Telehealth in home care

Part 2: What CMS does and does not allow home health agencies to do

Editor’s note: Today’s blog post is the second in a series of posts exploring the impact of the coronavirus on telehealth in the home health field as we evaluate the benefits to agencies and provide pointers on how agencies can ramp up their telehealth usage. This post reviews what CMS does and not allow.

Relaxed rules during the COVID-19 public health emergency are connecting patients to practitioners in record numbers of virtual visits, spurring home care providers to re-evaluate how they can make better use of telehealth services.

A second round of waivers announced late last week by the Centers for Medicare and Medicaid Services (CMS) makes it easier than ever for patients to receive health care in the safety of their homes via phone, tablet or laptop computer.

But home health providers shouldn’t get too excited, warns J’non Griffin, owner and president of Home Health Solutions, a nationwide consulting and outsourcing firm for home health, hospice and long-term care.

Many of the latest telehealth waivers do not apply to home health – and even in cases where CMS has specifically relaxed the rules so that home health can use telehealth, virtual visits are not yet billable for home health agencies.

“While home health can and should use telehealth visits as part of the patient’s overall plan of care, virtual visits cannot replace routine, in-person visits and agencies are not allowed to bill Medicare for them at this time,” J’non said.

Medicare Part B, not home health Last week’s updated telehealth waivers specifically allow physical therapists, occupational therapists and speech-language therapists to provide and bill Medicare for virtual visits – a rules change home health advocates have sought.

But the waiver applies to Medicare Part B services rather than home health. “So there is still no reimbursement from CMS at this point for virtual visits for home health,” J'non said.

Audio and video generally needed

Another rules relaxation included in last week’s waiver removes the video requirement for certain remote evaluation and management services -- but not all of them. In general, both video and audio will be required for telehealth compliance. “This change was made because some Medicare beneficiaries don’t have access to interactive audio-video technology that is required for Medicare telehealth services, or choose not to use it even if offered by their practitioner,” J’non said.

The updated blanket waiver allows audio-only equipment to suffice for some evaluation and management services, behavioral health counseling and educational services. (See designated codes here.) "However, it is important to note that audio-only calls will not suffice for the face-to-face encounter when it is conducted via telehealth," J'non said. "That encounter will still require video in order to be valid." What is (and isn’t) allowed Here is a review of what home health agencies can and can’t do right now: Types of devices: Specific types of devices and platforms have been approved by CMS for virtual visits. Although a telephone call will be allowed for some types of services (see codes here), virtual visits in most cases must be conducted via a “non-public facing remote communications device” using both video and audio. The Department of Health and Human Services Office of Civil Rights explains in a series of FAQs on telehealth and HIPAA exactly what may and may not be used for telehealth during the COVID-19 crisis. Access the FAQs here.

Face-to-Face Encounter: The face-to-face encounter between patient and physician (or other allowed provider) may be conducted via telehealth during the public health emergency. Video will be required for the encounter to be valid, and it must occur on an approved device or platform. No specific documentation requirements for a telehealth encounter have been established by CMS at this time. Home Health Solutions recommends providers note in the patient’s medical record when and how the telehealth encounter occurred, the name of the provider who conducted it via telehealth, and have the provider who is certifying the patient note that it is recognized as the official encounter. Non-physician providers: CMS already allowed nurse practitioners, clinical nurse specialists and physician assistants to conduct the face-to-face encounter, although they were not allowed to certify patients for home care. Now, these non-physician providers may also use telehealth to conduct the face-to-face encounter during the public health emergency. Certifying patients: CMS is also allowing nurse practitioners, clinical nurse specialists and physician assistants to certify patients for home health services during the public health emergency. However, many states have scope-of-practice regulations that may prevent this. Some states have enacted scope-of-practice waivers but many have not. See our list here. Initial Assessment: A virtual visit is allowed for the initial assessment. Home health agencies will be able to determine the patient’s homebound status remotely or by record review. Platforms such as Zoom, Skype, or Apple’s Facetime, which offers live video with audio so that patient and nurse can see and talk to each other via iPhone, will suffice. The initial assessment will still need to be conducted by an RN within 48 hours of referral and should verify the patient’s homebound status.

Homebound eligibility: Requirements are broader now than before the pandemic. CMS has said a patient may be eligible for home care during the public health emergency if he or she has a diagnosis of COVID-19 or is suspected to have a diagnosis of COVID-19, and the physician has recommended that the patient not leave his or her home. Qualifying criteria for homebound eligibility may also be an underlying medical condition which places the patient at an increased risk of COVID-19. Although eligibility requirements are less strict, sufficient documentation establishing the patients meets the new criteria will be required. OASIS: The comprehensive assessment and ompletion of the OASIS must be done in person, not remotely, but providers have been given more time to complete it (30 days instead of 5). Routine visits: Virtual visits may be used in addition to but not in place of regular, in-home visits as part of the patient's plan of care. As an example, a plan of care might call for four nursing visits per week, two in person and two virtual visits. Re-cert: A virtual visit could be used for re-certification but remember that it will not be a billable visit. NEXT IN THIS TELEHEALTH SERIES: How telehealth can benefit home health agencies, even without reimbursement. (Did you miss the first post in this series? Click here to read it now.)

Confused about when to complete the RFA 05 OASIS under PDGM? Our webinar explains what CMS says about matching claims, OASIS and plan of care under 30-day billing periods. Comes with a sample Significant Change in Condition (SCIC) policy for your agency.