MEDISCORE
  • Process
  • Solutions
  • DEMO
  • BLOG
  • Contact


​STAY INFORMED


LATEST DEVELOPMENTS IN THE
​MANAGED MEDICARE WORLD

DO’S and DON'TS for Telehealth HCC Risk Adjustment

4/24/2020

1 Comment

 
CMS has approved risk adjustment for diagnosis captured via telehealth with a brief press release for all encounters that would meet risk adjustment criteria had they been face to face. As this rule is novel in its scope and application we’re hearing quite a bit of chatter and confusion around the nuances of implementing these new policies. 
​

 ​We’ve reached out to our experts and have compiled a list of Do’s and Don’ts in the hopes of resolving some of the confusion. 
​

Telehealth Risk Adjustment Do’s

  1. EDS Submissions: For EDS/EDPS  that have been provided via telehealth, use place of service code “02” for telehealth or use the CPT telehealth modifier “95” with any place of service.
  2. Interactive Communication: Ensure all telehealth services use interactive audio and video telecommunications system that permits real-time interactive communication. Both the provider and the patient must be able to see and speak to each other during a telehealth encounter. 
  3. Documentation Standards: Ensure all telehealth service documentation meet the required “M.E.A.T.” standard for EDS submissions. Telehealth exceptions are not documentation exceptions, the note must meet the standards of a face-to-face encounter. ​
  4. Approved Providers: Ensure all telehealth providers meet the same “approved provider” standard as face-to-face encounters. These include approved specialists as well, not just PCPs.

Telehealth Risk Adjustment Don'ts 

  1. EDS Submissions: Report services to the EDS that have been provided via telehealth using face-to-face inpatient or outpatient codes or fill place of service with placeholder codes other than what CMS has stated. 
  2. Wait for face-to face encounter to document for diagnosis: Don’t code for conditions that do not have the required “M.E.A.T.” in documentation simply because they were discussed over a telehealth encounter. Providers should also be weary of documenting for physical exams that can not be conducted via telemedicine to satisfy the evaluation or assessment portions of the note. 
  3. Telephone Communication: Audio only communications such as traditional telephone calls do not meet the telehealth requirements, CMS has separate submission codes for telephone encounters. Diagnoses from telephone or other audio-only encounters should not be submitted for risk adjustment until they have a telehealth or face-to-face encounter reconfirmation. ​
  4. Other health care personnel: Submit codes for HCCs captured by other (non-approved) healthcare personnel such as a Registered Nurse to conduct telehealth encounters. 
 


1 Comment

Understanding the Expansion of Medicare Telemedicine Under Rule 1135

4/7/2020

3 Comments

 
Centers for Medicare & Medicaid Services (CMS) has broadened access to Medicare telehealth services so that beneficiaries can receive a wider range of services from their doctors without having to travel to a healthcare facility. These policy changes build on the regulatory flexibilities granted under the President’s emergency declaration. CMS is expanding this benefit on a temporary and emergency basis under the 1135 waiver authority and Coronavirus Preparedness and Response Supplemental Appropriations Act. 

The benefits are part of the broader effort by CMS and the White House Task Force to ensure that all Americans – particularly those at high-risk of complications from the virus that causes the disease COVID-19  – are aware of easy-to-use, accessible benefits that can help keep them healthy while helping to contain the community spread of this virus.   

EXPANSION OF TELEHEALTH WITH 1135 WAIVER: Under this new waiver, Medicare can pay for office, hospital, and other visits furnished via telehealth across the country and including in patient’s places of residence starting March 6, 2020.  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.  

 KEY EXCEPTIONS to note for the duration of the COVID-19 Public Health Emergency

  • At-Home Telemedicine is permissible: While patients must generally travel to or be located in certain types of originating sites such as a physician’s office, skilled nursing facility or hospital for the visit, effective for services starting March 6, 2020 and for the duration of the COVID-19 Public Health Emergency, Medicare will make payment for Medicare telehealth services furnished to beneficiaries in any healthcare facility and in their home.

  • Providers *may* see new patients via telemedicine: To the extent the 1135 waiver requires an established relationship, HHS will not conduct audits to ensure that such a prior relationship existed for claims submitted during this public health emergency. 
​
  • Good Faith HIPAA Waiver: Effective immediately, the HHS Office for Civil Rights (OCR) will exercise enforcement discretion and waive penalties for HIPAA violations against health care providers that serve patients in good faith through everyday communications technologies, such as FaceTime or Skype, during the COVID-19 nationwide public health emergency.  Please visit Health & Human Services HIPAA, Civil Rights and Covid-19 page for more information. ​


Telemedicine Expansion Summary ​

Picture
3 Comments

    Authors

    Physicians, Attorneys, Coders, Billers,
    ​Experts in Medicare Risk Adjustment

    Archives

    April 2020
    January 2019
    December 2018
    October 2018
    September 2018
    August 2018

    Categories

    All

    RSS Feed

LOCATION

​30 S 15th St
Floor 15
Philadelphia, PA 19102

202 Bicknell Ave 
​Santa Monica, CA 90405

CONTACT US

GIVE US A CALL TODAY!

(267) 419-7647 
​

Picture

    SUBSCRIBE

Submit
Picture
Picture
  • Process
  • Solutions
  • DEMO
  • BLOG
  • Contact