There are four main types of Medicare virtual services physicians and other professionals can provide to Medicare beneficiaries during the COVID-19 Public Health Emergency:
1. Telehealth/Telemedicine Visits: Effective for services starting March 6, 2020 and for the duration of the COVID-19 Public Health Emergency, Medicare will make payment for Medicare telemedicine services furnished to patients in broader circumstances.
Key points of the Medicare COVID-19
Waiver,
Interim Final Rule 1,
Interim Final Rule 2:
- Pays for telemedicine services at the same rate as in-person visits;
- Waives geographic and originating site restrictions so patients can receive telemedicine services in non-rural areas;
- Allows the use of telephones that have audio and video capabilities;
- Allows reimbursement for any telemedicine covered code, even if unrelated to COVID-19 diagnosis, screening, or treatment;
- Allows for new patients to receive telemedicine services suspending the established patient relationship requirement.
- Suspends penalties for noncompliance with HIPAA so that physicians can use any non-public facing remote communication application to communicate with patients. Applications that are non-public facing include but are not limited to Apple FaceTime, Facebook Messenger video chat, Google Hangouts video, and Skype. Public-facing applications like Facebook Live, Twitch, TikTok, etc. are not permitted. Additional information can be found on the HHS notice.
- Removes frequency limitations on Medicare telemedicine for subsequent inpatient visits (CPT 99231-99233), subsequent skilled nursing visits (CPT 99307-99310), and critical care consult codes (CPT G0508-G0509).
- Allows for physician supervision of non-physician practitioners to be conducted virtually using real-time audio/visual technology for services requiring direct supervision by a physician or other practitioner.
CMS has developed a
toolkit to help physicians understand the general concepts of telemedicine and its implementation.
2. Virtual Check-Ins: Virtual check-ins are brief phone calls or video chats to see whether patients need to have an in-person visit. New and established patients in all geographical locations may receive this service from their homes and have a brief communication with physicians using various applications including telephones, or exchange information through video or images. The communication cannot be related to a medical visit within the previous seven days and may not lead to a medical visit within the next 24 hours (or soonest appointment available). The patient must verbally consent to receive virtual check-in services. More information on
Virtual Check-Ins is available from CMS.
3. E-Visits: Available in all locations, including the patient’s home, and all geographical areas (not just rural), for new and established patients, Medicare patients may have non-face-to-face
patient-initiated communications with their physicians using online patient portals. Patients must generate the initial inquiry, and communications can occur over a seven-day period. The services may be billed using CPT codes 99421-99423 and HCPCS codes G2061-G2063, as applicable. More information on
E-Visits is available from CMS.
4. Telephone (audio only): Payment for these codes is paid at parity with in-person rates. These codes are available to new or established patients and may be furnished using audio-only devices. Claims must be submitted with modifier 95 and the place of service code you would normally have seen the patient (usually POS 11) to receive payment parity.
Additional information can be found on the CMS
letter to clinicians.
MEDICAID
Medicaid, Medicaid managed care organizations (MCOs), and the Healthy Texas Women Program continuously update their coverage polices. Consult their
COVID-19 page for updates and guidance (note the
Recent News column on the right side of the page for specific notices). Texas Medicaid managed care organizations must provide all medically necessary, Medicaid-covered services to eligible clients. Administrative procedures such as prior authorization, pre-certification, referrals, and claims filing may differ from traditional Medicaid and from MCO to MCO. Providers should contact the client's specific plan for coverage and billing rules.
CHRONIC PAIN PATIENTS
The TMB updated
Ch. 174 of the Texas Administrative code making the Emergency Rule permanent effective Oct. 7, 2021. For further guidance, consult the
TMB COVID-19 page, and the
DEA’s COVID-19 website.
COVID-19 PAYOR POLICY NOTICES
Please verify benefits, coverage, and coding guides for all plans prior to rendering telemedicine services. You may also consult the TMA Practice Viability Toolkit for coding help.
Special Coding Advice: AMA has developed
coding scenarios to assist in coding telemedicine services.
COVID-19 TELEMEDICINE VENDORS
Standard Telemedicine Information (pre-COVID-19)
IMPLEMENTING TELEMEDICINE IN YOUR PRACTICE
If your organization is considering implementing a telemedicine program but you currently have limited experience with telemedicine systems, please review the following information to assist you and your practice in this process.
Contract Language:
Contracts are a necessary part of any telemedicine venture. A telemedicine service contract will share many of the same contracting concerns as an EHR, such as who owns the equipment, who owns the data, and expectations around service call timing, up-time, software updates and turnaround times. Agreements made with telemedicine providers or technology vendors should be reviewed to ensure that insurance provisions include mutual hold-harmless and indemnification language and that adequate insurance coverage is required. Confer with legal counsel to determine which state laws apply to the organization’s telemedicine services, monitor changes in applicable regulations and take steps to ensure that procedures for education and compliance are in place. The American Society for Health Care Risk Management has developed a white paper discussing Telemedicine Risk Management Considerations.
The Coker Group offers TMA/HCMS physician members free technology contract review services. Coker Group is a member of TMA-approved Group Discount Programs.
Policy and Procedures:
Although telemedicine has the potential to improve several aspects of medical care, such as facilitating physician-patient communication and monitoring treatment of chronic conditions, telemedicine poses unique challenges in ensuring patient-safety and privacy of health information. Therefore, it is prudent for telemedicine providers to develop a comprehensive set of policies and procedures (P&P).
The TMA has developed templates to assist practices in developing their own P&P. These can be found under the section titled “Policies, Procedures and Forms for Telemedicine Services” on their own P&P. These can be found under the section titled “Policies, Procedures and Forms for Telemedicine Services” on their
Telemedicine web page.
Additionally, organizations considering telemedicine or adding new telemedicine technologies to an already existing panel of services must consider how the new or added services will be incorporated into privacy and security policies, procedures, and workflows. For example:
- Incorporate telemedicine into the Notice of Privacy Practices.
- Include telemedicine equipment in the organization’s Security Management Plan and annual Security Risk Assessment.
- Ensure all staff and providers who participate in telemedicine services have received telemedicine specific healthcare privacy and security training.
- Determine the need for Business Associate Agreements. Evaluate all parties, including any vendors involved in the provision of services, for compliance with federal and state privacy and confidentiality regulations, and require the ability to provide proof compliance if asked. Require telemedicine vendors to hold their subcontractors accountable as well.
Vendors:
After reviewing and understanding payor policies (see above for COVID policies and below for standard policies) and ensuring you will receive proper payment for conducting telemedicine services, below are resources to help identify a vendor that fits your needs.
Educational Resources/Webinars:
The TMA has developed a comprehensive web page of resources to assist in the implementation of telemedicine including a Getting Started Guide.
Additionally, the TMA has a multitude of
telemedicine webinars which offer CME credit and are free to members:
The AMA has developed a Quick Guide to Telemedicine in Practice which includes a Telemedicine Implementation Playbook (available for download) designed to support physicians and practices in expediting the implementation of telemedicine. The AMA also offers resources “Digital Leadership” and a free Telemedicine Module within their Steps Forward program which provides 0.5 CME credits.
The American Telemedicine Association has many resources, educational courses and events. The ATA is a non-profit association with a membership network of thousands of industry leaders and healthcare professionals.
PAYOR POLICIES
In general, most State telemedicine legislation only applies to fully-insured plans (TDI or DOI on front of patients insurance card), thus coverage for telemedicine varies by plan and patients benefits. It is imperative to verify coverage prior to rendering telemedicine services.
Standard Policy Notices:
Below are links to standard payor telemedicine policies outside of the COVID-19 crisis.
RULES AND LEGISLATION
Please review TMA's white paper on
Texas Laws and Regulations Relating to Telemedicine.
Note: The information provided on this fact sheet does not, and is not intended to, constitute legal advice; instead, all information, content, and materials available are for general informational purposes only. Information on this fact sheet may not constitute the most up-to-date legal or other information.
Below are the current TMA policies as related to telemedicine: