Providing Telehealth Services During COVID-19 Crisis

March 30th, 2020 - Wyn Staheli, Director of Research

Categories: CPT^® Coding HCPCS Coding Modifiers Covid-19

There are some questions surrounding the announcement that Medicare is waiving some telehealth requirements during this pandemic. Please keep in mind that “waiving requirements” does not mean that anything goes. There are some industry experts who are concerned (rightly so) about patient privacy and the long-term implications of these changes. We have heard that some payers are not exactly following Medicare, so you need to make sure that you know individual payer requirements during this time.

Medicare Coverage of Telehealth

Let’s begin by reviewing the Medicare changes. CMS expanded telehealth benefits TEMPORARILY under the 1135 waiver authority and Coronavirus Preparedness and Response Supplemental Appropriations Act (CARES Act).

The following are some basics of this change:

What? Medicare will pay for office, hospital, and other visits furnished via telehealth across the country and including in the patient’s places of residence.
When? Begins March 6, 2020 and ends when it is announced or the end of the year, whichever comes first.
Who? The rules of who can provide services have not changed. If Medicare previously did not pay for you to provide the service and be reimbursed, you still can NOT do so.
Where? Pretty much anywhere. There is no longer a limitation on geographic area or location.
How much? Healthcare providers may, at their discretion, reduce or waive cost-sharing (deductibles and coinsurance) for telehealth visits paid by federal healthcare programs.

The following is a summary table of Medicare’s three main types of telehealth services:

Medicare’s Three Main Types of Telehealth Services
Type of Service	What is the Service?	Code(s)	Patient Relationship with Provider
Medicare Telehealth Visits	A patient visit with a Medicare provider using (in most cases) a live (audiovisual) telecommunications system to deliver the healthcare service.	For 2020, there are 100 services Medicare lists as covered when rendered via telehealth. Some common telehealth services include: 99201-99215 (Office or other outpatient visits) G0425-G0427 (Telehealth consultations, emergency department or initial inpatient) G0406-G0408 (Follow-up inpatient telehealth consultations in hospital or SNF) See an innoviHealth Reimbursement Guide for a complete listing.	New* or established patient * Technically these codes are ONLY for an established patient. However, during this crisis, HHS stated that they will not conduct audits to check if this is an established patient so you can use them for a new patient.
Virtual Check-in	A brief (5-10 minutes) check in with a patient via telephone or other telecommunications device to decide whether an office visit or other service is needed. A remote evaluation of recorded video and/or images submitted by an established patient.	G2012 G2010	Established patient
E-Visits	A communication between patient and their provider through an online patient portal which is *initiated only* by the patient. Note: Providers cannot initiate the service but they CAN inform patients this service is available.	99421-99423 G2061-G2063	Established patient

ALERT: Virtual Check-ins and E-Visits MUST be initiated by the patient — NOT the provider. However, you CAN let your patient’s know that you have this service available and how they can contact you.

We recommend reviewing the “Medicare Telemedicine Health Care Provider Fact Sheet” in the References section below for more comprehensive information.

Commercial Payer Telemedicine Coverage

Prior to the national emergency declaration, most commercial payers already provided some form of benefit for telehealth services'; however, this national declaration allowed the federal government to make significant changes and encouraged private payers to do likewise to accommodate the needs of patients who are trying to shelter in place or social distance. For example, Blue Cross and Blue Shield of Illinois lifted the “cost-sharing for medically necessary health services delivered via telehealth” and added more services to their list of covered telehealth services (e.g., 90791, 90792, 90832-90838, 99213-99215.) To report telehealth services, Medicare requires Place of Service (POS) code 02 while BCBSIL requires the use of modifier 95 and POS code 02.

Some payers are waiving coinsurance and deductibles related to COVID-testing but not necessarily telemedicine services so be sure you specifically check their policy for that information.

As each payer is responsible for publishing policy changes, be sure to regularly check payer websites for announcements about telehealth policy changes.

Other Important Telehealth Services Information

There are a few other important things to keep in mind when providing telehealth services.

Compliance Manuals: This is a rapidly changing situation, so to protect your business it is important to update your compliance manual for coding and billing policy changes and include copies of payer announcements about those changes. Even though Medicare has said that they will not be auditing certain services at this time; again, we suggest maintaining a printed copy of these notifications filed in the company compliance plan to help protect your practice in case of an audit at a later date.

HIPAA: As mentioned previously, even though the OCR stated that they would “waive potential penalties for HIPAA violations against providers who serve patients through everyday communication technologies during the COVID-19 public health emergency,” they didn’t say that they wouldn’t investigate. As such, it is still preferable to use HIPAA-approved technologies for telehealth visits simply to protect your patients and avoid any potential problems down the road.

Note: There are many approved HIPAA video conferencing applications so this would be a good time to get geared up to make telehealth a regular part of your practice with appropriate official practice policies, employee training, and software. Please note that regular Skype is not HIPAA-approved, but Skype Business (Enterprise E3 or E5 package) can be made HIPAA-compliant if set up properly including obtaining a signed Business Associate Agreement (BAA) with Microsoft.

HHS.gov published “HIPAA for Professionals,” an online listing of some vendors that represent that they provide HIPAA-compliant video communication products and that they will enter into a HIPAA BAA.

The OCR also issued a reminder about when it is appropriate to release PHI. They said (emphasis added):

The guidance explains the circumstances under which a covered entity may disclose PHI such as the name or other identifying information about individuals, without their HIPAA authorization, and provides examples including:

When needed to provide treatment;

When required by law;

When first responders may be at risk for an infection; and

When disclosure is necessary to prevent or lessen a serious and imminent threat.

This guidance clarifies the regulatory permissions that covered entities may use to disclose PHI to first responders and others so they can take extra precautions or use personal protective equipment. The guidance also includes a reminder that generally, covered entities must make reasonable efforts to limit the PHI used or disclosed to that which is the "minimum necessary" to accomplish the purpose for the disclosure.

Coding: As of April 1st, there are several new codes related to COVID. Be sure you know them and report them as applicable. Click HERE to read a comprehensive article about coding.

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