COVID-19 and Telemedicine

As the world navigates through these unprecedented times in trying to slow the spread of the COVID-19 virus, our provider clients are routinely asking, “What now?”

On March 16, 2020, Governor Murphy signed Executive Order 104, which, among other things, requires non-essential services to close from 8:00 PM to 5:00 AM. Governor Murphy clarified that healthcare clinics and facilities are essential services. And healthcare clinics and facilities are excluded from the restriction of gatherings to fifty people or less. For the time being then, healthcare providers are permitted to continue serving their patients as they deem safe and appropriate.

Despite this, many of our provider clients are exploring alternative ways to provide patient services considering widespread social distancing efforts. One such method is through telemedicine. Currently in New Jersey, the licensed healthcare providers permitted to deliver services via telemedicine include physicians, nurses, nurse practitioners, psychologists, psychiatrists, psychoanalysts, clinical social workers, physician assistants, professional counselors, respiratory therapists, speech pathologists, audiologists, optometrists, or any other healthcare professional acting within the scope of a valid license or certification.

So, assuming a healthcare provider is permitted to provide telemedicine services, the next question is whether they can be paid for that service. This, like most of healthcare reimbursement is an often-confounding maze of governmental regulation and private payer rules.

On March 17, 2020, the Centers for Medicare and Medicaid Services (“CMS”) decided to expand Medicare’s coverage of telemedicine services nationwide due to seniors being particularly vulnerable to symptoms associated with COVID-19. Previously, the patient receiving services via telemedicine needed to be in a designated rural area and needed to travel to a healthcare facility while the healthcare provider could be located off-site. For now, Medicare beneficiaries will be able to receive services such as exams, mental health counseling, and preventative health screenings via telehealth from their own homes.

The major commercial payers also seem to be revising their current telemedicine reimbursement policies to respond to COVID-19-related changes within the healthcare community.

As of March 17, 2020, UnitedHealthcare has decided to waive any originating site requirements that may apply under its commercial plans so that telemedicine services provided via a real-time audio and video communication system can be billed for patients at home. Further, UnitedHealthcare will consider for reimbursement the same telemedicine services recognized by CMS, as well as the following additional services: (i) medical genetics and genetic counseling services; (ii) education and training for patient self-management by a qualified, nonphysician health care professional using a standardized curriculum; (iii) alcohol and/or substance abuse screening and brief intervention services; and (iv) remote real-time interactive video-conferenced critical care evaluation and management of the critically ill or critically injured patient provided the appropriate codes and modifiers are used.

Horizon Blue Cross Blue Shield of New Jersey (“Horizon BCBSNJ”) will consider for reimbursement telemedicine services when modifiers 95 or GT are appended to CPT or HCPCS codes that ordinarily describe face-to-face services including but not limited to, office or other outpatient professional visits, inpatient professional visits, or individual psychotherapy services. Horizon BCBSNJ also cautions that a secured electronic channel is required to be utilized by a telemedicine provider so that all transactions and data communication comply with the Health Insurance Portability and Accountability Act (“HIPAA”). And as of March 13, 2020, Horizon BCBSNJ is waiving all member cost-sharing obligations for covered telemedicine services delivered by an in-network doctor or through Horizon BCBSNJ’s telemedicine platforms.

Aetna will consider for reimbursement two-way, real-time audiovisual interactive communications between a patient and the healthcare provider if the appropriate telemedicine modifier is used.

Humana requires a healthcare provider to submit a charge for a telemedicine service with modifier GT, modifier 95, or POS code 02 and allows healthcare providers to bill for telemedicine and interprofessional telephone or internet assessment and management services. However, Humana does not allow for Internet-only telemedicine services, CPT codes 99421-99423, 99444 and 98969-98972 to be billed unless provided pursuant to a Humana telemedicine vendor partnership or when required by an applicable state mandate.

Cigna’s coverage for telemedicine is determined by the patient’s individual plan, so reimbursement for telemedicine services is not guaranteed at this time. However, Cigna is currently waiving out-of-pocket costs for COVID-19 testing-related visits with in-network providers, whether at a doctor’s office, urgent care clinic, emergency room, or via telemedicine, through May 31, 2020; so further guidance regarding Cigna’s telemedicine reimbursement policies may be forthcoming.

Also on March 17, 2020, the Office for Civil Rights at the United States Department of Health and Human Services (“OCR”) announced that it would be exercising its enforcement discretion and waiving potential penalties for HIPAA violations by healthcare providers serving their patients through telemedicine during the COVID-19 emergency. Specifically, a healthcare provider may use applications such as Apple FaceTime, Facebook Messenger video chat, Google Hangouts, or Skype, to provide telemedicine without running the risk that OCR might impose HIPAA-related penalties and fines against them. However, healthcare providers still may not use Facebook Live, Twitch, TikTok, or other similar public-facing video communication applications. Should a healthcare provider elect to use the temporarily-permitted applications, they should notify their patients that these third-party applications potentially introduce privacy risks and should enable all available encryption and privacy modes when using such applications. We will keep our clients updated as to when the commercial payers respond to this announcement, but it is possible that using a temporarily permitted third-party application may affect reimbursement from payers that require HIPAA-compliant video-conferencing.

We know that new precautions are being taken every day that may affect how our provider clients should proceed. We are working diligently to provide analysis of the most up-to-date information, so please check back frequently for additional updates. Should you have questions specific to your practice or facility, we are available at 609-799-5150.

Posted in: Compliance, Regulation, Reimbursement, Telemedicine