Medicare Compliance & Reimbursement

Medicare’s expansion of telehealth under the 1135 waiver aims to help providers keep high-risk patients at home in the wake of the 2019 novel coronavirus (COVID-19) pandemic.

Now: Under the waiver, Medicare can now “pay for office, hospital, and other visits furnished via telehealth across the country,” explains the fact sheet. The payment changes also include care administered via telehealth services to beneficiaries in their homes, too. The waivers are backdated to March 6, 2020.

According to the Centers for Medicare & Medicaid Services (CMS), “a range of providers, such as doctors, nurse practitioners, clinical psychologists, and licensed clinical social workers, will be able to offer telehealth to their patients,” the fact sheet notes.

Understand These 5 Key Telehealth Waiver Points

As you address COVID-19 concerns in your office, review five major factors of the telehealth 1135 waiver expansion:

1. Know the virtual service options under the waiver. Physicians and other specified providers designated in Medicare guidance have three virtual service options under the waiver: Medicare health visits, virtual check-ins, and e-visits.

2. Understand that CMS removed location restrictions. The agency got rid of site barriers and geographic requirements. Medicare practices can now offer telehealth services at any location.

3. Use basic tech to reach patients. Providers can use smartphones or computers to care for beneficiaries — if both have the capabilities. Patient portals can also be accessed as a means of communications.

4. Review relaxed HIPAA enforcement. “The HHS Office for Civil Rights (OCR) will exercise enforcement discretion and waive penalties for HIPAA violations against healthcare providers that serve patients in good faith through everyday communications technologies, such as FaceTime or Skype,” the fact sheet says.

5. See new copay options. If you want to offer your patients cost-sharing options under the telehealth waiver, you can. The HHS Office of Inspector General (OIG) issued new flexibilities on copays.

Remember: State rules and regulations still apply, so it’s critical that you check in with your state medical board and the Medicare Administrative Contractor (MAC) in your jurisdiction.

Resource: See the waiver particulars and payment advice at www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet.