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CMS: Hospitals can continue to bill for remote outpatient therapies

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By Anuja Vaidya

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– In a Frequently Asked Questions (FAQ) document, the Centers for Medicare and Medicaid Services (CMS) said hospitals may continue to bill for various outpatient therapies delivered via remote care technologies in patients’ homes through the end of the calendar year (CY) 2023.

Released late last month, the document addresses several frequently asked questions regarding changes in policies and regulations following the COVID-19 public health emergency (PHE) deadline on May 11.

CMS says that through the end of the year, hospitals can bill for outpatient physical therapy (PT), occupational therapy (OT), speech-language pathology (SLP), Diabetes Self-Management Training (DSMT), or Medical Nutrition Therapy services ( MNT) delivered at home to beneficiaries through telecommunications technology by hospital staff.

The agency also noted that therapists and other professionals who provide these services are still on the far-site list of professionals for Medicare telehealth services. But hospital physicians who aren’t distant physicians eligible for Medicare telehealth services can sometimes also provide DSMT services.

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“To enable these services to continue to be delivered to patients in their homes through telecommunication technology through the end of fiscal year 2023, we are exercising enforcement discretion in reviewing the telehealth provider status of clinical staff providing personally any part of a remotely delivered DSMT service, provided the professional is otherwise qualified to provide the service,” CMS said.

Thus, through the end of the year, providers offering remote PT, OT, SLP, DSMT and MNT services can continue to bill “in the same way they did during the PHE,” the agency added.

But other flexibilities associated with remote assistance ended with the PHE.

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For example, the regulatory flexibilities provided through the Hospital Without Walls initiative, which allowed hospitals to bill beneficiaries for services provided by hospital staff in their homes using telecommunications technology, ended because “the home of the beneficiary is no longer considered a department based on the hospital provider after the end of the PHE.”

But in some circumstances, hospitals will be able to continue billing for mental and behavioral health services delivered to patients’ homes through telecommunications technology.

Additionally, patients who received remote monitoring or other communication technology-based services while PHE was in effect will continue to be considered an “established patient.”

“This rule applies as long as the patient has consented to receive subsequent remote monitoring and other services based on communication technology,” CMS said. “This consideration would hold even if the patient did not have an in-person or telehealth-capable initiation service.”

As the PHE drew to a close, healthcare industry stakeholders called for telehealth flexibilities to become permanent.

But their request was only partially granted, with Congress extending some telehealth and home hospital waivers under the Medicare program through December 31, 2024. As a result, stakeholders continued to demand that the regulatory flexibilities are made permanent.

Earlier this month, the Telehealth Access for America campaign, which includes the American Telemedicine Association, Ascension and CVS Health, sent a letter to US Senate and House leaders urging Congress to “make telehealth a permanent piece of the health care puzzle”.

Last week, the Department of Health and Human Services (HHS) released a fact sheet detailing the post-May 11 changes to telehealth regulations. These include the HHS Office of Civil Rights tightening penalties for HIPAA non-compliance against suppliers who use remote monitoring technology and the Drug Enforcement Agency ending the flexibility that allows suppliers to prescribe controlled substances, such as Adderall and oxycodone, with no prior in-person doctor visit in November 2023.

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