Telehealth and other payor updates

On March 17, the Trump Administration announced expanded Medicare telehealth coverage that will enable beneficiaries to receive a wider range of health care services without having to travel to a health care facility. This temporary broadened telehealth access to Medicare patients (under the 1135 waiver authority and Coronavirus Preparedness and Response Supplemental Appropriations Act), is effective March 6, 2020.

The expanded Medicare telehealth coverage allows:

  • Medicare to pay for office visits furnished via telehealth in all areas of the country (not only rural areas) and in any setting, including a patient’s home.
  • These visits are considered the same as in-person visits and are paid at the same rate as regular, in-person visits. CMS will allow payment for any telehealth-covered code, even if unrelated to COVID-19 screening, diagnosis, or treatment.
  • Physicians may reduce or waive cost-sharing for telehealth visits paid by federal health care programs.
  • HHS will not enforce the established relationship requirement that a patient must have seen the physician within the last three years.
  • Services may be provided using smart phones that have audio and video capabilities. According to the CMS Medicare Telemedicine Fact Sheet, audio-only visits are allowed via telephone but are paid at a different rate.

CMS has developed a Toolkit regarding Telehealth and can be found here. For additional information, check out the CMS telehealth FAQ.

HIPAA Restrictions Suspended

Effective immediately, the U.S. Health and Human Services (HHS) Office for Civil Rights (OCR) will not penalize physicians for noncompliance with HIPAA when they serve patients in good faith through common, nonpublic-facing communications technologies, such as FaceTime or Skype.

According to the announcement, this applies to services provided via telehealth for any reason, regardless of whether the service is related to the diagnosis or treatment of health conditions related to COVID-19.

HHS encourages physicians to notify patients of the potential security risks of using these services, but notification is not required. Physicians should not use public-facing communication services like Facebook Live, Twitch, and TikTok.

Physicians will need to document the visit as though it took place in person. The OCR has issued a new FAQ on this notice.

Medicare Provisional Provider Enrollment due to COVID-19

WPS—the Kansas Medicare Administrative Contactor—has established a telephone hotline to allow physicians and non-physicians practitioners to initiate provisional temporary Medicare billing privileges via telephone and address questions regarding provider enrollment flexibilities afforded by the COVID-19 waiver. Provider enrollment staff will be available to assist you with your provisional Medicare billing privileges and COVID-19 related inquiries.

The WPS hotline is (844) 209-2567.

CMS has released a new FAQ regarding Medicare Provider Enrollment Relief that may be helpful as well.

Policy and Guidance from other Payors

Policy and guidance from payors are changing often. How you bill for Medicare my not be how a commercial plan wants you to bill. Please check with the specific payor when billing for telehealth. Below are the payers we have heard from. We encourage you to check their links for updates.

Medicaid Managed Care OrganizationsThe Kansas Department of Health and Environment (KDHE) has released an updated Bulletin regarding COVID-19 coverage, announcing testing and treatment for COVID-19 will require an order from a qualified provider and use of HCPCS codes U0001 and U0002 for laboratory testing. These codes as well as any treatment for COVID-19 will be exempt from Spenddown, which is the patient’s out of pocket cost. All claims related to COVID-19 services need to be billed separately from non-COVID-19 services. KDHE is working quickly to make necessary program changes to increase the scope of telemedicine services. Additional information regarding Provider Enrollment Updates is available. Updates to Medicaid program can be found at the KMAP website under "Publications."

Blue Cross Blue Shield of Kansas will cover the cost of testing for the COVID-19 virus at no cost to the member. Details available here. Additional news about BCBSKS efforts and updates are available at: BCBSKS COVID-19.

UnitedHealthcare is expanding its telehealth policies effective immediately. They are monitoring national and local updates from the CDC, CMS, and other outlets to adjust their policies as needed. Updates to may be found here.

Aetna will waive co-pays and apply no cost-sharing for all diagnostic testing related to COVID-19. Updates available here.


Guidance for Reducing or Waiving Cost-sharing for Telehealth

For physicians who wish to reduce or waive cost-sharing obligations for telehealth, the Office of the Inspector General (OIG) has released a statement and FAQ:

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If you have questions about these updates or other payor issues, please contact Ruth Clark, KMS Director of Health Care Finance: This email address is being protected from spambots. You need JavaScript enabled to view it..