The Centers for Medicare and Medicaid Services (CMS) has broadened access to Medicare telehealth services so that beneficiaries can receive a wide range of services from their doctors without having to travel to a healthcare facility.

The Coronavirus Preparedness and Response Supplemental Appropriations Act, enacted on March 6, 2020, includes a provision allowing the Department of Health and Human Services (HHS) to waive certain Medicare telehealth payment requirements during the Public Health Emergency (PHE) declared by the HHS Secretary on January 31, 2020. The waiver allows beneficiaries in all areas of the country to receive telehealth services, including at their home.

The changes represent a significant departure from Medicare's restrictive rules on telehealth reimbursement. Current telehealth law only allows Medicare to pay practitioners for services like routine visits furnished through telehealth under certain circumstances. For example, the beneficiary receiving those services must generally be located in a rural area and receive telehealth services at a local medical facility.

Expanded telehealth services are available not just for patients with COVID-19 but also for any Medicare beneficiary, as long as it relates to a reasonable and necessary Medicare service ordinarily covered by Medicare.

The waiver lifts limitations, as of March 6, 2020, on where, how, and with whom patients can access telehealth visits, as well as restrictions on providers' flexibility to waive or reduce patients' cost-sharing obligations.

Important changes for Medicare telehealth services

Patients can access telehealth visits from home. “Eligible originating sites” for telehealth visits now include patients' homes and "any healthcare facility." Medicare beneficiaries no longer have to live in rural areas and leave their home to travel to a clinic, hospital, or other type of medical facilities for the service.

Patients and providers can connect through their smartphones. The waiver authorizes smartphones — or "telephones with audio and video capabilities" — for telehealth visits. In addition, HHS will exercise enforcement discretion and waive penalties for HIPAA violations for providers who deliver telehealth services in good faith using everyday video chat technologies like Skype or FaceTime.

The Advisory Board notes that HHS recommends that providers inform patients of potential privacy risks of using these forms of communication and enable encryption and privacy modes when using their smartphones.

Patients don’t need an existing relationship with a provider to get telehealth services. CMS is trying to keep Medicare beneficiaries at home and away from a doctor’s office, clinic, or hospital. Although current telehealth law requires that a patient have a prior established relationship with a particular practitioner, HHS will not conduct audits to ensure that such a prior relationship existed for claims submitted during this PHE. This provides beneficiaries with more options to use the expanded telehealth benefit.

Providers can waive or reduce cost-sharing requirements. The use of telehealth does not change the out-of-pocket costs (deductibles and coinsurance) for beneficiaries. The HHS Office of Inspector General (OIG), however, is providing flexibility for healthcare providers to reduce or waive cost sharing for telehealth visits paid by federal healthcare programs, without facing penalties under federal anti-kickback regulations.

Some things haven't changed

Some current restrictions remain in place relating to patient-provider interactions and the services and providers that are eligible for telehealth.

Medicare telehealth visits must be a real-time, audio-visual interaction. A telehealth visit must use interactive audio and video communication between a patient and a provider. Telephone, messaging, and other online interactions do not qualify for the expanded reimbursement opportunity, though they still qualify for shorter-duration virtual check-ins and e-visits.

Qualified providers and eligible services are unchanged. The waiver does not change the types of providers who can deliver telehealth services. Physicians, nurse practitioners, physician assistants, certified nurse midwives, nurse anesthetists, licensed clinical social workers, clinical psychologists, and registered dietitians or nutrition professionals may all provide telehealth services within the scope of their practice.

In addition, the kinds of services eligible for Medicare telehealth reimbursement haven’t changed; see CMS’ list of eligible services available through telehealth here. The only change is that these services can be provided to patients in any location.

Patients need to initiate the telehealth service. The patient – not the provider – must ask for telehealth services; however, practitioners may educate beneficiaries on the availability of the service prior to patient initiation.

CMS has is maintaining a list of frequently asked questions about changes in the program, available here.

For more information on this topic or to learn how Baker Tilly specialists can help.

Mark Ross
Partner, CPA
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