Expanding Provider Services Using Telehealth During the COVID-19 Pandemic
By Colleen Matthews and Devon Judge
March 30, 2020
The COVID-19 pandemic is challenging healthcare providers to creatively and safely manage their patients’ medical needs.
Providers are leveraging innovative tools such as telehealth visits in the short term to “flatten the curve” and treat acute or chronically ill patients; while developing long term strategies for continued maintenance. In this article, we discuss the latest COVID-19 policy changes and items for providers to consider when expanding the use of telehealth services.
- March 6, 2020: Federal government released 1135 Waiver and “Coronavirus Preparedness and Response Supplemental Appropriations Act,” expanding telehealth services. Effective immediately, CMS will reimburse participating providers for telehealth services furnished to Medicare beneficiaries in any healthcare facility or their home, beyond previous rural restrictions.
- March 17, 2020: CMS released additional policy changes to expand telehealth access to all Medicare beneficiaries and broaden Managed Care Organizations’ (MCOs) ability to waive or reduce cost sharing amounts with healthcare providers.
- March 17, 2020: Office for Civil Rights (OCR) at the U.S Department of Health and Human Services (HHS) announced it will exercise discretion for HIPAA violations against health care providers that serve patients during the COVID-19 public health emergency. Providers may now leverage alternative communications apps, such as FaceTime or Skype, when used in good faith, for any telehealth treatment or diagnostic purpose, regardless of whether the service is directly related to COVID-19. Under waiver, HHS will not audit claims to verify existing established patient qualifications for telehealth services.
Governors have also released directives at the state level to expand telehealth coverage for Medicaid beneficiaries and reduce MCO co-pay barriers for patient evaluations, follow-up visits, medication refills, and testing for COVID-19. Medicaid still requires a provider to practice within the scope of their State Practice Act, which may limit furnishing telehealth services across state lines.
While state and federal governments are working independently to slow the spread of COVID-19, increasing access to telehealth continues to be encouraged for MCOs and healthcare providers. It is highly recommended that providers validate telehealth policy changes with contracted MCOs to ensure proper reimbursement protocols are understood and followed by clinical operations, revenue cycle and compliance staff.
Provider organizations need to assess and understand factors which can impact expansion of the use of telehealth services, including organizational type1, regulatory and contractual requirements as well as operational capabilities. (Note: this document applies to practices already using telehealth.)
Telehealth technology, privacy, consent, licensure and documentation requirements will vary by state and even by program (e.g., Medicaid). The Center for Connected Health Policy provides a review of “State Telehealth Laws” that can serve as a guide. However, due to the rapidly changing landscape created by the pandemic, federal and state agencies (and other benefit managers) continue to frequently update their policies to help ease access to telehealth services in order to relieve anticipated burdens on the healthcare system. While this means granting greater flexibility, some of these changes will likely be limited or temporary in nature.
To help slow the spread of COVID-19 and reduce exposure, it is imperative that patients avoid travel to physicians’ offices and other healthcare facilities. Accordingly, the HHS announced a policy of discretion for Medicare telehealth services, to the extent the 1135 waiver requires patients to have a prior established relationship with their telehealth practitioner. HHS also announced that the department will not conduct audits to ensure that such a prior relationship existed for claims submitted during this public health emergency.
The Office for Civil Rights (OCR) will also exercise discretion and waive penalties for HIPAA violations against health care providers that 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 see the HHS.gov website for details.
Contracts with MCOs, and regulatory policies, will dictate specific health plan protocols for supporting documentation, including billing and coding for telehealth, while changes continue to be announced. For example, Horizon BCBSNJ recently announced it will waive all cost sharing obligations (not just copays) for in-network covered telehealth services, both related and unrelated to COVID-19. Evaluating current contracts and carefully considering new ones are critical to properly conduct business and get reimbursed (using the appropriate modifier) for telehealth services. Ongoing and open communications with plans is vital to keeping abreast of any new policy changes, as well as the cessation of temporary ones.
While preparing for a substantial increase in the use of telehealth services, providers should perform a capability assessment of staffing, processes, and technological capacity, to ensure access will be readily available. Shifting visits from in-person to virtual environments may require redeployment, training, and/or retraining of current staff, as well as increasing the use of remote monitoring devices, especially for the chronically ill. The use of screening tools should be considered or enhanced as well as any requirement for patient consent, which may or may not be waived.
Billing for covered telehealth services should follow CMS recognized CPT codes: 99341 to 99345 (New Patients) and 99347 to 99350 (Established Patients), with modifier GT or GQ codes; appended with modifier 95 (recognized by the AMA), unless otherwise specified by specific contract payers. Additional reimbursement CPT codes can be found on the CMS Covered Telehealth Services webpage.
“Originating” and “Distant” sites should be documented according to beneficiary and servicing providers Place Of Services (POS) locations. CMS policies require “Telehealth Visit” services to be provided via real-time audio and video communication systems and can be billed for members at home or another location. CMS and MCOs such as United Health Care (UHC) have also issued new guidance allowing telephonic “Virtual Check-in Visits” to be reimbursed without visual technologies.
While the COVID-19 Pandemic has brought telehealth into the collective minds of governments, payers and patients as a way to curtail the spread of the virus, it has also given providers an opportunity to introduce this technology to their patients in the short term and implement it thoughtfully as part of their long term population health strategies.
As a leading change facilitator in this era of sweeping health care reform, the Mazars Healthcare Consulting Practice offers health care payors and providers a powerful combination of service and results-oriented strategy to help them meet their business goals, overcome challenges, and improve performance. For more information about their timely, valuable information and insights into policies, best practices and industry developments, visit mazarsusa.com/hc.
1 Before implementing any telehealth initiative, it is important for providers to understand the regulatory requirements in their jurisdiction specific to the type of organization (IPA, Article 28, ACO Participant, etc.). It is recommended that providers consult a legal professional or regulatory authority before implementing any telehealth initiative.
- Center for Connected Health Policy: https://www.cchpca.org/
- CMS Telehealth HealthCare Provider Fact Sheet (Mar 17, 2020): https://www.cms.gov/newsroom/fact-sheets/medicare-telehealth-health-care-provider-fact-sheet
- Horizon Press Release: https://www.horizonhealthnews.com/horizon-eliminates-cost-sharing-for-qualified-in-network-telemedicine-services/
- U.S Department of Health and Human Services: HIPPA Guidance (March 17, 2020) https://www.hhs.gov/hipaa/forprofessionals/special-topics/emergency-preparedness/index.html
- CMS Memo to MA Organizations, Part D & Medicare-Medicaid Plans: https://www.cms.gov/files/document/hpms-memo-covid-information-plans.pdf
- CMS Booklet on Telehealth Services: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/TelehealthSrvcsfctsht.pdf
- NYS: COVID-19 Telephonic Communication Services: https://www.health.ny.gov/health_care/medicaid/program/update/2020/docs/2020-03-13_covid-19_telephonic.pdf
Telehealth Toolkit for General Practitioners Here:https://www.cms.gov/files/document/general-telemedicine-toolkit.pdf