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MLN Booklet

TELEHEALTH SERVICES

ICN MLN901705 March 2020

Target Audience: Medicare Fee-For-Service Providers

The Hyperlink Table, at the end of this document, provides the complete URL for each hyperlink.

TABLE OF CONTENTS

Originating Sites………………………………………………………………………………………………………………….. 3

Distant Site Practitioners……………………………………………………………………………………………………… 4

Telehealth Services……………………………………………………………………………………………………………… 4

Telehealth Services Billing and Payment………………………………………………………………………………. 7

Telehealth Originating Sites Billing and Payment………………………………………………………………….. 8

Resources…………………………………………………………………………………………………………………………… 8

Helpful Websites………………………………………………………………………………………………………………….. 9

Regional Office Rural Health Coordinators…………………………………………………………………………… 9

CPT codes, descriptions and other data only are copyright 2018 American Medical Association. All Rights Reserved.

Applicable FARS/HHSAR apply. CPT is a registered trademark of the American Medical Association. Applicable FARS/

HHSAR Restrictions Apply to Government Use. Fee schedules, relative value units, conversion factors and/or related

components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA

does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data

contained or not contained herein.

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Telehealth Services MLN Booklet

Page 2 of 9 ICN MLN901705 March 2020

CMS Alert!

Medicare Beneficiaries Expanded Telehealth Benefits During COVID-19 Outbreak

Under the Coronavirus Preparedness and Response Supplemental Appropriations Act

and Section 1135 waiver authority, the Centers for Medicare & Medicaid Services (CMS)

broadened access to Medicare telehealth services, so beneficiaries can get a wider range of

services from their doctors and other clinicians without traveling to a health care facility. On

March 6, 2020, Medicare began temporarily paying clinicians to furnish beneficiary telehealth

services residing across the entire country.

Before this announcement, Medicare could only pay clinicians for telehealth services, such

as routine visits in certain circumstances. For example, the beneficiary getting the 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. In addition, the beneficiary generally could not get telehealth

services in their home.

Under this Section 1135 waiver expansion, a range of providers, such as doctors, nurse

practitioners, clinical psychologists, and licensed clinical social workers, can offer a

specific set of telehealth services. The specific set of services beneficiaries can get include

evaluation and management visits (common office visits), mental health counseling, and

preventive health screenings. Beneficiaries can get telehealth services in any health care

facility including a physician’s office, hospital, nursing home or rural health clinic, as well

as from their homes. This change broadens telehealth flexibility without regard to the

beneficiary’s diagnosis, because at this critical point it is important to ensure beneficiaries

follow CDC guidance including practicing social distancing to reduce the risk of COVID-19

transmission. This change will help prevent vulnerable beneficiaries from unnecessarily

entering a health care facility when clinicians can meet their needs remotely.

To read the Fact Sheet on this announcement visit: https://www.cms.gov/newsroom/factsheets/

medicare-telemedicine-health-care-provider-fact-sheet

To read the Frequently Asked Questions on this announcement visit: https://www.cms.gov/

files/document/medicare-telehealth-frequently-asked-questions-faqs-31720.pdf

Telehealth Services MLN Booklet

Learn about these Medicare telehealth services topics:

●● Originating sites

●● Distant site practitioners

●● Telehealth services

●● Telehealth services billing and payment

●● Telehealth originating sites billing and payment

●● Resources

●● Helpful websites and Regional Office Rural Health Coordinators

Medicare pays for specific (Part B) physician or practitioner services furnished through a

telecommunications system. Telehealth services substitute for an in-person encounter.

ORIGINATING SITES

An originating site is the location where a Medicare beneficiary gets physician or practitioner medical

services through a telecommunications system. The beneficiary must go to the originating site for the

services located in either:

●● A county outside a Metropolitan Statistical Area (MSA)

●● A rural Health Professional Shortage Area (HPSA) in a rural census tract

The Health Resources and Services Administration (HRSA) decides HPSAs, and the Census Bureau

decides MSAs. To see a potential Medicare telehealth originating site’s payment eligibility, go to

HRSA’s Medicare Telehealth Payment Eligibility Analyzer.

Providers qualify as originating sites, regardless of location, if they were participating in a Federal

telemedicine demonstration project approved by (or getting funding from) the U.S. Department of

Health & Human Services as of December 31, 2000.

Beginning July 1, 2019, the

Substance Use-Disorder Prevention

that Promotes Opioid Recovery and

Treatment (SUPPORT) for Patients

and Communities Act removes

the originating site geographic

conditions and adds an individual’s

home as a permissible originating

telehealth services site for treatment

of a substance use disorder or a

co-occurring mental health disorder.

Each December 31 of the prior calendar year (CY),

an originating site’s geographic eligibility is based on

the area’s status. This eligibility continues for a full CY.

Authorized originating sites include:

●● Physician and practitioner offices

●● Hospitals

●● Critical Access Hospitals (CAHs)

●● Rural Health Clinics

●● Federally Qualified Health Centers

●● Hospital-based or CAH-based Renal Dialysis

Centers (including satellites)

●● Skilled Nursing Facilities (SNFs)

●● Community Mental Health Centers (CMHCs)

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Telehealth Services MLN Booklet

●● Renal Dialysis Facilities

●● Homes of beneficiaries with End-Stage Renal Disease

(ESRD) getting home dialysis

●● Mobile Stroke Units

Note: Medicare does not apply originating site geographic

conditions to hospital-based and CAH-based

renal dialysis centers, renal dialysis facilities, and

beneficiary homes when practitioners furnish monthly

home dialysis ESRD-related medical evaluations.

Independent Renal Dialysis Facilities are not eligible

originating sites.

Beginning January 1, 2019, the

Bipartisan Budget Act of 2018

removed the originating site

geographic conditions and added

eligible originating sites to diagnose,

evaluate, or treat symptoms of an

acute stroke. Go to MLN Matters®

article, New Modifier for Expanding

the Use of Telehealth for Individuals

with Stroke to learn how to use the

new modifier for billing.

DISTANT SITE PRACTITIONERS

Distant site practitioners who can furnish and get payment for covered telehealth services (subject to

State law) are:

●● Physicians

●● Nurse practitioners (NPs)

●● Physician assistants (PAs)

●● Nurse-midwives

●● Clinical nurse specialists (CNSs)

●● Certified registered nurse anesthetists

●● Clinical psychologists (CPs) and clinical social workers (CSWs)

o CPs and CSWs cannot bill Medicare for psychiatric diagnostic interview examinations with

medical services or medical evaluation and management services. They cannot bill or get paid

for Current Procedural Terminology (CPT) codes 90792, 90833, 90836, and 90838.

●● Registered dietitians or nutrition professional

TELEHEALTH SERVICES

You must use an interactive audio and video telecommunications system that permits real-time

communication between you at the distant site, and the beneficiary at the originating site.

Transmitting medical information to a physician or practitioner who reviews it later is permitted only in

Alaska or Hawaii Federal telemedicine demonstration programs.

CPT only copyright 2018 American Medical Association. All rights reserved.

Page 4 of 9 ICN MLN901705 March 2020

Telehealth Services MLN Booklet

CY 2019 Medicare Telehealth Services

Service HCPCS/CPT Code

Telehealth consultations, emergency department or initial inpatient G0425–G0427

Follow-up inpatient telehealth consultations furnished to

beneficiaries in hospitals or SNFs

G0406–G0408

Office or other outpatient visits 99201–99215

Subsequent hospital care services, with the limitation of 1 telehealth

visit every 3 days

99231–99233

Subsequent nursing facility care services, with the limitation of

1 telehealth visit every 30 days

99307–99310

Individual and group kidney disease education services G0420–G0421

Individual and group diabetes self-management training services,

with a minimum of 1 hour of in-person instruction furnished in the

initial year training period to ensure effective injection training

G0108–G0109

Individual and group health and behavior assessment

and intervention

96150–96154

Individual psychotherapy 90832–90838

Telehealth Pharmacologic Management G0459

Psychiatric diagnostic interview examination 90791–90792

End-Stage Renal Disease (ESRD)-related services included in the

monthly capitation payment

90951, 90952, 90954, 90955,

90957, 90958, 90960, 90961

End-Stage Renal Disease (ESRD)-related services for home dialysis

per full month, for patients younger than 2 years of age to include

monitoring for the adequacy of nutrition, assessment of growth and

development, and counseling of parents

90963

End-Stage Renal Disease (ESRD)-related services for home

dialysis per full month, for patients 2–11 years of age to include

monitoring for the adequacy of nutrition, assessment of growth

and development, and counseling of parents

90964

End-Stage Renal Disease (ESRD)-related services for home

dialysis per full month, for patients 12–19 years of age to include

monitoring for the adequacy of nutrition, assessment of growth

and development, and counseling of parents

90965

End-Stage Renal Disease (ESRD)-related services for home dialysis

per full month, for patients 20 years of age and older

90966

End-Stage Renal Disease (ESRD)-related services for dialysis

less than a full month of service, per day; for patients younger than

2 years of age

90967

End-Stage Renal Disease (ESRD)-related services for dialysis less

than a full month of service, per day; for patients 2–11 years of age

90968

CPT only copyright 2018 American Medical Association. All rights reserved.

Page 5 of 9 ICN MLN901705 March 2020

Telehealth Services MLN Booklet

CY 2019 Medicare Telehealth Services (cont.)

Service HCPCS/CPT Code

End-Stage Renal Disease (ESRD)-related services for dialysis less

than a full month of service, per day; for patients 12–19 years of age

90969

End-Stage Renal Disease (ESRD)-related services for dialysis less than

a full month of service, per day; for patients 20 years of age and older

90970

Individual and group medical nutrition therapy G0270, 97802–97804

Neurobehavioral status examination 96116

Smoking cessation services G0436, G0437, 99406, 99407

Alcohol and/or substance (other than tobacco) abuse structured

assessment and intervention services

G0396, G0397

Annual alcohol misuse screening, 15 minutes G0442

Brief face-to-face behavioral counseling for alcohol misuse,

15 minutes

G0443

Annual depression screening, 15 minutes G0444

High-intensity behavioral counseling to prevent sexually transmitted

infection; face-to-face, individual, includes: education, skills training

and guidance on how to change sexual behavior; performed

semi-annually, 30 minutes

G0445

Annual, face-to-face intensive behavioral therapy for cardiovascular

disease, individual, 15 minutes

G0446

Face-to-face behavioral counseling for obesity, 15 minutes G0447

Transitional care management services with moderate medical

decision complexity (face-to-face visit within 14 days of discharge)

99495

Transitional care management services with high medical decision

complexity (face-to-face visit within 7 days of discharge)

99496

Advance Care Planning, 30 minutes 99497

Advance Care Planning, additional 30 minutes 99498

Psychoanalysis 90845

Family psychotherapy (without the patient present) 90846

Family psychotherapy (conjoint psychotherapy) (with patient present) 90847

Prolonged service in the office or other outpatient setting requiring

direct patient contact beyond the usual service; first hour

99354

Prolonged service in the office or other outpatient setting requiring direct

patient contact beyond the usual service; each additional 30 minutes

99355

Prolonged service in the inpatient or observation setting requiring

unit/floor time beyond the usual service; first hour (list separately in

addition to code for inpatient evaluation and management service)

99356

CPT only copyright 2018 American Medical Association. All rights reserved.

Page 6 of 9 ICN MLN901705 March 2020

Telehealth Services MLN Booklet

CY 2019 Medicare Telehealth Services (cont.)

Service HCPCS/CPT Code

Prolonged service in the inpatient or observation setting requiring

unit/floor time beyond the usual service; each additional 30 minutes

(list separately in addition to code for prolonged service)

99357

Annual Wellness Visit, includes a personalized prevention plan of

service (PPPS) first visit

G0438

Annual Wellness Visit, includes a personalized prevention plan of

service (PPPS) subsequent visit

G0439

Telehealth Consultation, Critical Care, initial, physicians typically

spend 60 minutes communicating with the patient and providers

via telehealth

G0508

Telehealth Consultation, Critical Care, subsequent, physicians

typically spend 50 minutes communicating with the patient and

providers via telehealth

G0509

Counseling visit to discuss need for lung cancer screening using

low dose CT scan (LDCT) (service is for eligibility determination

and shared decision making

G0296

Interactive Complexity Psychiatry Services and Procedures 90785

Health Risk Assessment 96160, 96161

Comprehensive assessment of and care planning for patients

requiring chronic care management

G0506

Psychotherapy for crisis 90839, 90840

Prolonged preventive services G0513, G0514

A physician, NP, PA, or CNS must furnish at least one ESRD-related “hands on visit” (not telehealth)

each month to examine the beneficiary’s vascular access site.

TELEHEALTH SERVICES BILLING AND PAYMENT

Submit professional telehealth service claims using the appropriate CPT or HCPCS code.

If you performed telehealth services “through an asynchronous telecommunications system”, add the

telehealth GQ modifier with the professional service CPT or HCPCS code (for example, 99201 GQ).

You are certifying the asynchronous medical file was collected and transmitted to you at the distant

site from a Federal telemedicine demonstration project conducted in Alaska or Hawaii.

Submit telehealth services claims, using Place of Service (POS) 02-Telehealth, to indicate you

furnished the billed service as a professional telehealth service from a distant site. As of January 1,

2018, distant site practitioners billing telehealth services under the CAH Optional Payment Method II

must submit institutional claims using the GT modifier.

CPT only copyright 2018 American Medical Association. All rights reserved.

Page 7 of 9 ICN MLN901705 March 2020

Telehealth Services MLN Booklet

Bill covered telehealth services to your Medicare Administrative Contractor (MAC). They pay you the

appropriate telehealth services amount under the Medicare Physician Fee Schedule (PFS). If you are

located in, and you reassigned your billing rights to, a CAH and elected the Optional Payment Method

II for outpatients, the CAH bills the telehealth services to the MAC. The payment is 80 percent of the

Medicare PFS facility amount for the distant site service.

TELEHEALTH ORIGINATING SITES BILLING AND PAYMENT

HCPCS Code Q3014 describes the Medicare telehealth originating sites facility fee. Bill your MAC for

the separately billable Part B originating site facility fee.

Note: The originating site facility fee does not count toward the number of services used to determine

payment for partial hospitalization services when a CMHC serves as an originating site.

RESOURCES

Telehealth Services Resources

For More Information About… Resource

Telehealth Services CMS.gov/Medicare/Medicare-General-Information/Telehealth/

Telehealth-Codes.html

CMS.gov/Medicare/Medicare-General-Information/Telehealth

CMS.gov/Regulations-and-Guidance/Guidance/Manuals/

Downloads/clm104c12.pdf

Physician Bonuses CMS.gov/Medicare/Medicare-Fee-for-Service-Payment/

HPSAPSAPhysicianBonuses

CMS.gov/Outreach-and-Education/Medicare-Learning-

Network-MLN/MLNProducts/MLN-Publications-Items/

CMS1246598.html

Hyperlink Table

Embedded Hyperlink Complete URL

Health Professional Shortage Area https://www.cms.gov/Medicare/Medicare-Fee-for-Service-

Payment/HPSAPSAPhysicianBonuses

Medicare Telehealth Payment

Eligibility Analyzer

New Modifier for Expanding the

Use of Telehealth for Individuals

with Stroke

Learning-Network-MLN/MLNMattersArticles/Downloads/

MM10883.pdf

Substance Use-Disorder Prevention

that Promotes Opioid Recovery and

Treatment (SUPPORT) for Patients

and Communities Act

Page 8 of 9 ICN MLN901705 March 2020

Telehealth Services MLN Booklet

HELPFUL WEBSITES

American Hospital Association Rural

Health Care

Critical Access Hospitals Center

Critical-Access-Hospitals-Center.html

Disproportionate Share Hospitals

Service-Payment/AcuteInpatientPPS/dsh.html

Federally Qualified Health Centers Center

Federally-Qualified-Health-Centers-FQHCCenter.

html

Health Resources and

Services Administration

Hospital Center

Hospital-Center.html

Medicare Learning Network®

National Association of Community

Health Centers

National Association of Rural Health Clinics

National Rural Health Association

Rural Health Clinics Center

Health-Clinics-Center.html

Rural Health Information Hub

Swing Bed Providers

Service-Payment/SNFPPS/SwingBed.html

Telehealth

General-Information/Telehealth

Telehealth Resource Centers

U.S. Census Bureau

REGIONAL OFFICE RURAL HEALTH COORDINATORS

To find contact information for CMS Regional Office Rural Health Coordinators who provide technical,

policy, and operational assistance on rural health issues, refer to CMS.gov/Outreach-and-Education/

Outreach/OpenDoorForums/Downloads/CMSRuralHealthCoordinators.pdf.

Medicare Learning Network® Product Disclaimer

The Medicare Learning Network®, MLN Connects®, and MLN Matters® are registered trademarks of the U.S.

Department of Health & Human Services (HHS).

Page 9 of 9 ICN MLN901705 March 2020

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With concerns around staffing and supply shortages in nursing homes amid the coronavirus, telemedicine has emerged as a key potential weapon, receiving the first-ever major green light for reimbursement on the national level — as part of an $8.3 billion bill allowing the federal government to cover remote care for Medicare recipients passed last Wednesday.

But the bill is only a partial win, and doesn’t cover new patient relationships.

With the death toll at a nursing facility in Kirkland, Wash., operated by Life Care Centers of America, reaching 18 people, concerns about increasingly vulnerable residents and staff are pushing industry experts and politicians to think outside the box and come up with alternative patient care solutions — particularly as the government recommends heavily restricting all non-emergency visits to nursing homes.

Traditionally, telemedicine was an out-of-pocket expense for many operators, unless the facility was located in a rural community. The new emergency bill waives this restriction, but the latest infusion of funds will only be funneled into telemedicine services for pre-existing relationships between providers and patients, according to two telemedicine providers.

“It was very exciting when it came out, like, ‘Wow, Congress recognized that telemedicine is going to be so crucial to this,’” Mordy Eisenberg, chief operating officer of the Stamford, Conn.,-based telehealth provider TapestryCare, said of the coronavirus crisis. “But it feels like our hands are tied … We can’t see new admissions over telemedicine.”

The only way to allow new patient telemedicine access is to place practitioners in a facility, Eisenberg said — not an ideal method for infection prevention.

Pointing to good intentions, Eisenberg noted that the bill will give primary care doctors increased opportunities to see their patients at home.

But for nursing homes, he said, “this legislation falls very short — because it really does not allow us to start care for these patients that are really vulnerable, especially [as] you get these new admissions coming in, especially now. Even if we’re in a facility right now, and we’ve never seen that particular patient and if that patient develops an illness, we can’t see them.”

Merely focusing on funding rural telemedicine “doesn’t make sense anymore,” he stated.

“The benefits of telemedicine into facilities are the same no matter where they are,” Eisenberg said, adding that he hopes the restrictions baked into the new bill are temporary. “There are many urban facilities that don’t have access to care, and then telemedicine makes a big difference.”

As some loved ones with relatives in nursing homes are currently “in the dark,” Eisenberg said, having the ability to use telemedicine services include offering instant communication with families and allows for clinicians to see patients without risking anyone’s health.

The company has been seeing an uptick in business since the coronavirus scare, and is working on contingency plans and infection-control policies with several new nursing homes.

Touting the bill’s inclusion of telehealth in the broader discussion of disease prevention, Third Eye is lining up more group physician partnerships where they don’t already have providers, and is in. the process of expanding to the Pacific Northwest for a total of 30 states. The company is also assistinghealth systems in using their existing telemedicine technology in states where a practice isn’t already set up.

“We haven’t talked to a lot of people who have actual reported cases, but we do have people who are putting policies in place now, where they think that pretty soon it may be difficult for their own staff or physicians, who would normally have come on site,” Herbstman said.

Provider licensing restrictions per state have not been changed in the bill, but the telehealth leaders are hopeful that some of these parameters could be waived in the very near future, he said.

Although some nursing home medical directors and primary care providers may be concerned that telehealth companies will inherently change care plans or clinical protocols, Herbstman and Third Eye chief growth officer Ray George said that their model involves referring back to the primary care provider and the acute care provider when a practitioner isn’t available.

Telemedicine is an investment, but in the long run, it could be a lifesaver for staying afloat in the turbulent waters of the nursing home sector — especially during an infectious-disease scare. When a facility sends a patient to the hospital for an unnecessary transfer, his or her bed is normally held at the nursing home for the approximate time of a four-day stay, with daily Medicare reimbursement at $500 a day.

“So typically a nursing home doesn’t get $2,000 for holding the bed while the resident stays at the hospital,” Herbstman said.

Although TapestryCare is seeing more interest in new partnerships as well, Eisenberg stressed the importance of containment in order to ensure that more people don’t visit nursing homes. The company is taking a proactive approach to help streamline new policies around screening visitors and what to do in the case of an outbreak.

“We have our own infectious diseases specialists and group that have written up some policies that we’ve been helping disseminate to the facilities,” he said.

For now, a patient’s primary care physician will be able in theory to provide telehealth services in an urban setting with the new bill.

“But do they have the equipment to use? Probably not. Do they have the time to deal with it? Probably not. We’re set up for this and we’re doing it very well in the rural markets,” Eisenberg said. “It would be very easy to turn this on for our urban facilities, but I think they missed the mark.”

The post As Coronavirus Concerns Grow, Skilled Nursing Facilities Find Relief in Telehealth — But Gaps Remain appeared first on mTelehealth.

One of the major hurdles to the expansion of telehealth has been the Medicare “originating site” requirement. This requirement limits Medicare telehealth reimbursement to services delivered in a physician’s office or healthcare facility in a rural area, but not in a home or non-rural area. In a shift, the “Telehealth Services During Certain Emergency Periods Act of 2020,” enacted March 6, 2020 as Division B of the Coronavirus supplemental appropriations package, lifts these obstacles during certain public health emergencies.

First, the Act allows for the waiver of the rural originating site requirement to allow Medicare fee-for-service payments to qualified providers for telehealth services. A “qualified” provider, for these purposes, is a physician or practitioner, or one in the same practice, who furnished an item or service to the patient for which Medicare paid during the prior three-year period. Second, the Act allows for Medicare reimbursement for telehealth services to beneficiaries at home. Third, it lifts a regulatory restriction on the use of a telephone to deliver telehealth services, but only if the telephone has audio and video capabilities that are used for two-way, real-time interactive communication.

These changes have the potential to ease access to needed healthcare while limiting the unnecessary exposure of patients to communicable diseases in the community, and of the community to patients with communicable diseases. The availability of Medicare telehealth services at home, in non-rural areas, and without specialized technology is especially important for older and frailer patients who may be the most vulnerable to more serious clinical outcomes.

This is welcome relief, to be sure, but its practical impact will remain to be seen. Longstanding barriers to Medicare reimbursement – including the originating site requirement – have artificially stunted the growth of telehealth. As a result, the healthcare system may be underprepared to deploy this important tool quickly to deliver care on a widespread basis. Additionally, the Act’s focus is narrow, limited as it is to an emergency area during the period of specified public health emergencies.

Moving forward, there may be a silver lining: the recognition of telehealth’s value in responding to an emergency may serve as a catalyst to lift undue restrictions on reimbursement outside the emergency context. There are some signs that this may be occurring.

In the meantime, unanswered questions remain relating to a host of issues, including non-Medicare reimbursement, professional licensure, privacy and security, and others. Stay tuned as we explore these issues and their implications for the delivery of healthcare through telehealth.

The post Coronavirus Appropriations Act Eases Restrictions on Medicare Telehealth Reimbursement during Emergency appeared first on mTelehealth.

The U.S. Centers for Health & Human Services (CMS) has issued guidelines for protecting health care workers who operate in the home and community from COVID-19, including hospice providers. 

The CMS materials contain guidance for screening for and treatment of the virus in addition to when patients should be transitioned to higher acuity care. The agency recommended that hospices identify high-risk individuals prior to making home visits or on arrival and immediately screen for symptoms that could indicate a COVID-19 or other respiratory infection, particularly for patients who had close contact with a person who had traveled to restricted countries, such as China, within the previous 14 days, or who had contact with a person known or suspected to have been exposed to the virus. 

“CMS is laser focused on protecting patients, no matter where or they are receiving care,” said CMS Administrator Seema Verma. “We are receiving up-to-the minute information about COVID-19 and are in turn, making necessary updates to our requirements and sharing that information with our providers throughout the health care system. America’s patients and providers should rest secure knowing that we are taking aggressive precautions to safeguard your health.”

Most hospice patients are older than 65 and are among the demographics that are most vulnerable to the disease, according to the U.S. Centers for Disease Control & Prevention (CDC).

To date, 423 people in the United States have acquired the virus, resulting in 19 deaths. Health officials have identified cases in 35 states, including the District of Columbia.

Previously CMS had issued Frequently Asked Questions regarding the virus, including instruction on how to bill the agency for testing and treatment of COVID-19 in the home and other health care settings.

“Medicare pays for evaluation and management and other services furnished in a beneficiary’s home by a physician or nurse practitioner,” the agency indicated. “Additionally, Medicare makes payment for a number of non-face-to-face services that can be used to assess and manage a beneficiary’s conditions. These include: care management services, remote patient monitoring services, and communication technology based services.”

The post CMS Issues COVID-19 Prevention Guidance for Hospices appeared first on mTelehealth.

Vice President Pence said Tuesday that a group of major health insurance companies have agreed not to charge patients copays when they get tested for coronavirus. 

Pence made the comments at a meeting at the White House with the CEOs of major health insurance companies aimed at encouraging people to get tested by removing cost barriers. 

Some insurance companies had already announced they were waiving copays, but Pence’s announcement appeared to cover a larger group. 

“I’m pleased to report that as you requested, Mr. President, that all the insurance companies here, either today, or before today, have agreed to waive all copays on coronavirus testing, and extend coverage for coronavirus treatment in all of their benefit plans,” Pence said while seated next to President Trump and the insurance CEOs. 

Pence said the companies gathered represent almost 240 million Americans. 

The leaders of major health insurers, including UnitedHealth Group, Anthem, Cigna, Humana, Aetna and the Blue Cross Blue Shield Association were at the meeting, according to the White House. 

Pence said the insurers had agreed to cover telemedicine to allow people to speak to their doctors remotely about the coronavirus. He also said they had agreed to “no surprise billing.”

The details of those announcements were not immediately clear. 

“We all have the same commitment to making sure that cost is not a barrier to people getting tested and treated,” said Matt Eyles, CEO of the trade group America’s Health Insurance Plans, in the meeting.

The post Pence: Major health insurers have agreed to waive copays for coronavirus tests appeared first on mTelehealth.

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The post Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020 appeared first on mTelehealth.

After days of issuing updated guidance for skilled nursing operators and other Medicare providers regarding COVID-19, the U.S. Centers for Medicare & Medicaid Services (CMS) is now turning its attention to home health agencies.

CMS issued home health guidance related to infection control and prevention for COVID-19 — often referred to as the coronavirus — on Tuesday night.

While the guidance is largely nothing home health agencies don’t already know, it stands as a reminder of the severity of the situation, which is worsening by the hour.

At least 31 people in the United States have died as a result of the coronavirus, with nearly 1,000 more falling ill. Multiple states have declared a state of emergency to round up additional resources aimed at combating the virus.

“We are arming our providers on the front lines with the information they need to remain safe, while giving quality care to their patients,” CMS Administrator Seema Verma said in a statement. “Today’s guidance will help providers identify patients who may have contracted the disease and minimize further transmission. It will also equip them to get these patients the medical care they need in order to recover.”

CMS guidance to home health agencies is meant to reinforce recommendations set forth by the U.S. Centers for Disease Control and Prevention (CDC), with specific considerations of when it is safe to treat patients at home and when patients should be considered for hospitalization.

CMS’s guidance also suggests home health providers should take a more assertive role in monitoring family-member exposure when caring for patients with known or suspected COVID-19 cases.

“CMS is recommending home health agencies remain vigilant, regularly monitor patients for any symptoms of the virus, and communicate effectively with patients, family members and other caregivers so that the entire care team understands a patient’s individual needs and goals of care,” CMS officials stated.

Popular Reports

CMS said that the new guidance is meant to answer questions that the agency has received from Medicare and Medicaid in-home care providers related to the COVID-19 outbreak.

While there aren’t many reports of home health providers caring for patients with confirmed COVID-19 at the moment, CMS encouraged home health providers to continue treatment at home — as long as patients could continue isolation protocols and infection-prevention practices.

Following a logical timeline, home health provider interaction is likely to increase as COVID-19 patients are discharged from the hospital.

“Initially, symptoms may be mild and not require transfer to a hospital as long as the individual with support of the [home health agency] can follow the infection prevention and control practices recommended by CDC,” CMS noted.

Apart from patient and clinician exposure, some home health providers have begun to worry about supply capacity and maintaining existing Medicare standards.

CMS put some of those concerns to rest.

“State and Federal surveyors should not cite home health agencies for not providing certain supplies … if they are having difficulty obtaining these supplies for reasons outside of their control,” policymakers stated.

Those supplies typically include items such as gowns, respirators, surgical masks and alcohol-based hand rubs.

On Saturday, U.S. Surgeon General Jerome Adams implored Americans to stop buying medical masks, calling attention to ongoing need within the medical community. Throughout the country, masks have widely sold out at stores where available, with price gouging happening online.

National Association for Home Care & Hospice (NAHC) President William A. Dombi discussed coronavirus concerns with Home Health Care News last week.

“This is one of those times when the home health agencies have to figure out where the balance is to be struck between the safety of their staff and caring for the patients that they have,” Dombi said. “When you have patients who are on service already, they are absolutely the priority for care. One of the things we suggest is that agencies take a look at their ability to meet their current patient census.”

Tuesday’s guidance from CMS also included dialysis facilities.

CMS is urging dialysis facilities to identify high-risk individuals prior to appointments or upon arrival and immediately begin screening for fever or symptoms of a respiratory infection. Typically, those symptoms include cough and sore throat.

Generally, CMS urges all Medicare providers to inquire about travel to restricted countries within at least 14 days.

The full guidance is available here.

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On Thursday, the Senate approved a bill that will provide $8.3 billion in emergency funds to help mitigate the effects of COVID-19, otherwise known as the coronavirus. Apart from funding, the bill made major changes to telehealth statutes, possibly allowing home-based care providers to both rely heavier on telehealth tools and be properly reimbursed for those services. 

Specifically, Congress is allowing the U.S. Department of Health and Human Services (HHS) to waive certain originating-site constraints, such as the ones that restrict telehealth in nonrural settings. Providers will also be allowed to conduct telehealth instruction over telephones with audio and video capabilities. 

“Because all of the United States is currently under this public health emergency designation, any Medicare beneficiary would now be eligible for care from a provider via a two-way audio-video mechanism, including a smartphone,” legal experts from Alston & Bird wrote in an advisory note. “This applies anywhere in the U.S. for any Medicare-reimbursable telehealth service — not just for treatment of the coronavirus.”

Since the coronavirus began spreading throughout the United States, many home health industry insiders have pushed for greater use of telehealth technology.

Among them is Raj Kaushal, the founder of Senior Healthways Inc. and a former president at LHC Group Inc. (Nasdaq: LHCG).

“We have to look at delivery of care in the case of an outbreak — and how we can shift it,” Kaushal told Home Health Care News. “Can we utilize a triage system? Can we use telehealth? If we’re an agency that doesn’t have telehealth, can we use telephone and text monitoring systems? Video conferencing? We need to find ways to make sure exposure to the patient and the staff is minimal, if it comes to that.”

Despite opening some new doors, there are still certain limitations to the newly relaxed telehealth requirements. Also, for providers that do use smartphones to connect with patients, existing HIPAA standards will still apply.

So far, the coronavirus has impacted more than 108,000 people around the world. As of Monday afternoon, the number of confirmed cases in the United States was approaching 600.

Telehealth becoming vital 

Telehealth has long been considered a big part of the future for health care providers. As providers’ fears worsen, that future could come sooner by necessity. 

The Society for Post-Acute and Long-Term Care Medicine — formerly known as The American Medical Directors Association (AMDA) — represents a community of over 50,000 medical directors, physicians, nurse practitioners, physician assistants and other practitioners working in long-term care settings. Its incoming board president, Dr. David Nace, told HHCN last week that telehealth would play a large role in containing the virus in long-term care settings. 

“I think it has to have a very strong role. Even in the nursing home setting, even in the assisted-living setting, you want to minimize the number of individuals that come in contact with an infected individual,” Nace said. “One of the things that can be quite helpful is the use of telemonitoring and telehealth equipment … . I think that is very appealing in the long-term care setting, and it’s been one of the things that we’ve been thinking a lot about.”

Telehealth tools have their limitations, and they won’t ever be able to replace in-person provider care completely. 

But having the ability to access patients virtually will allow providers to avoid person-to-person contact unless it’s absolutely necessary. 

“I absolutely do believe that [this will speed up the shift to telehealth]. I’m pretty confident, both from the home health organization [perspective] and the potential of CMS opening up different reimbursement models to support this,” Horner said. “I don’t think there’s going to be a choice here.” 

There’s already been examples in areas with a large number of cases — such as Seattle — of both patients and nurses refusing to meet with each other in person. 

Opening doors

Previously, roadblocks for reimbursement prevented providers from committing more to telehealth. Medicare historically has only reimbursed providers for telehealth under special circumstances. 

While policymakers will likely still need to work out details, last week’s language will open more opportunities for providers to be reimbursed for other services in different settings.

In a 2019 study of 159 home health agencies conducted by Definitive Healthcare, roughly 28% of respondents said they had a goal of establishing new telehealth services within the next year or so. 

Definitive Healthcare is a Framingham, Massachusetts-based provider of health care data and analytics. Of the 159 participants, roughly 70% were agency-level providers and 30% corporation-type businesses. 

That has given the agency confidence while bracing for the spread of coronavirus, COO Linda Murphy told HHCN. 

“If you think about the old days when we had a hurricane come through, you’d have everybody on the phone calling patients as well as staff hitting the road to try to talk to patients and get them prepared,” Murphy said. “With technology today, you can be so much more efficient and provide even more detailed information because you can standardize messaging across the whole arena or make it very specialized depending on the type of patient that you’re dealing with.”

Even before last week’s changes to the telehealth reimbursement process, there were perks to using virtual care as a cost-saving tool. That’s especially true under the Patient-Driven Groupings Model (PDGM), which has more agencies strapped for cash. 

“[Telehealth] certainly adds an element of non-reimbursable costs, but it also saves on that visit and it still gives us the potential to achieve the quality outcome that we are looking for,” Sharon Harder, president of C3 Advisors, told HHCN in February. “As we think of home health, generally, all of these innovations are going to help us with our margins when it comes to PDGM.”

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