Practice Management Alert

Hint: Medicare says certain conditions must be met for reimbursement.

Don't get too excited about the new telehealth option Medicare has publicize for Part B recipients. Medicare has some very strict rules about which physician/patient situations qualify for telehealth reimbursement, and you may be surprised.

Medicare determines telehealth eligibility by location of the place of service (POS), and only locations that Medicare determines as rural can qualify.

"Unfortunately, it [telemedicine] doesn't go by the patient's condition," said Lori Langevin, provider outreach and education consultant at the Center for Medicare and Medicaid Services' (CMS) National Government Services (NGS) in a Jan. 25, 2018, webinar, "Medicare Telehealth Services for Part B Providers."

"We can't stress that enough," she said. "Some of our providers are using telehealth based on patient's physical health, and you really can't do that."

Location, Location, Location

Medicare will reimburse Part B providers for telehealth services only if the patient presents from a qualifying - and rural - location. For example, Medicare won't pay for the physician's time or service if the patient is in her own home.

A patient must present from a rural location, but also from a qualifying POS. Here's a list of qualifying originating sites with their POS codes, according to NGS:

• Offices of physicians/practitioners (POS 11)
• Hospitals (POS 21, 22, 23)
• Critical access hospitals (POS 21, 22, 23)
• Rural health clinics (POS 72)
• Federally qualified health centers (POS 50)
• Hospital-based or CAH-based renal dialysis centers (including satellites) (POS 65)
• Skilled nursing facilities (POS 31, 32)
• Community mental health centers (POS 53)

Other conditions apply, too, said Gail O'Leary, provider outreach and education consultant at CMS NGS, who co-presented the Jan. 25 webinar.

"The service must be on the list of Medicare telehealth services and meet all of the following:

• "Must be furnished via an interactive telecommunications system;
• "Must be furnished by a physician or authorized practitioner;
• "Must be furnished to an eligible telehealth individual;
• "Individual receiving the service must be located in a telehealth originating site."

The Health Resources and Services Administration (HRSA) determines whether the originating site qualifies as rural, and reevaluates these sites every year.

Important: Verify your address. Many sites that qualified in December 2017 lost their qualifying rural status on Jan. 1.

"The patient has to present from a rural location; the doctor can be anywhere. There is no requirement for the doctors' location," O'Leary said.

For example: Medicare Part B will reimburse a physician located in Boston if she has a telemedicine appointment with a Part B recipient who uses a video system to call in from a qualifying, rural site of origin, like a rural skilled nursing facility, as long as the other conditions are met and the documentation has the necessary information.

Reminder: "The patient's home is not an approved originating site," O'Leary said multiple times.

Even if the patient is homebound, a telemedicine encounter qualifies for Part B reimbursement "only if the patient presents at an originating site in a rural location," O'Leary said. "Their condition has no bearing on coverage requirements."

Use the Right Equipment

Though the technology in your office (or even your pocket) make connecting over a video call possible, you need to use equipment that is advanced enough that there won't be any lag time.

You must use "interactive audio and video telecommunications system that permits real-time communication between the doctor and the beneficiary," NGS said. "Asynchronous 'store and forward' technology is not permitted."

Submit this Documentation

The claim for reimbursement should be the same as with any Part B patient encounter, except you need to add the following information, per NGS:

• "A statement that the service was provided using telemedicine;
• "The location of the patient;
• "The location of the provider; and
• "The names of all persons participating in the telemedicine service and their role in the encounter."

Part A: Though the webinar focused on Part B providers, Part A has similar options. Part A providers "would also » get this facility site fee, but a bit different because instead of place of service it's type of bill," Langevin said.

Resource: Check the eligibility of any address here: https://datawarehouse.hrsa.gov/tools/analyzers/geo/Rural.aspx