by the spread of the 2019 Novel Coronavirus (COVID-19).
Recognizing the urgency of this situation, and understanding that some pre-existing Medicare payment rules may inhibit innovative uses of technology and capacity that might otherwise be effective in the efforts to mitigate the impact of the pandemic on Medicare beneficiaries and the American public, we are changing Medicare payment rules during the Public Health Emergency (PHE) for the COVID-19 pandemic so that physicians and other practitioners, home health and hospice providers, inpatient rehabilitation facilities, rural health clinics (RHCs), and federally qualified health centers (FQHCs) are allowed broad flexibilities to furnish services using remote communications technology to avoid exposure risks to health care providers, patients, and the community.
We are also altering the applicable payment policies to provide specimen collection fees for independent laboratories collecting specimens from beneficiaries who are homebound or inpatients (not in a hospital) for COVID-19 testing.
We are also expanding, on an interim basis, the list of destinations for which Medicare covers ambulance transports under Medicare Part B. In addition, we are making programmatic changes to the Medicare Diabetes Prevention Program (MDPP) and the Comprehensive Care for Joint Replacement (CJR) Model in light of the PHE, and program-specific requirements for the Quality Payment Program to avoid inadvertently creating incentives to place cost considerations above patient safety.
This IFC will modify the calculation of the 2021 and 2022 Part C and D Star Ratings to address the expected disruption to data collection and measure scores posed by the COVID-19 pandemic and also to avoid inadvertently creating incentives to place cost considerations above patient safety.
This rule also amends the Medicaid home health regulations to allow other licensed practitioners to order home health services, for the period of this PHE for the COVID-19 pandemic in accordance with state scope of practice laws. We are also modifying our under arrangements policy during the PHE for the COVID-19 pandemic so that hospitals are allowed broader flexibilities to furnish inpatient services, including routine services outside the hospital.”
Telehealth Facility Fees
HCPCS code Q3014 – Telehealth originating site facility fee may be used. No Medicare local coverage determinations (Medicare LCDs) were found for this code at the time this was published.
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Related links: Telehealth bonuses, eligibility, modifiers and special provisions for substance use disorder prevention
Physician Bonuses
Medicare Telehealth Payment Eligibility Analyzer
New Modifier for Expanding the Use of Telehealth for Individuals with Stroke
Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act
Medical Billing Expert Witness