On Tuesday, July 28, CMS updated the COVID-19 Frequently Asked Questions (FAQs) on Medicare Fee-for-Service (FFS) Billing to provide guidance on billing HCPCS code G0463 when a physician is providing a remote service to a patient in the patient’s home, which has been designated as a provider-based department.  As we noted last week (see our memorandum of July 22), CMS has taken inconsistent positions on this issue in its Office Hours calls—first stating that billing a G0463 is not permitted, then stating that it is, and then reversing course again to prohibit it.  In its first official written guidance on the subject, CMS changed course once again.

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Click here for a PDF version of this memo.

On Tuesday, July 21, in a CMS “Office Hours” COVID-19 call, CMS provided the latest guidance on billing HCPCS code G0463 when a physician is providing a telehealth service to a patient in the patient’s home, which has been designated as a provider-based department.  The guidance represents a departure from previous oral advice provided by CMS and is the latest twist in a confusing mix of written guidance and oral advice on the subject of how hospitals should bill for these visits.

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By Rebecca Burke, Esq. and Megan La Suer, Esq

Current as of June 1, 2020

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Over the last several weeks, Powers has been reporting on the telehealth expansion during the COVID-19 pandemic. (More information is  available on the Powers website.) The Coronavirus Aid, Relief, and Economic Security Act (CARES Act), enacted on March 27, 2020 and the Centers for Medicare and Medicaid Services (CMS) Interim Final Rule (IFR), issued on March 31, both contain significant telehealth provisions. CMS has also been issuing a steady stream of guidance regarding implementation of these provisions, although many questions still remain unanswered. On April 30, 2020 CMS issued a new series of updates including new waivers and a new IFR. This series of Q & As address many of the temporary telehealth provisions that apply during the COVID-19 public health emergency (PHE) including the April 30, 2020 announcements. Powers will be updating this document as the Administration continues to issue additional guidance.  The information contained in this document shall not be considered legal advice but should be instructive for providers seeking to be in compliance with laws, regulations, and guidance that are being issued and changed frequently.

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Updated May 12, 2020

In an Interim Final Rule published on March 31, CMS authorized physicians to bill for telehealth visits as if they were office visits in response to the COVID-19 public health emergency (“PHE”).  Since then, many hospitals have pointed out that there was no mechanism for a hospital to bill an originating facility fee for a telehealth service performed by a physician from a hospital outpatient department or other provider-based clinic.  Consequently, these services were reimbursed less when performed from a hospital site, as compared to a physician office site.  (The UB92 hospital outpatient billing form does not provide for billing of a telehealth originating site facility fee because the patient is not physically present at the hospital.) This issue was raised repeatedly by providers during the CMS “Office Hours” teleconferences, during which CMS acknowledged the inconsistency and promised to release additional guidance.

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Designing a Coherent Policy Consistent with Resident Privacy Rights and New Federal and State Requirements

As the COVID-19 crisis has unfolded, Skilled Nursing Facilities (SNFs) and Assisted Living Facilities (ALFs) have faced new transparency requirements imposed by both federal and state authorities that mandate certain specified disclosures of the COVID-19 status of residents and staff to other residents and their family members. Read More

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On April 30, 2020, CMS issued a display copy of an Interim Final Rule (IFR) to clarify certain policies and make regulatory changes in response to the COVID-19 PHE.  At the same time, CMS announced new waiver authorities under the CARES Act and released other documents to further clarify policies during the pandemic.  The significant changes are summarized below.

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As part of the Coronavirus Aid, Relief, and Economic Security (CARES) Act, the Department of Health & Human Services (HHS) has announced $30 billion in immediate relief funding to providers in support of the national response to COVID-19.

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