Health Law Scan

Legal Insights and Perspectives for the Healthcare Industry

The Center for Medicare and Medicaid Services (CMS) released a far-reaching interim final rule (IFR) to address the coronavirus (COVID-19) pandemic on March 30. The IFR represents a comprehensive set of policy changes designed to shift the provision of Medicare services from face-to-face care to remote care through telehealth, in order to mitigate the risks of exposure to COVID-19 for patients and healthcare providers. Above all else, the IFR prioritizes physically distancing patients from their care teams and other patients.

The IFR, with a display copy totaling 220 pages, is a massive rule issued at perhaps historic speed. Although it was published just three weeks after the passage of initial legislation (the CPRSAA), and only days after the passage of the CARES Act, the IFR touches on nearly every aspect of the Medicare program, including home health and hospice, intensive care services, radiation therapy management, physicians’ services, and inpatient rehabilitation.

Of special note, most physician services in hospitals, skilled nursing facilities, and other care settings can now be performed remotely. Providers are instructed to bill using the POS code that would normally apply, but append a new “95” modifier to each claim to indicate the use of communication-based technologies.

The overarching goal of the IFR is to promote access to remote care to keep patients and healthcare providers safe during the public health emergency (PHE) by reducing or eliminating barriers to remote care and incentivizing the adoption of remote treatment mechanisms. To achieve this goal, the IFR expands the types of codes Medicare providers and suppliers can bill for telehealth services, permits greater flexibility for patient consent and telecommunication modalities, and increases reimbursement for services particularly important to the COVID-19 fight—including specimen collection and physician evaluation and management services, which will now all be reimbursed at the nonfacility rate.

Although the vast majority of the IFR’s policy changes only apply during the PHE and will likely sunset at the conclusion of the PHE, the next few months represent a dress rehearsal of sorts for telehealth. If access is enhanced, cost is maintained, and patients and practitioners alike believe that high-quality healthcare services can be provided through telehealth, Congress may have the necessary information to act on further enabling this technology. With the American healthcare system in a state of rapid evolution, telehealth is likely here to stay.

We have prepared a comprehensive summary of the IFR’s provisions.
Read the White Paper.