Highlights from CMS’ “Office Hour” Regarding Telehealth, Hospitals Without Walls and Putting Patients over Paperwork
April 9, 2020

On April 7, 2020, the Centers for Medicare & Medicaid Services (“CMS”) hosted its first open conference call in a series of “Office Hours” to allow hospitals, health systems, and providers the opportunity to ask CMS agency officials questions pertaining to temporary actions taken by CMS in response to COVID-19. CMS’ first “Office Hour” addressed promoting telehealth in Medicare, hospitals without walls, putting patients over paperwork and expanding the health care workforce. The complete recording of the April 7, 2020 Office Hour is available here . Below are some highlights from CMS’ April 7, 2020 “Office Hour”.

Telehealth in Medicare
Health Care Providers, Generally

  • In instances where two-way audio and video technology is unavailable, but a health care provider can still otherwise provide evaluation and management (“E/M”) using audio only communications, the provider should utilize telephone E/M codes specific to telephone or audio only E/M.

  • Under CMS’ current rules, telehealth services only apply when the provider and patient are in different places. When both the provider and patient are located in different parts of the same hospital, telehealth rules would not apply.

  • In response to a question about elderly Medicare patients being unable to access video and thus whether CMS will recognize certain CPT codes, CMS noted that under the new interim Final Rule there are payable CPT codes for telephone E/M. Services may be payable under the physician fee management schedule, similar to standard E/M visits, but with specific CPT codes. 

  • If a health care provider is rendering an audio-visual service and, in the midst of the service, the patient has a technical issue with the video freezing or being dropped, the telehealth service can still be billed as E/M with the appropriate modifier if enough of the service was furnished with audio and video capabilities. However, if the service would better be described by telephone E/M because a bulk of the service was done solely over the telephone, then the telephone E/M code may be more appropriate.

  • In answering a question regarding telehealth documentation requirements under CMS’ new guidelines, CMS was unable to give a specific answer pertaining to the level of specificity required in documentation. However, CMS noted that it expects the same level of documentation that would ordinarily be provided.

  • For certain infusion services, such as chemotherapy, recent CMS guidance has stated that direct supervision may be met if a physician is available via telehealth. In clarifying this guidance, CMS noted that a physician does not have to be on a consistent open line via telehealth, and that it is sufficient if the physician is immediately available. CMS remarked that the use of virtual presence is intended to replace the need for in-person presence. Thus, to the extent that in-person presence would not require personal supervision but immediate availability in person, the same would be true for a virtual presence.

Hospice Centers

  • Hospice centers can use voice-to-voice communications for routine home care, but cannot use voice-to-voice communications for the telehealth face-to-face encounter requirement.

  • In answering a question regarding whether hospices can report Service Intensity Add-on (“SIA”) adjustment visits through telehealth, CMS stated that telehealth would be a part of the routine home care rate and would not rise to such add-ons. 

  • Initial assessments for hospice admission can be done via telehealth. 
Hospitals Without Walls
Health Care Providers and at-Home Patients

  • CMS noted that it expects to issue guidance soon regarding whether, under the expanded hospitals without walls initiative, a waiver can be used to treat a patient that would otherwise be at a hospital from the patient’s home.

Putting Patients over Paperwork 
Long-Term Care Facilities

  • In answering a question pertaining to the documentation required under the 1135 waiver to waive the three midnight stay requirement, CMS said blanket waivers are available when discharge may be done under three days. CMS recommends having documentation pertaining to when waivers are exercised. Additionally, CMS noted that documentation can be from either a discharging hospital or the physician.

Rehabilitation Providers

  • In response to a question about CMS waiving IRF quality reporting program data, CMS stated that it will address IRF patient assessment instrument in an upcoming guidance. 
Advanced/Accelerated Payments 
  • If hospitals have received a quote from the applicable Medicare Administrative Contractor (“MAC”) regarding the advanced/accelerated payment maximum, and the hospital believes the amount from the MAC is incorrect, the hospital can send specific facility information to CMS’ mailbox at COVID-19@cms.hhs.gov. But, for Part A and Part B providers other than those covered by the Coronavirus Aid, Relief, and Economic Security Act (the “CARES Act”), to streamline the accelerated payment process, CMS will review claims history and history proceeding the COVID-19 emergency. 

  • Generally, 210 days is the maximum amount of time for a provider to repay the advanced/accelerated payment. Medicare will not make recoupments between the day the provider received the advanced/accelerated payment to day 120. At day 121, Medicare may recoup from claims payments made. Certain hospitals under the CARES Act may have up to 365 days to repay the advanced/accelerated payment.

  • CMS does not believe there is a specific CPT code pertaining to payment recoupment, instead, there will be a statement that indicates “COVID-19” as the reason for recoupment. Health care providers interested in finding out more information about this can send a question to CMS’ mailbox at COVID-19@cms.hhs.gov.
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Texas Board of Legal Specialization
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Board Certified – Health Law
Texas Board of Legal Specialization
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