CMS Relaxes Regulatory Requirements

On March 30, 2020, CMS published “Medicare and Medicaid Programs; Policy and Regulatory Revisions in Response to the COVID-19 Public Health Emergency” - an interim final rule to provide additional flexibility to physicians during the COVID-19 pandemic. The following changes are effective as of March 1, 2020, and for the duration of this current public health emergency:

• Added Medicare coverage of, and payment for, telephone evaluation and management (E/M) services (CPT 99441-99443). These services may be provided to new or existing patients.

• Physicians allowed to select the level of office/outpatient E/M furnished via Medicare telehealth based on medical decision making (MDM) or time.

  • Time is defined as all the time associated with the E/M on the day of the encounter. The current typical times associated with office E/M are what should be met for the purposes of level selection.

  • CMS is maintaining the current definition of MDM.

  • CMS has removed any requirements regarding documentation of history and/or physical exam in the medical record for such visits.

• Allows telehealth, virtual check-ins, e-visits, and telephone E/M services to be provided to any patient — new or existing.

• Clarifies that consent must be obtained annually and may be obtained either before or at the time of service.

• For Rural Health Clinics (RHC) and Federally Qualified Health Centers (FQHC) — expands the services included in Virtual Communication Services (HCPCS G0071) to include the services reflected in CPT 99421-99423.

  • CMS will revise the payment amount of G0071 to the average national non-facility amount for HCPCS G2012 and G2010 and CPT 99421-99423.

  • All virtual communication services billable using HCPCS code G0071 will also be available to new patients that have not been seen in the RHC or FQHC within the previous 12 months.

• Clarifies the Office of Inspector General’s (OIG) Policy Statement to state that physicians will not be subject to sanctions for reducing or waiving cost-sharing for a broad category of non-face-to-face services, including:

  • telehealth visits

  • virtual check-in services

  • e-visits

  • monthly remote care management

  • monthly remote patient monitoring

• Expands the list of services that can be provided via telehealth. The updated list can be found here (www.cms.gov).

• Provides payment for telehealth services at the non-facility rate under the Medicare physician fee schedule when appropriate

  • Physicians must bill the telehealth service with the Place of Service (POS) code they would have used if the service had been provided in person. Physicians must also append modifier -95 to the claim lines that describe services delivered via telehealth.

  • Any service reported with POS 02 (Telehealth) will be paid at the facility rate under the Medicare physician fee schedule.

Related Links

• Trump Administration Provides Financial Relief for Medicare Providers (3/28/20)

• Long-Term Care Nursing Homes Telehealth and Telemedicine Tool Kit (3/27/20)

• Medicare Telemedicine Health Care Provide Fact Sheet (3/17/20)

• Medicare Telehealth Frequently Asked Questions (FAQs) (3/17/20)

• Telehealth Benefits in Medicare are a Lifeline for Patients During Coronavirus Outbreak (3/9/20)

• CMS fact sheet on the accelerated/advance payment process and how to submit a request (3/20)

• Telehealth Services (3/20)

• General Provider Telehealth and Telemedicine Tool Kit (3/20)

Medicare Telehealth Services

• Are provided using telecommunication technology and include office, hospital visit, or other services that generally occur in person. CMS recently updated the list of Medicare telehealth services(www.cms.gov).

• Are considered the same as in-person visits and paid at the same rate as in-person visits.

  • To receive payment at the same rate as an in-person visit, CMS is instructing physicians to bill services delivered via telehealth with the same Place of Service (POS) code they would have used if the service had been provided in-person.

  • Physicians should append modifier -95 to the claim lines that describe services delivered via telehealth.

  • Claims billed with the POS 02 will be paid at the facility rate under the Medicare physician fee schedule.

• Physicians can select the level of office/outpatient E/M furnished via telehealth using medical decision making or time.

  • Time is defined as all the time associated with the E/M on the day of the encounter. The current typical times associated with office E/M are what should be met for the purposes of level selection. They can be found here(www.cms.gov).

  • CMS is maintaining the current definition of medical decision making.

  • CMS has also removed any requirements regarding documentation of history and/or physical exam in the medical record for office/outpatient E/M encounters provided via telehealth.

• Can be provided to established Medicare patients via phone if the phone allows for audio-video interaction between the physician and patient.

• The Department of Health and Human Services (HHS) has announced that it will not conduct audits(www.cms.gov) to ensure a prior relationship existed for claims submitted during the COVID-19 public health emergency. Therefore, telehealth services can be provided to new and established patients.

• Can be provided in all settings, including a patient’s home. Originating site restrictions have been waived(www.cms.gov).

• The HHS Office of Inspector General (OIG) is allowing practices to waive cost-sharing for telehealth visits(www.cms.gov).

Documentation Requirements

Documentation requirements for any form of virtual care (telehealth service or non-telehealth digital online service) are the same as those for documenting in-person care.

• If a code is time-based, evidence of time must be documented. 

  • CMS is allowing physicians to select the level of office/outpatient visit E/M for services delivered via telehealth using either time or medical decision making. Time is defined as all time associated with the E/M on the day of the encounter.

  • The current typical times associated with office E/M are what should be met for the purposes of level selection. They can be found here(www.cms.gov).
    CMS is maintaining the current definition of medical decision making. Current guidelines can be found here(www.cms.gov).
    CMS has also removed any requirements regarding documentation of history and/or physical exam in the medical record for office/outpatient E/M encounters provided via telehealth.

• If exchanged asynchronously, videos, images and communications must be stored and retained according to state regulation.

• Real-time (synchronous) videos, such as during a video visit or video phone call, are not required to be stored.

Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs)

The CARES Act recently provided additional flexibility for billing telehealth services. FQHCs and RHCs can now serve as the distant site for telehealth services. They were previously limited to serving as the originating site. CMS has also expanded the services included in HCPCS G0071 and adjusted payment accordingly.

Virtual Communication Services

• FQHCs and RHCs can bill for Virtual Communication Services (HCPCS G0071). G0071 includes:

  • 5 minutes or more of virtual (non-face-to-face) communication between an RHC or FQHC practitioner and RHC or FQHC patient; or

  • 5 minutes or more of remote evaluation of recorded video and/or images by an RHC or FQHC practitioner, occurring in lieu of an office visit; or

  • the services as described by CPT codes 99421-99423.

    •  Online digital evaluation and management for a patient, for up to 7 days, cumulative time during the 7 days; 5-10 minutes, 11-20 minutes, or 21 or more minutes

• The services are no longer restricted to established patients and can be provided to new and established patients.

• Consent may be obtained prior or at the time of service.

• Effective for services furnished on or after March 1, 2020, CMS will revise the payment amount for HCPCS G0071 to reflect an average of the national non-facility payment rates for G2012, G2010, and 99421-99423.

• The RHC and FQHC face-to-face requirements are waived for these services.

*The HHS Office for Civil Rights (OCR) will exercise enforcement discretion(www.hhs.gov) and waive penalties for Health Insurance Portability and Accountability Act (HIPAA) violations against health care providers that serve patients in good faith through everyday communication technologies, such as FaceTime or Skype, during the COVID-19 public health emergency.