In response to the COVID-19 public health emergency (PHE), the Centers for Medicare & Medicaid Services (CMS) has included relaxed telehealth guidelines to help providers care for patients and promote social distancing. Providers have been able to implement Medicare telehealth visits, virtual check-ins, e-visits, and remote monitoring. Waiver 1135 removed the restrictions on a patient’s location. Before, patients could only receive telehealth services if they lived in certain rural areas and it was performed in a clinical setting. During the PHE, patients can remain in their own homes, located anywhere. The requirement for providers to need a license in the state where the patient is located was waived to help eliminate barriers. The HIPAA Privacy rules have also been relaxed for telehealth. As long as providers have shown good faith, efforts to utilize non-public facing audio or video communications like Skype for Business, Microsoft Teams, Updox, Zoom for Healthcare and Doxy.me, the OCR will exercise enforcement discretion. Public-facing applications like Facebook Live, Twitch, TikTok, and similar video communication applications should not be used by healthcare providers in the provision of telehealth.
Under the expansion, clinical psychologists and licensed clinical social workers can also perform telehealth services alongside doctors and nurses. Virtual check-in services or brief check-ins for new or established patients are permitted over the phone, through video chat, or patient portals.
As a result, many providers have implemented Telehealth Evaluation and Management (E/M) office visits, as well as check-ins and e-visits. A lesser known service included in the waiver is the Annual Wellness Visit (AWV). The Initial Preventive Physical Examination (IPPE), also known as the Welcome to Medicare Preventive Visit, is not included in the waiver. Providers are allowed to perform the Initial AWV and Subsequent AWV during the PHE. Some telehealth services can be performed by audio only, but AWVs must include audio and video. As before, AWVs can be performed by clinical staff with direct supervision by a provider. Providers can also be proactive and reach out to existing patients that are eligible for an AWV. During the telehealth visit, patients are allowed to self-report weight, height, body mass index and blood pressure, which would usually be taken in person. During the PHE period, the provider would document in the medical chart that the information was “self-reported by patient” or “unable to obtain due to COVID-19 PHE.” A majority of the exam can be performed by asking questions and observing the patient on video.
Advanced Care Planning (ACP) is an optional service during an AWV. Like the AWV, there is no co-pay for the patient for ACP. This is a win-win; the patient gets a valuable service and the provider is able to add a billable service for time spent helping the patient.
Once the PHE is over, it will be important to know what happens next. Will all the waivers go away, or will CMS implement some of the changes moving forward? In early June, CMS Administrator Verma Seema hinted that waivers permitting broader telehealth coverage will be extended after the coronavirus pandemic. It was brought up in the Senate as well. This could be good news for all.
LW Consulting, Inc. (LWCI) can review medical records and physician notes to ensure that all documentation is being completed correctly and that it meets all the required elements.
LWCI recently completed a probe sample audit for a large medical group. Read our “Annual Wellness Visit: Audit Reveals EMR Template Vulnerability for Busy Medical Group” article to learn more about the results and the steps that were implemented to ensure the medical group completed documentation correctly.
For more information, contact Jim Wright at 717-213-3128 or email JWright@LW-Consult.com.