The current global outbreak of coronavirus disease (COVID-19) is making a significant impact on healthcare delivery in the United States. As the American College of Surgeons and others urge postponing elective procedures, clinicians are looking for ways to minimize disruption of day-to-day patient care in the urology clinic. Telehealth and telemedicine are emerging as possible options for urologists.
- AUA Frequently Asked Questions on Telehealth [pdf]
- AUA Whitepaper: Telemedicine in Urology (includes guidance to help members who are considering providing telehealth services to their patients)
- Insurance Coverage and State Legislation Tracking Spreadsheet [.xlsx]
Medicare Fee for Service Telehealth Update
Refer to the following links for guidance on providing telehealth services for Medicare fee-for-service patients. Prior rules & restrictions have been greatly liberalized.
Additional resources to clarify CMS's changes to Medicare telehealth services
The Office of Inspector General (OIG) issued a statement that physicians and other practitioners will not be subject to administrative sanctions for reducing or waiving cost-sharing obligations (co-insurance and deductibles) for telehealth visits during the COVID-19 pandemic. Read the additional Frequently Asked Questions (FAQs).
The Office for Civil Rights (OCR) at the Department of Health and Human Services notified covered entities, including physicians, that it would exercise enforcement discretion under the HIPAA Rules for physicians using telehealth in good faith. OCR has issued new FAQs on this notice.
The Drug Enforcement Administration (DEA) issued a statement to allow an adequate supply of controlled substances in the United States in the use of telemedicine services to assure that patients will have access to schedule II-V prescriptions without face to face medical examinations.
From the Centers for Medicare and Medicaid Services
- FAQs on Availability and Usage of Telehealth Services through Private Health Insurance Coverage in Response to Coronavirus Disease 2019 (COVID-19)
- Telehealth Toolkit for General Practitioners
Coding Advice during COVID-19
New guidance from the American Medical Association provides special coding advice and scenarios during the COVID-19 public health emergency, including information on telehealth services for patients. The AMA site also outlines CMS payment policies and regulatory flexibilities related to COVID-19.
Other Telehealth Reimbursement
According to a March 10, 2020, CMS directive, Medicare Advantage Organizations may also provide enrollees access to Medicare Part B services via telehealth in any geographic area and from a variety of facilities, including beneficiaries’ homes.
Should a Medicare Advantage Organization wish to expand coverage of telehealth services beyond those approved by CMS, CMS will exercise its enforcement discretion regarding the administration of benefit packages, until it is determined that the exercise of this discretion is no longer necessary.
Reimbursement for telehealth varies by state with some states having parity laws requiring the same reimbursement as in-office evaluation and management services. In states without parity laws, policies may be changing rapidly and access to reimbursement to telemedicine services is expanding rapidly. Contact the applicable commercial insurer to find out what telemedicine services are being reimbursed.
States and state Medicaid programs have their own limitations on how telehealth can be used. CMS published frequently asked questions for State Medicaid and Children’s Health Insurance Program (CHIP) Agencies.
States can cover telehealth using various methods of communication such as telephonic, video technology commonly available on smart phones and other devices. No federal approval is needed for state Medicaid programs to reimburse providers for telehealth services in the same manner or at the same rate that states pay for face-to-face services.
Medicaid eligibility and reimbursement for telehealth vary by state. Check with your state’s Medicaid administrator regarding rules and regulations.