COVID-19 Emergency Rules for Telemedicine Visits

In an effort to provide better access to healthcare during the COVID-19 outbreak, the federal government, the State of Ohio, and many commercial payers have expanded coverage of telemedicine services. At this time, it is unknown when the emergency rules will end (or if they will be enacted as permanent policy). However, the Ohio Association of Advanced Practice Nurses (“OAAPN”) remains committed to providing its members with on-going updates on this topic for its members. If you have any questions, please contact us at info@oaapn.org

MEDICARE:

Medicare has released guidance on coverage for e-visits, virtual check-in visits, and expanded telehealth service coverage. According to Medicare.gov, e-visits allow a patient to talk to his/her provider using an online patient portal without going to the provider’s office. These services can be furnished by doctors, nurse practitioners, physician assistants, licensed clinical workers, clinical psychologists, and/or therapists. Patients will pay 20% of the Medicare- approved amount for the services, and deductibles apply. For most telehealth services, the patient will pay the same amount that he/she would if he/she received the services in person. (https://www.medicare.gov/coverage/e-visits). 

  • Patient must provide verbal consent. 
  • Patients must be established patients of the practice. 
  • Communication must not be related to a medical visit within the past 7 days. 
  • Electronic communication cannot lead to a medical visit in the next 24 hours. 

A virtual check-in allow[s] a patient to talk to a provider, like a physician, nurse practitioner or physician assistant, using a device such as a phone, integrated audio/video system, or captured video image without going to the provider’s office (https://www.medicare.gov/coverage/virtual-check-ins). 

  • Patient must provide verbal consent. 
  • Patients must be established patients of the practice. 
  • Communication must not be related to a medical visit within the past 7 days. 
  • Electronic communication cannot lead to a medical visit in the next 24 hours. 

Medicare telehealth includes services such as office visits, psychotherapy, consultations, and certain other medical or health services that are provided by an eligible provider who isn’t at the same location as the patient using an interactive 2-way telecommunications system (like real-time audio and video). (https://www.medicare.gov/coverage/telehealth). Previously telehealth services were only available to rural Medicare enrollees if they received telehealth services at a clinic, hospital or other medical facilities. They could not receive telehealth services from home. 

  • Patient must provide verbal consent. 

“Clinicians can bill Medicare immediately for dates of service starting March 6, 2020. Telehealth services are paid under the Physician Fee Schedule at the same amount as in-person services. Medicare coinsurance and deductible still apply for these services.” (https://www.cms.gov/newsroom/press-releases/president-trump-expands-telehealth-benefits-medicare-beneficiaries-during-covid-19-outbreak). 

  • 99211-99215 (outpatient hospital established patients visits) 
  • 99307-99310 (subsequent nursing facility care) 

Minimum required documentation to create a billing encounter must contain five pieces of data: 

  • Patient 
  • Provider of service 
  • Date of service 
  • Actual service (CPT or HCPCS code) 
  • Diagnosis to support performing the service (ICD-10) 

HIPAA:

During the COVID-19 national health care emergency providers (APRNs, Physicians, PAs) may provide telehealth services through remote communications technologies. Technologies may not fully comply with the requirements of the HIPPA rules. (https://www.hhs.gov/hipaa/for-professionals/special-topics/emergency-preparedness/notification-enforcement-discretion-telehealth/index.html). 

The Office of Civil Rights (ORC) “will not impose penalties for noncompliance with the regulatory requirements under the HIPAA Rules against covered health care providers in connection with the good faith provision of telehealth during the COVID-19 nationwide public health emergency.” (https://www.hhs.gov/hipaa/for-professionals/special-topics/emergency-preparedness/notification-enforcement-discretion-telehealth/index.html). 

Technologies that MAY be used that do not meet HIPPA requirements: 

  • Apple FaceTime 
  • Facebook Messenger video chat 
  • Google Hangouts video 
  • Skype 

HIPPA compliant providers: 

  • Skype for Business 
  • Updox 
  • VSee 
  • Zoom for Healthcare 
  • Doxy.me 
  • Google G Suite Hangouts Meet 

You can NOT use: 

  • Facebook Live 
  • Twitch 
  • TikTok 
  • Instagram 

*OAAPN recommends that HIPPA compliant technologies be used first and foremost.

Ohio Medicaid:

Ohio Medicaid released draft emergency rules for telemedicine coverage on Monday, March 16, 2020. At this time, we are still awaiting the final emergency rule to be released. 

Ohio Department of Mental Health & Addiction:

The Ohio Department of Mental Health and Addiction announced on Saturday, March 14, 2020 that it would be filing emergency rules to allow complete mental health telehealth coverage throughout Ohio. At this time, we are still awaiting the final emergency rule to be released. 

Commercial Payers:

It is unclear how commercial payers will reimbursement for these services at this time. We can confirm that Aetna commercial patients pay $0 for covered telemedicine visits until June 4th. Also, United Health Care does recognize APRNs as telemedicine providers. 

As you are aware, information regarding COVID-19 and our response to this crisis is changing daily, if not hourly. OAAPN is working tirelessly to keep our members apprised of information as it becomes available.