Updates on Medicare’s Telehealth Coverage During the Coronavirus Crisis

On March 6, congress passed the Coronavirus Preparedness and Response Supplemental Appropriations Act. This new rule allows healthcare providers to bill Medicare fee-for-service for patient care by Telehealth during the current coronavirus pandemic crisis.

This legislation allows the U.S. Department of Health and Human Services (HHS) secretary the authority to waive or modify certain Telehealth Medicare requirements when the President has declared a National Emergency. It also expands coverage on Telehealth services provided by audio and video interaction between the provider and the covered patient. CMS has clarified that the established-relationship rule will not be enforced and mentions “The patient must initiate the service and give consent to be treated virtually, and the consent must be documented in the medical record before initiation of the service”.

Also, enrollees in Medicare Advantage plans may be able to receive clinically appropriate services via Telehealth from their home, as CMS has also announced that they are waiving HIPAA privacy rules, and allowing applications such as FaceTime and Skype to be used. These benefits can be very helpful to patients covered under Medicare Advantage as these now become billable services covered by Medicare – which means the Medicare coinsurance and deductible would now apply. CMS has also released a very helpful FAQ document you can find here, this document includes additional hotlines that physicians and non-physician practitioners can contact.

The new updates to Medicare on Telehealth coverage have raised the question for many providers in the risk adjustment space about how this applies to risk adjustment documentation. At the moment, the documentation provided by CMS seems to indicate that providers now have the ability to do Telehealth medicare risk adjustment visits with the patient, but this is still uncharted territory and there are still a lot of specifications to be determined. While there is not yet a lot of specifics regarding Medicare risk adjustment amid the coronavirus crisis, one thing is for sure: the aid of technology in the documentation process is critical in hectic times like this.

Without a doubt the main priority is the patient, which means a lot of providers will not have time to focus on risk adjustment at the moment. Having technology such as HCC coding and risk adjustment tools in place now is what is going to help providers make sure they don’t miss out on capturing critical diagnosis codes for either in-person or online visits. If not already in place, this might be a good time for providers to consider adding HCC Coding technology. It would be good to consider tools that offer a concurrent workflow that offers a prospective approach (at the point of the encounter with the patient), and at the same time offers a “coder enabled” or retrospective workflow.
Although it is challenging to keep up with documentation in the midst of a pandemic crisis, the use of technology can help providers uncover gaps and document more proficiently. By getting the additional revenue from risk adjustment, clinics can eventually provide more resources for the patients and for the team.

Healthcare technology companies like Inferscience offer tools specific for clinicians providing services to Medicare Advantage patients: with the purpose of providing technology that can optimize the HCC documentation process and help increase RAF scores. Inferscience’s HCC Assistant and HCC Validator solutions make prospecting and code validation quick and easy.

At Inferscience, we’d like to extend our appreciation of healthcare providers all over the United States, if you’re a healthcare provider looking for HCC Coding technology tools you can visit our website at or contact us at 617 848 9502.

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