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Medicare Waiver Expands Telehealth Service Coverage to All Beneficiaries

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Medicare Waiver Expands Telehealth Service Coverage to All Beneficiaries

by Mary Byron

Updated: 10/13/2020: US Health and Human Services have extended the health emergency to January 21, 2020.

The Centers for Medicare & Medicaid Services (CMS) has announced a significant, temporary broadening of telehealth services coverage.

As of March 6, and for the duration of the novel coronavirus (COVID-19) public health emergency, CMS stated that it will pay for professional Medicare telehealth services furnished to beneficiaries in all areas of the country in all settings. These visits will be considered the same as in-person visits and paid at the same rate as regular, in-person visits. Services covered include the Medicare annual wellness visit (AWV) and Medicare preventive services. These temporary changes are meant to allow providers the opportunity to continue to care for their patients from afar while the threat of coronavirus remains high.

CMS is lifting requirements concerning beneficiaries traveling to originating sites (e.g., physician's office, skilled nursing facility, hospital) for the visit. CMS will pay for Medicare telehealth services furnished to beneficiaries in any healthcare facility or in their home.

While CMS acknowledges that the Medicare coinsurance and deductible would generally apply to these services, the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) is also providing flexibility for providers to reduce or waive cost-sharing for telehealth visits paid by federal healthcare programs.

Finally, CMS noted that to the extent the 1135 waiver requires an established relationship, HHS will not conduct audits to ensure that such a prior relationship existed for claims submitted during the public health emergency.

On 4/30/20, Medicare further waived restrictions, and now allows Annual Wellness Visits, E/M visits and many preventive services to be conducted via audio-only telehealth (i.e. over the telephone) for the duration of the waiver.

Prevounced was designed to help make performing the annual wellness visit and preventive services easy and efficient both in person as well as via telehealth. As of March 8, we have incorporated all temporary coverage changes into our eligibility system to help guide providers and maximize patient well-being while the crisis waiver is in place. If you would like to see how Prevounce can help your practice adapt to the constantly changing Medicare landscape, schedule a demonstration with us today.

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