By: Tammie Lunceford
Since the Public Health Emergency has ended, some practices are re-evaluating the use of Telemedicine services, but the patient population wants the convenience and many providers found effective ways to incorporate it in their daily workflow. Even though Medicare will continue to cover telehealth services and many flexibilities will be in place until 2024, the HIPAA enforcement discretion expired August 9th. The HHS Office for Civil Rights (OCR) allowed providers to use some types of communication technology that isn’t HIPAA-compliant during the PHE. The OCR granted a brief extension of its enforcement discretion, but you’ll need to put telehealth services on hold If your practice isn’t using a secure system when the extension expires. HIPAA compliance for telehealth services applies to audio-only services, including telephone E/M codes (99441-99443). To protect your practice and patients from breaches, make sure staff understand the security requirements for phone-based care that the HHS Office for Civil Rights (OCR) outlined in a guide on audio-only services.
The Office of Inspector General has released a brief as a useful compliance roadmap for providers, and one that should inspire providers to look internally as coding, billing, auditing, and monitoring practices. Practices should remember that services must meet the standards of care that are set by CMS and state law, and the documentation for each visit must prove the service was up to standard. In addition, there will be instances where “a virtual evaluation may not be appropriate.” Practices have been used to leniency with HIPAA and other laws, strict compliance could pose a problem. Example: In addition to meeting the documentation requirements for the service, your practice must document whether the patient gave you verbal or written consent to conduct a virtual appointment, in addition, the provider must clearly document whether the connection was audio and visual or audio-only.
In the final 2023 Medicare final physician fee schedule, CMS announced that practices can continue to use the POS code that they would have used for an in-person visit. Utilize with POS 11 (office) for the rest of the year. You also should report the telehealth service with modifier 95. In 2024, you will report POS 10 for Telehealth provided in patient’s home. If the physician is at home or in another location other than office, you will report POS 02 (Telehealth provided other than in patient’s home). CMS will not require modifier 95. Reimbursement for POS 10 will be at the non-facility rate, but POS 02 will be reimbursed at the facility rate. Telemedicine is a great way to deliver test results and discuss treatment options after a recent in-person visit. When a patient is in a trusted relationship with a provider, they are more comfortable with a less formal visit.
Tammie Lunceford is a Healthcare Consultant with Warren Averett.