On March 25, 2020, the Office of Inspector General, Health and Human Services (OIG) issued two frequently asked questions (FAQs), clarifying its March 17th Policy Statement Regarding Physicians and Other Practitioners That Reduce or Waive Amounts Owed by Federal Health Care Program Beneficiaries for Telehealth Services During the 2019 Novel Coronavirus (COVID-19) Outbreak (Policy Statement).
The Policy Statement had provided that waivers of beneficiary cost sharing amounts would be allowed during the COVID-19 Public Health Emergency, if both of the following conditions are satisfied:
- a physician or other practitioner reduces or waives cost-sharing obligations (i.e., coinsurance and deductibles) that a beneficiary may owe for telehealth services furnished consistent with the then-applicable coverage and payment rules; and
- the telehealth services are furnished during the COVID-19 Public Health Emergency.
The FAQs subsequently issued clarify that: 1) the Policy Statement is not limited to “telehealth visits” but intended to apply to a range of non-face-to-face encounters, and 2) the Policy Statement applies whether the practitioner is billing directly or another eligible individual or entity is billing on the practitioner’s behalf, through a reassignment of the right to receive payments.
Below is the text of the FAQs:
- Does the Policy Statement apply to services provided remotely through information or communication technology, or is the Policy Statement limited to the specific services the Centers for Medicare & Medicaid Services (CMS) refers to as “telehealth visits”?
Answer: OIG’s Policy Statement is not limited to the services governed by 42 C.F.R. § 410.78 and referred to by CMS as “telehealth visits.” OIG intends for the Policy Statement to apply to a broad category of non-face-to-face services furnished through various modalities, including telehealth visits, virtual check-in services, e-visits, monthly remote care management, and monthly remote patient monitoring.
- Many physicians and other practitioners are organized within larger healthcare provider entities and systems. Does the Policy Statement apply to a hospital, for example, when a physician or other practitioner who has reassigned his or her right to receive payments to the hospital provides services remotely through information or communication technology?
Answer: The Policy Statement applies to a physician or other practitioner billing for services provided remotely through information or communication technology or a hospital or other eligible individual or entity billing on behalf of the physician or practitioner for such services when the physician or other practitioner has reassigned his or her right to receive payments to such individual or entity.