Medicare Compliance & Reimbursement

Tip: Know the documentation requirements.

Remember: Over the last few months, the Centers for Medicare & Medicaid Services (CMS) announced that Medicare payers will reimburse providers for telehealth visits — even if the patients are in their homes during the encounters. In addition, CMS will no longer closely restrict the type of device used for the telehealth visit.

Instead, patients can use their computers or smartphones to access face-to-face (F2F) telehealth services.

Though the 1135 waivers offer providers flexibility to tackle COVID-19 while decreasing the risks of spreading the virus, “the telehealth coverage guidelines have changed significantly” and pose challenges for many Medicare practices, said reps from Part B Medicare Administrative Contractor (MAC) NGS Medicare in the May 27 webinar, “Telehealth Services in the Age of COVID-19 for Part B Providers.”

Read on for tips that NGS staffers shared during the call that can help you maximize your telehealth claims.

Tip 1: Know That the Telehealth Waivers Are Temporary

The current telehealth expansion that includes the 1135 waivers and flexibilities were put into place to help providers through the pandemic. They are temporary but will remain in effect for the duration of the COVID-19 public health emergency (PHE), according to NGS Medicare guidance.

“Some providers have asked us, ‘Is there an end date?’ At this time, no,” said NGS Medicare’s Lori Langevin during the webinar. “CMS says we are just going forward until the public health emergency has ended, but no, we don’t have a date,” she added.

Tip 2: Utilize Online CMS Code List

As part of its COVID-19 telehealth expansion, CMS added 85 codes to its coverage list that are now payable under the Medicare Physician Fee Schedule (MPFS).

“You’ll submit the appropropriate CPT^® or HCPCS code, which is going to be one of the codes listed on the CMS website list,” Langevin stressed.

Plus: Appending modifier 95 (Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system) tells the payer that you performed the service via telehealth. “Whether its audio or audio-video — and these specifications will be on that [CMS code] list — you have to have modifier 95 on there,” explained Langevin.

Find the CMS list of covered telehealth codes during the PHE effective March 1, 2020, at www.cms.gov/Medicare/Medicare-General-Information/Telehealth/Telehealth-Codes.

Tip 3: Use Appropriate POS Codes

In the past, CMS paid for telehealth only when patients were in a specific health setting during the visit, and only when certain technologies were used. With the new changes that allow telehealth to take place in any setting and using a wider range of platforms, many providers are confused about which place of service (POS) code to use on their Part B claims.

“You are going to use your place of service option as if you were seeing patients face-to-face,” Langevin advised. “Most providers would be using POS 11 [office], but, of course, POS 21 [Inpatient hospital] or POS 23 [Emergency room – hospital] are applicable.”

Tip 4: Understand These Reimbursement Facts

According to NGS Medicare, there is no reduction in payment for care administered at a distant site; practitioners will be paid MPFS rates for the services provided.

“As far as the payment for distant site, it will be equal to the current fee schedule amount for services provided. You’ll want to bill the location you would pre-COVID-19,” Langevin said.

Important: The MACs understand that clinicians may be caring for patients in their homes, and that’s perfectly fine. Due to the temporary nature of the telehealth waivers, providers will still want to bill with their practice locations.