How COVID-19 affects the F2F

Medicare grants leniency to home health in face-to-face physician requirements during public health emergency

Medicare has relaxed its strict rules requiring an in-person encounter between homebound patients and physician for claims billed during the COVID-19 public health emergency, allowing telehealth visits instead. “This is welcome news for home care providers,” said J’non Griffin, owner and president of Home Health Solutions, a nationwide consulting and outsourcing firm serving home health, hospice and long-term care. “We’ve been deeply concerned the conflict between the need to protect our vulnerable homebound patients from the risks incurred when leaving their home to seek medical services during this pandemic and need to meet Medicare’s face-to-face requirements,” she said. Homebound patients are among those identified as most at risk for COVID-19, the disease caused by the SARS-Cov-2 coronavirus, because they tend to have underlying medical conditions such as respiratory and heart issues, diabetes, and immune-compromised illnesses. “This change in policy for the duration of the public health emergency will enable vulnerable patients access to the care they need while limiting their exposure, and help mitigate community spread of the coronavirus,” J’non said. How it works The Centers for Medicare and Medicaid Services (CMS) has broadened access to Medicare beneficiary telehealth services under a new policy of enforcement discretion announced in conjunction with the Coronavirus Preparedness and Response Supplemental Appropriations Act. The policy change will be effective for episodes of home care beginning March 6 and will continue through the duration of the public health crisis related to COVID-19. Prior to the policy change, Medicare would only accept telehealth as a substitute for in person patient-physician encounters on a limited basis for patients in designated rural areas and under very specific circumstances. CMS had previously implemented changes in 2019 to enable Virtual Check-Ins, which are short patient-initiated communications with a healthcare practitioner. Medicare Part B separately pays clinicians for E-visits, which are non face-to-face patient-initiated communications through an online portal. The new policy change allows telecommunications technology to be used in place of many visits to doctor’s offices, the hospital, or other services which generally occur in person, including the face-to-face encounter which is required for a valid home health certification. In a fact sheet for providers, CMS said, "Effective immediately, the Office for Civil Rights (OCR) will exercise enforcement discretion and waive penalties for HIPAA violations against health care providers that serve patients in good faith through everyday communications technologies, such as FaceTime or Skype, during the COVID-19 nationwide public health emergency." Face-to-face changes Prior to the policy change, Medicare required a face-to-face encounter between patient and physician to occur within a 90-day period prior to home care, or within 30 days following the patient’s home health admission. The reason for the face-to-face encounter was required to be related to the reason for home health services or the home health referral would be invalid. Under the COVID-19 policy change, audits will not be conducted to ensure that those face-to-face requirements are met for claims submitted during the current health emergency. Patients will be allowed to communicate with the physician using an interactive audio and telecommunications system that permits real-time communication between the provider and the patient in his or her home. This important change is expected to make it faster and easier for home health agencies to provide treatment and services, without placing homebound patients at increased risk. Things are changing fast We realize that events are evolving rapidly in regard to COVID-19 and it may be challenging to keep up with the latest information and guidelines. Home Health Solutions remains committed to providing the helpful information you need in a timely manner, but often a new press conference announcing new recommendations, guidelines or actions by emergency management officials change the situation immediately after we post information. One excellent source of information we highly recommend is the new Coronavirus Resources Page on the National Home Care and Hospice web site. New code available Beginning April 1, home care providers should use a specific ICD-10 diagnosis code to identify COVID-19. The new code, U07.1, is designed for use as a primary code, and should be accompanied by diagnosis codes for pneumonia and all other manifestations of the disease. It is to be used only for confirmed cases of COVID-19. The new code was adopted at a meeting of the World Health Organization on March 18. The WHO had previously planned to implement the COVID-19 diagnosis code on Oct. 1, but expedited its implementation in response to the declaration of a pandemic. Until April 1, coders should use previously published interim guidelines for reporting illnesses caused by COVID-19. Those guidelines are presented in detail in a Decision Health blog, which may be read by clicking here.