Telemedicine Rules and What Telemedicine "visits" are Available for Therapists

As we at NARA traverse the best and the worst of times, we step back to look at the unfolding news that hopefully offers an opportunity to use to view this as one of the best of time.

Telemedicine Rules

CMS announced today during the White House COVID-19 Task Force a number of important initiatives related to “telehealth”.  This update is to provide key facts, and help NARA members prepare to offer services to Medicare beneficiaries consistent with regulations effective during the declared emergency.  PTs, OTs and SLPs will be able to provide telehealth services that are categorized by CMS as E-Visits. 

These codes were added to the 2020 Medicare Physician Fee Schedule (MPFS), but not available for therapy providers. The CMS announcement broadened access to Medicare telehealth services so that beneficiaries can receive a wider range of services…without having to travel to a healthcare facility. CMS is expanding the telehealth benefit on a temporary and emergency basis under the 1135 waiver authority and Coronavirus Preparedness and Response Supplemental Appropriations Act.

What Telemedicine “Visits” are Available for Therapists to Assist Medicare Beneficiaries?

Per CMS “Clinicians who may not independently bill for evaluation and management visits (for example – physical therapists, occupational therapists, speech language pathologists, clinical psychologists) can also provide these e-visits and bill the following codes:

• G2061: Qualified non-physician healthcare professional online assessment and management, for an established patient, for up to seven days, cumulative time during the 7 days; 5–10 minutes
• G2062: Qualified non-physician healthcare professional online assessment and management service, for an established patient, for up to seven days, cumulative time during the 7 days; 11–20 minutes
• G2063: Qualified non-physician qualified healthcare professional assessment and management service, for an established patient, for up to seven days, cumulative time during the 7 days; 21 or more minutes.

What is the CMS Guidance for the eVisit Codes?

• These services can only be reported when the billing practice has an established relationship with the patient.
• There are no geographic or location restrictions for these visits.
• Patients communicate with their “therapists” without going to the “clinic: by using online patient portals.
• Individual services need to be initiated by the patient; however, practitioners may educate beneficiaries on the availability of the service prior to patient initiation. 
• Therapists bill using HCPCS codes G2061-G206, as applicable.
• The Medicare coinsurance and deductible would generally apply to these services.

HHS /OCR Guidance on HIPAA Waivers

HHS Office for Civil Rights (OCR) will exercise enforcement discretion and waive penalties for HIPAA violations against health care providers that serve patients in good faith through everyday communications technologies, such as FaceTime or Skype, during the COVID-19 nationwide public health emergency.  https://www.hhs.gov/hipaa/for-professionals/special-topics/emergency-preparedness/index.html

OIG Guidance on Waiving Copayments and Deductibles

The OIG, in a March 17, 2020 Statement indicate that “Physicians and practitioners do not risk enforcement action if they waive any cost-sharing for telehealth visits during the public health emergency”. OIG would not bring an enforcement action under either the Federal anti-kickback statute or the beneficiary inducements civil monetary penalty statute for waiving or reducing such cost-sharing, provided all applicable Centers for Medicare & Medicaid Services (CMS) payment and coverage rules are met.  This serves to notify providers that OIG will not enforce these statutes if providers choose to reduce or waive cost-sharing for telehealth visits during the COVID-19 public health emergency, which the HHS Secretary determined exists and has existed since January 27, 2020. 

Complimentary Webinar Offered by NARA Members Clinicient and Nancy Beckley & Associates

Long time NARA members Clinicient and Nancy Beckley & Associates are offering a complimentary webinar to discuss “telehealth” in general and to address compliance with the CMS Emergency Authority allowing PT, OT & SLP to conduct eVisits. Register here: https://register.gotowebinar.com/register/5057734102101361420?fbclid=IwAR3viipnhM993ZCPgY2s4oKBOGuxCzd9aBGfQWJvS0JJqE8ttMdky0qTmTc 

What To Do Next?

NARA members are advised to explore the opportunities presented by CMS to continue to serve Medicare beneficiaries during the COVID-19 emergency. This may include notifying current patients of their ability to be in contact with their provider, as well as determining an eVisit protocol for the variety of patients that are typically seen on caseload.  While not intended to be a substitute for a patient visit either clinically or financially, it offers an opportunity to keep in touch with our vulnerable seniors and keep the normalcy of therapy in their lives.