CMS waiver on telehealth amid COVID-19 represents a ‘sea change’

CMS recently announced that video and chat apps that normally do not comply with HIPAA security and privacy regulations can be used to facilitate patient care during the COVID-19 public health emergency.

“The fact that, for now, providers can use any nonpublic-facing remote communication tool is a sea change for doctors and for patients,” Neil H. Baum, MD, chief medical advisor at Vanguard Communications, a health care marketing and practice improvement firm, told Healio Primary Care.

CMS also said that health care providers can bill for telehealth visits at the same rate as in-person visits for more than 70 new medical services, including ED visits.

“The fact that CMS, under the president’s declaration of emergency for COVID-19, allows for reimbursement for telehealth services is just as much of a sea change,” Baum said.

 

Peter R. Honig, DO, a family physician with a private practice in Philadelphia, said the HIPPAA waivers, which allow providers to use apps such as FaceTime and iPhone, could lead to a surge in telemedicine use.

Baum offered several tips for physicians to make the most of the waivers:

  • Ask your insurance providers if telemedicine is covered and if those visits are considered an office visit or a nurse visit.
  • Check with payers to understand CPT codes and what your payment will be.
  • Check with your malpractice insurance provider to ensure that you can conduct telehealth visits.
  • Choose apps with Business Associate Agreements, as these apps will be useable after the national COVID-19 emergency declaration is lifted.
  • Pick apps that allow for private one-to-one communication.
  • See if a nurse or scribe can join the chat and take notes (the patient must allow a third person being present).
  • Keep each patient’s case on its own piece of paper or computer document labelled with the patient’s last name, first initial and date of the visit.
  • Establish a template or form for yourself, such as the SOAP method (subjective, objective, assessment and plan), so it can be documented in an organized and efficient way.

Some sources told Healio Primary Care that not every patient will benefit from the CMS waiver.

Jacqueline W. Fincher
Jacqueline W. Fincher

“I've had telehealth calls that you get about halfway through and then the video cuts out or the audio cuts out and they've lost their connection,” said Jacqueline W. Fincher, MD, MACP, an internist at the Center for Primary Care McDuffie Medical office in rural eastern Georgia. “That’s kind of frustrating and obviously not very efficient.”

Conrad L. Flick, MD, of Family Medical Associates in Raleigh, North Carolina, said many Medicare patients “still do not have computers or Wi-Fi or networks that will allow them to do this from an audio and video standpoint.”

Conrad Flick
Conrad L. Flick

In addition to relaxing restrictions on telemedicine, CMS said will not penalize providers for noncompliance with other HIPAA provisions, including the requirement to acquire a patient's agreement to speak with family members or friends involved in his or her care and the patient's right to request privacy restrictions and confidential communications. – by Janel Miller

References:

CMS. CMS. Medicare telemedicine health care provider fact sheet. https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet. Accessed April 3, 2020.

CMS. Trump administration makes sweeping regulatory changes to help U.S. health care system address COVID-19 patient surge. https://www.cms.gov/newsroom/press-releases/trump-administration-makes-sweeping-regulatory-changes-help-us-healthcare-system-address-covid-19. Accessed April 3, 2020.

HHS. COVID-19 & HIPAA bulletin limited waiver of HIPAA sanctions and penalties during a nationwide public health emergency. https://www.hhs.gov/sites/default/files/hipaa-and-covid-19-limited-hipaa-waiver-bulletin-508.pdf. Accessed April 6, 2020.

Vanguard Communications. About Vanguard. https://vanguardcommunications.net/about/. Accessed April 6, 2020.

Disclosures: Baum, Flick, Fincher and Pinot report no relevant financial disclosures.

CMS recently announced that video and chat apps that normally do not comply with HIPAA security and privacy regulations can be used to facilitate patient care during the COVID-19 public health emergency.

“The fact that, for now, providers can use any nonpublic-facing remote communication tool is a sea change for doctors and for patients,” Neil H. Baum, MD, chief medical advisor at Vanguard Communications, a health care marketing and practice improvement firm, told Healio Primary Care.

CMS also said that health care providers can bill for telehealth visits at the same rate as in-person visits for more than 70 new medical services, including ED visits.

“The fact that CMS, under the president’s declaration of emergency for COVID-19, allows for reimbursement for telehealth services is just as much of a sea change,” Baum said.

 

Peter R. Honig, DO, a family physician with a private practice in Philadelphia, said the HIPPAA waivers, which allow providers to use apps such as FaceTime and iPhone, could lead to a surge in telemedicine use.

Baum offered several tips for physicians to make the most of the waivers:

  • Ask your insurance providers if telemedicine is covered and if those visits are considered an office visit or a nurse visit.
  • Check with payers to understand CPT codes and what your payment will be.
  • Check with your malpractice insurance provider to ensure that you can conduct telehealth visits.
  • Choose apps with Business Associate Agreements, as these apps will be useable after the national COVID-19 emergency declaration is lifted.
  • Pick apps that allow for private one-to-one communication.
  • See if a nurse or scribe can join the chat and take notes (the patient must allow a third person being present).
  • Keep each patient’s case on its own piece of paper or computer document labelled with the patient’s last name, first initial and date of the visit.
  • Establish a template or form for yourself, such as the SOAP method (subjective, objective, assessment and plan), so it can be documented in an organized and efficient way.

Some sources told Healio Primary Care that not every patient will benefit from the CMS waiver.

Jacqueline W. Fincher
Jacqueline W. Fincher

“I've had telehealth calls that you get about halfway through and then the video cuts out or the audio cuts out and they've lost their connection,” said Jacqueline W. Fincher, MD, MACP, an internist at the Center for Primary Care McDuffie Medical office in rural eastern Georgia. “That’s kind of frustrating and obviously not very efficient.”

Conrad L. Flick, MD, of Family Medical Associates in Raleigh, North Carolina, said many Medicare patients “still do not have computers or Wi-Fi or networks that will allow them to do this from an audio and video standpoint.”

Conrad Flick
Conrad L. Flick

In addition to relaxing restrictions on telemedicine, CMS said will not penalize providers for noncompliance with other HIPAA provisions, including the requirement to acquire a patient's agreement to speak with family members or friends involved in his or her care and the patient's right to request privacy restrictions and confidential communications. – by Janel Miller

References:

CMS. CMS. Medicare telemedicine health care provider fact sheet. https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet. Accessed April 3, 2020.

CMS. Trump administration makes sweeping regulatory changes to help U.S. health care system address COVID-19 patient surge. https://www.cms.gov/newsroom/press-releases/trump-administration-makes-sweeping-regulatory-changes-help-us-healthcare-system-address-covid-19. Accessed April 3, 2020.

HHS. COVID-19 & HIPAA bulletin limited waiver of HIPAA sanctions and penalties during a nationwide public health emergency. https://www.hhs.gov/sites/default/files/hipaa-and-covid-19-limited-hipaa-waiver-bulletin-508.pdf. Accessed April 6, 2020.

Vanguard Communications. About Vanguard. https://vanguardcommunications.net/about/. Accessed April 6, 2020.

Disclosures: Baum, Flick, Fincher and Pinot report no relevant financial disclosures.

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