Telehealth Update - COVID-19
Tuesday, March 17, 2020
The number of positive cases of COVID-19 continues to grow. Measures to secure social distancing announced yesterday should benefit New Jersey by slowing community spread of the virus.
The key issues reported by members to MSNJ are:
1. Lack of access to Personal Protective Equipment (PPE). This is a known weakness and one that is likely to persist. MSNJ is working with partners to discuss uniform standards for PPE use during the COVID-19 outbreak considering this shortage. We are hearing different standards for PPE use in different settings. We hope to contribute to a uniform standard to keep all our healthcare workers safe.
2. Telemedicine questions. Yesterday, we urged actions to streamline telemedicine adoptions so physicians can see patients virtually if their conditions permit. Today, CMS announced an expansion of rule allowing physicians to provide routine care via telemedicine. Further the NJ Assembly took action to facilitate the use of telemedicine during this emergency. Today, in light of the COVID-19 nationwide public health emergency, the HHS Office for Civil Rights (OCR) is exercising its enforcement discretion and, effective immediately, will not impose penalties on physicians using telehealth in the event of noncompliance with the regulatory requirements under the Health Insurance Portability and Accountability Act (HIPAA). Finally, MSNJ requested today that all commercial insurers in NJ follow CMS’ lead in simplifying payment rules for routine care delivered via telemedicine during this emergency.
3. Testing remains limited, although authorities have stated that rapid response testing will begin to be deployed. This should increase the capacity to test symptomatic patients. MSNJ advises physicians NOT to routinely refer patients to Emergency Departments for testing. If a patient reports fever and respiratory symptoms YOU must call ahead to the Emergency Department and advise them you are referring a patient. So, please change the messaging on your office voicemails that tell patients to go to the ER if they have symptoms.
Finally, we have connected with a law firm to provide the nuts and bolts of conducting and getting paid for telemedicine visits. Please register in the below article.
Marc J. Levine, MD
CMS Expansion of Medicare Telehealth Coverage
Today, CMS announced an expansion of Medicare telehealth coverage – effective March 6, 2020, Medicare will “temporarily pay clinicians to provide telehealth services for beneficiaries residing across the entire country.” CMS Administrator Seema Verma emphasized that the “changes allow seniors to communicate with their doctors without having to travel to a healthcare facility so that they can limit risk of exposure and spread of this virus.”
CMS will permit the following:
- A “range” of providers, including doctors, nurse practitioners, clinical psychologists, and licensed clinical social workers” to offer telehealth to Medicare beneficiaries.
- Beneficiaries to receive telehealth services “in any healthcare facility including a physician’s office, hospital, nursing home or rural health clinic, as well as from their homes.”
- Beneficiaries to receive services including “common office visits, mental health counseling, and preventive health screenings.”
CMS adds that this action “broadens telehealth flexibility without regard to the diagnosis of the beneficiary,” and that “patients will now be able to access their doctors using a wider range of communication tools including telephones that have audio and video capabilities.”
Billing – CMS states that “clinicians can bill immediately for dates of service starting March 6, 2020,” and telehealth services “are paid under the Physician Fee Schedule at the same amount as in-person services.”
Patient Costs – CMS states that “Medicare coinsurance and deductible still apply for these services;” however, the Health and Human Services “Office of Inspector General (OIG) is providing flexibility for healthcare providers to reduce or waive cost-sharing for telehealth visits paid by federal healthcare programs.”
Medicaid – CMS also indicates that “states can cover telehealth using various methods of communication such as telephonic, video technology commonly available on smart phones and other devices,” and “no federal approval is needed for state Medicaid programs to reimburse providers for telehealth services in the same manner or at the same rate that states pay for face-to-face services.”
CMS explains that, prior to the announcement, Medicare could only pay “clinicians for telehealth services such as routine visits in certain circumstances,” including requirements that beneficiaries must live in a rural area and travel to a “local medical facility to get telehealth services from a doctor in a remote location,” and beneficiaries generally would “not be allowed to receive telehealth services in their home.”
More information can be found in the CMS press release, fact sheet and FAQ document.
No Penalties for HIPAA Noncompliance Using Telemehealth
Effective immediately, the HHS Office for Civil Rights (OCR) will not impose penalties on physicians using telehealth in the event of noncompliance with the regulatory requirements under HIPAA. Physicians may seek to communicate with patients and provide telehealth services through remote communications technologies. Some of these technologies, and their use, may not fully comply with the requirements of the HIPAA Rules. However, today’s announcement means that physicians who want to use audio or video communication technology to provide telehealth to patients during the COVID-19 nationwide public health emergency can use any non-public facing service that is available to communicate with patients. This exercise of discretion applies to telehealth provided for any reason, regardless of whether the telehealth service is related to the diagnosis and treatment of health conditions related to COVID-19.
Under this Notice, physicians may use popular applications that allow for video chats, including Apple FaceTime, Facebook Messenger video chat, Google Hangouts video, or Skype to provide telehealth without risk that OCR might seek to impose a penalty for noncompliance with the HIPAA Rules. Physicians should not use Facebook Live, Twitch, TikTok or other public facing communication services. Physicians are encouraged, but not required, to notify patients of the potential security risks of using these services and to seek additional privacy protections by entering into HIPAA business associate agreements (BAA).
MSNJ Telehealth Webinar Series:
Part 1: Implementing and Expanding Telehealth to Address COVID-19
Thursday, March 19, 2020 from 12:00pm to 1:00pm
Telehealth is being promoted as an essential strategy to ensure ongoing care during the Coronavirus pandemic. On a daily basis, the rules related to provision of, and payment for telehealth are evolving, and misinformation is abundant. This webinar will discuss the current landscape, and changing rules, for providing telehealth including reimbursement, data security, telemental health and consents.
More information and registration.
MSNJ Telehealth Webinar Series:
Part 2: Navigating Telehealth Reimbursement
Wednesday, March 25, 2020 from 12:00pm to 1:00pm
While telehealth has become an acceptable means of delivering health care, how third party payers reimburse telehealth services vary depending on the payer. This webinar will explore the rules and regulations impacting telehealth reimbursement by the Medicare and Medicaid programs and highlight the reimbursement policies of national commercial health plans.
More information and registration.