Master 4 Conditions to Qualify for Medicare Telehealth Reimbursement

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Master 4 Conditions to Qualify for Medicare Telehealth Reimbursement

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Medicare Telehealth Reimbursement

On April 21, 2021, the Department of Health & Human Services (HHS) renewed the Medicare telehealth requirement waivers that were implemented last year during the pandemic. The new expiration date for these relaxed rules is set for the end of July. This means you have a little while longer to take advantage of these telehealth waivers, but you also need to get ready for change.

There is a real chance that Congress could choose not to renew pandemic waivers again, and Medicare’s stricter requirements could go back into effect. Accordingly, if you want to continue to provide, bill and be eligible for Medicare telehealth reimbursement, you should be using this extra time getting ready.

Below you’ll find an outline of four key requirements that will help you qualify for Medicare telehealth reimbursement now and after the waivers possibly expire.

1. Originating Site Requirements for Medicare Telehealth

The physical location of your patient during a virtual visit constitutes the originating site. At the height of the public health emergency (PHE) last year, the Center for Medicare and Medicaid Services (CMS) expanded long-established Medicare telehealth reimbursement requirements to include all locations and settings. Patients within the United States at any type of healthcare facility or in their home are currently eligible to receive telehealth services under the relaxed guidelines – at least for the time being.

If the current waivers expire, telehealth services will be limited to the previous protocol outlined by CMS. However, a recent post on the American Medical Association (AMA) website clearly states that the Association is encouraging Congress to not return entirely back to the stricter guidelines. Previously, originating sites were limited to specifically identified locations within a qualifying rural area.

2. Distant Site Practitioner Eligibility for Medicare Telehealth 

Medicare defines a “distant site” as the location of the provider during provided telehealth services. The CMS waivers broadened the definition of an eligible provider to include Physical Therapists, Occupational Therapists, Speech Language Pathologists, and Clinical Psychologists.

Your ability to be eligible for Medicare telehealth reimbursement for these extended providers could end if the waivers are allowed to expire in July. Preceding the coronavirus outbreak, precise guidelines for eligible distant site practitioners only included Physicians, Nurse Practitioners, Physician’s Assistants, Nurse Midwives, Clinical Nurse Specialists, Certified Registered Nurse Anesthetists, Clinical Psychologists Social Workers, and Nutrition Professionals including Registered Dietitians.

3. Real-Time Communication

CMS also eased communication rules during the pandemic to permit audio-only services to qualify for Medicare telehealth reimbursement. Prior to the COVID-19 waivers, mandates required real-time, interactive audio and video communications between your patients and providers to comply.

In addition to these CMS changes, HIPAA encryption requirements were also made less stringent. Currently, while the waivers are in place, your practice can utilize user-friendly platforms including FaceTime and Skype without non-compliance ramifications. It is important that your practice start preparing now in case the current rules are converted back to pre-pandemic standards. Otherwise, you could be facing citations for non-compliance.

4. CPT/HCPCS Coding for Medicare Telehealth

The rules related to how you code your claims and qualify for Medicare telehealth reimbursement also changed. CMS expanded coverage to include additional services in the Medicare’s Physician Fee Schedule (PFS). Approximately 240 codes are now eligible for reimbursement when provided via telehealth.

Some of the current telehealth pandemic-related PFS changes have become permanent, while others will only be reimbursable through the end of the calendar year in which the PHE concludes. CMS has posted their List of 2021 Telehealth Services on their website. This regularly updated spreadsheet of reimbursable codes can assist your practice throughout the end of the PHE period.

There is no way to know what providing telehealth services at your practice will look like next year. The good news is you’ve got a little while longer with CMS’ relaxed Medicare telehealth reimbursement guidelines before you have to make a change. Don’t waste this additional time. There are things you can do now to prepare.

You can receive the help you need from regulatory expert and healthcare attorney, Anne Brendel, Esq. During her recent 60-minute online training, Telehealth Regulations: Head Off Paying Triple Damages and OIG Fines, Anne provided expert advice to help you comply with current Medicare telehealth rules, and how you can prepare for both federal and state-specific regulatory change. Register for this training today!

Note: In addition to CMS federal rule changes related to being eligible to receive Medicare telehealth reimbursement, many states have implemented their own rules as well. The Center for Connected Health Policy created an interactive tool to help you identify your state’s telehealth policies to help you get a handle on current and future requirements.


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