the update: covid-19
- Co-payments can be waived by the provider, for remote care management and telehealth services during the COVID-19 emergency.
- Remote patient monitoring can be for acute care (only requires 1 parameter) to support COVID-19 screening in addition to vitals management of co-morbidities.
- Telehealth and other remote care services can now be provided to established as well as new patients. No prior relationship with the patient needed.
- Consent for care management – can be obtained and documented during the COVID-19 emergency for the year – does not have to be at the first telehealth visit.
- Audits and prior approvals measures relaxed – CMS is encouraging clinicians to provide care remotely as a means to reduce risk. Evaluation and management services code selection can be by medical decision making or time (using Medicare’s average’s for the levels) for telehealth visits.
- More telehealth services and rpm opportunities for home health, hospice, FQHC/RHC, SNF, and hospital.
In response to the unique circumstances resulting from the outbreak of COVID-19 and the Secretary’s January 31, 2020 determination under section 319 of the Public Health Service Act that a PHE exists and has existed since January 27, 2020 (COVID-19 Declaration), the Office of Inspector General (OIG) issued a Policy Statement 1 to notify physicians and otherpractitioners that they will not be subject to administrative sanctions for reducing or waiving any cost-sharing obligations Federal health care program beneficiaries may owe for telehealth services furnished consistent with the then applicable coverage and payment rules.
OIG’s Policy Statement is not limited to the services governed by § 410.78 but applies to a broad category of non-face-to-face services furnished through various modalities, including telehealth visits, virtual check-in services, e-visits, monthly remote care management, and monthly remote patient monitoring. The Policy Statement applies to a physician or other practitioner billing for services provided remotely through information or communication technology or a hospital or other eligible individual or entity billing on behalf of the physician or practitioner for such services when the physician or other practitioner has reassigned his or her right to receive payments to such individual or entity.
OIG Policy Statement Regarding Physicians and Other Practitioners
In response to the unique circumstances resulting from the outbreak of 2019 novel coronavirus (COVID-19) and the Secretary’s January 31, 2020, determination, pursuant to section 319 of the Public Health Service Act, that a public health emergency exists and has existed since January 27, 2020 (COVID-19 Declaration), the Office of Inspector General (OIG) issues this Policy Statement to notify physicians and other practitioners that they will not be subject to administrative sanctions for reducing or waiving any cost-sharing obligations Federal health care program beneficiaries may owe for telehealth services furnished consistent with the then- applicable coverage and payment rules, subject to the conditions specified herein.
OIG is committed to protecting patients by ensuring that healthcare providers have the regulatory flexibility necessary to adequately respond to COVID-19 concerns. Ordinarily, routine reductions or waivers of costs owed by Federal health care program beneficiaries, including cost- sharing amounts such as coinsurance and deductibles, potentially implicate the Federal anti- kickback statute, the civil monetary penalty and exclusion laws related to kickbacks, and the civil monetary penalty law prohibition on inducements to beneficiaries. Nonetheless, recognizing the unique circumstances resulting from the COVID-19 outbreak, OIG will not subject physicians and other practitioners to OIG administrative sanctions for arrangements that satisfy both of the following conditions:
- A physician or other practitioner reduces or waives cost-sharing obligations (i.e., coinsurance and deductibles) that a beneficiary may owe for telehealth services furnished consistent with the then-applicable coverage and payment rules.
- The telehealth services are furnished during the time period subject to the COVID-19 Declaration.
This Policy Statement is subject to the following considerations:
- Nothing in this Policy Statement requires physicians or other practitioners to reduce or waive any cost-sharing obligations Federal health care program beneficiaries may owe for telehealth services during the time period specified in condition 2 above.
- For any free telehealth services furnished during the time period subject to the COVID-19 Declaration, OIG will not view the provision of free telehealth services alone to be an inducement or as likely to influence future referrals (i.e., OIG will not view the furnishing of subsequent services occurring as a result of the free telehealth services, without more, as evidence of an inducement).
- Nothing in this Policy Statement affects the operation of CMS’s programmatic rules and regulations.
- Nothing in this Policy Statement otherwise affects a physician’s or other practitioner’s responsibility to bill only for services performed and to comply with legal authorities related to proper billing, claims submission, cost reporting, or related conduct.
- Nothing in this Policy Statement affects a physician’s or other practitioner’s responsibility to comply with Federal, State, or local statute, rule, regulation, ordinance, or other law that may be applicable in effect at the time.
OIG reserves the right to reconsider the issues raised in this Policy Statement and to modify or terminate this Policy Statement.
Medicare Teleheath Services
Under the waiver authority exercised by the Secretary in response to the PHE for the COVID-19 pandemic, Medicare telehealth services can be furnished to patients wherever they are located, including in the patient’s home. As provided by the amendments to section 1135(b)(8) of the Act, when telehealth services are furnished under the waiver to beneficiaries located in places that are not identified as permissible originating sites in section 1834(m)(4)(C)(ii)(I) through (IX) of the Act, no originating site facility fee is paid.
We also recognize that as physician practices suddenly transition a potentially significant portion of their services from in-person to telehealth visits in the context of the PHE for the COVID-19 pandemic, the relative resource costs of furnishing these services via telehealth may not significantly differ from the resource costs involved when these services are furnished in person. For example, we expect that physician offices will continue to employ nursing staff to engage with patients during telehealth visits or to coordinate pre- or post-visit care, regardless of whether or not the visit takes place in person, as it would have outside of the PHE for the COVID-19 pandemic, or through telehealth in the context of the PHE for the COVID-19 pandemic.
Consequently, the assumptions that have supported payment of telehealth services at the PFS facility rate would not apply in many circumstances for services furnished during the PHE for the COVID-19 pandemic. Instead, we believe that, as more telehealth services are furnished to patients wherever they are located rather than in statutory originating sites, it would be appropriate to assume that the relative resource costs of services furnished through telehealth should be reflected in the payment to the furnishing physician or practitioner as if they furnished the services in person, and to assign the payment rate that ordinarily would have been paid under the PFS were the services furnished in-person.
For example, a physician practicing in an office setting who, under the PHE for the COVID-19 pandemic, sees patients via telehealth instead of in person would be paid at the non-facility, or office, rate for these services. Similarly, a physician who typically sees patients in an outpatient provider-based clinic of a hospital would be paid the facility rate for services newly furnished via telehealth. To implement this change on an interim basis, we are instructing physicians and practitioners who bill for Medicare telehealth services to report the POS code that would have been reported had the service been furnished in person.
This will allow our systems to make appropriate payment for services furnished via Medicare telehealth which, if not for the PHE for the COVID-19 pandemic, would have been furnished in person, at the same rate they would have been paid if the services were furnished in person. Given the potential importance of using telehealth services as means of minimizing exposure risks for patients, practitioners, and the community at large, we believe this interim change will maintain overall relativity under the PFS for similar services and eliminate potential financial deterrents to the clinically appropriate use of telehealth.
Because we currently use the POS code on the claim to identify Medicare telehealth services, we are finalizing on an interim basis the use of the CPT telehealth modifier, modifier 95, which should be applied to claim lines that describe services furnished via telehealth. We note that we are maintaining the facility payment rate for services billed using the general telehealth POS code 02, should practitioners choose, for whatever reason, to maintain their current billing practices for Medicare telehealth during the PHE for the COVID-19 pandemic.