Telemedicine Guidelines & COVID-19: Coding in Response to the 1135 Waiver Authority

Telemedicine Guidelines & COVID-19: Coding in Response to the 1135 Waiver Authority

State governors have put in effect stay-at-home orders in response to the highly contagious COVID-19 virus. Due to this, CMS has expanded coverage for its Medicare recipients through the use of telemedicine. The agency has also provided telemedicine guidelines for coding, in the 1135 waiver (CMS, 2020). According to CMS, “The benefits are part of the broader effort by CMS and the White House Task Force to ensure that all Americans – particularly those at high-risk of complications from the virus that causes the disease COVID-19 – are aware of easy-to-use, accessible benefits that can help keep them healthy while helping to contain the community spread of this virus” (2020).

CMS has made changes to broaden the geographical coverage area. Previously, Medicare only covered visits in designated rural areas and certain patient settings. As of March 6, patients can engage in virtual visits from their own homes (CMS, 2020). A patient must have an established billing relationship with the provider (CMS, 2020). To the extent of the 1135 Waiver, the U.S. Department of Health & Human Services will not conduct audits to ensure that such a prior relationship existed for claims submitted during this pandemic (CMS, 2020). The latest information from the AMA says that CMS has clarified that telehealth services are permitted with both new and established patients (2020). See this article for more in-depth coding of telemedicine.

What does this mean for Providers?

Providers must know which types of virtual services can be provided to Medicare beneficiaries. Potential HIPAA violations are of great concern to providers and other professionals that can provide telehealth services to Medicare beneficiaries. For this reason, it’s important to stay updated on new scenarios where penalties would be waived for HIPAA violations against health care providers that serve patients in good faith through everyday communications technologies.

This is Part 1 of a 3-Part Series. Stay tuned for more details and the latest updates for Providers in Part 2.

Our article, “CMS Increases List of Payable Medicare Telemedicine Services,” features more information about the list of payable telehealth services. Review our previous article for more medical coding and billing tips for COVID-19.

Healthcare organizations and facilities that need help combing through their coding backlog should consult with YES HIM Consulting’s team of skilled HIM experts. Our coding support, auditing, coder mentoring, and other HIM services help organizations get back on the right track.

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