QUESTION: I heard that CMS has proposed to extend some of the new telehealth flexibilities. Can you provide a little more information on this?
ANSWER: On Tuesday morning, the Centers for Medicare & Medicaid Services (“CMS”) submitted a proposed rule regarding revisions to payment policies under the Physician Fee Schedule. This proposed rule is available for public inspection in the Federal Register and is scheduled for publication on August 17th, 2020. The proposed rule addresses a wide range of topics. Among other things, CMS has proposed adding certain services to the Medicare Telehealth Services list permanently and has suggested that certain flexibilities will remain in place through the calendar year in which the public health emergency ends. Furthermore, CMS has expressed a willingness to solicit and use input from practitioners to determine whether further permanent changes should be made to the Medicare telehealth services list.
In the proposed rule, CMS noted that it had received a significant number of requests to add physical therapy, occupational therapy, and speech-language pathology services to the Medicare telehealth services list permanently. The agency explained that even though there are waivers in effect during the current public health emergency, its authority would be limited to some degree by statute.
CMS also reiterated its policy that telehealth rules do not apply when the beneficiary and the practitioner are in the same location, even if audio-visual technology assists in furnishing a service. This was done in response to a number of questions about whether services should be reported as telehealth when the individual physician or practitioner furnishing the services is in the same location as the beneficiary.
In addition, CMS addressed questions about payment for audio-only telehealth services. The agency explained that it was also limited in this area by statutory requirements relating to telehealth services (which typically require an interactive telecommunications system that includes two-way, audio-visual communication technology). The agency noted its willingness to explore other potential improvements, and invited comment on certain kinds of telephone-only check in services.
Notably, this is only a brief overview of some of the changes included in the proposal. It is important to emphasize that these policies are not yet finalized and may change significantly in the following weeks. Nevertheless, the proposed rule does indicate that the agency is focusing its attention on making certain telehealth flexibilities permanent, to the extent its authority will allow. For a fact sheet that discusses the proposed rule, click here. To review the full proposed rule, click here.
QUESTION: We run an acute care hospital. In order to prevent the spread of COVID-19, we have allowed some of our practitioners to provide services to Medicare beneficiaries via telehealth. These Medicare beneficiaries are receiving services in their homes that they would normally receive in the hospital’s outpatient department. What does the recent interim final rule from CMS say about the practitioner’s ability to bill for this sort of arrangement?
ANSWER: Effective March 1, 2020, when a practitioner who ordinarily practices in a hospital outpatient department furnishes a telehealth service to a patient who is located at home, they may submit a professional claim with the place of service code indicating that the service was furnished in the hospital’s outpatient department. Medicare will then pay the practitioner under the Physician Fee Schedule at the facility rate (as though the service had been provided in the hospital’s outpatient department).
The interim final rule contains further details about the hospital’s ability to bill for its services. To access the interim final rule, click here. For a general overview of recent Medicare telehealth developments, click here.
QUESTION: In an effort to manage exposure during the COVID-19 pandemic, we are trying to expand the use of telehealth throughout our system. Do we need to grant “telemedicine privileges” to Medical Staff members who have already been credentialed and privileged before the pandemic started if they are now using telehealth to treat patients remotely? We are Joint Commission accredited.
ANSWER: This question seems to be coming up a lot. Fortunately, The Joint Commission has given out some good guidance on how to handle this issue during the COVID crisis. In an FAQ document, The Joint Commission has advised:
“Licensed Independent Practitioners (LIP) CURRENTLY credentialed and privileged by the organization, who would now provide the same services via a telehealth link to patients, would not require any additional credentialing or privileging. The medical staff determines which services would be appropriate to be delivered via a telehealth link. There is no requirement that ‘telehealth’ be delineated as a separate privilege.” (Emphasis added.)
This Standards FAQ can be found here.
In light of this guidance, there does not appear to be a need to grant telemedicine privileges to physicians or other practitioners who have already been granted clinical privileges simply because they are now delivering services via telehealth. In light of the statement that the “medical staff determines which services would be appropriate to be delivered via a telehealth link,” it may be prudent to have your MEC weigh in on what services can be provided in this fashion.