COVID Telehealth Rules: The Essential Guide
Get clarity on the new telehealth rules
This guide covers the most important changes in the areas of technology, billing, & regulatory compliance, so you can make the most effective use of the new rules in your practice.
The rapid changes in telehealth regulations during the first months of the COVID-19 pandemic caught many medical practices by surprise.
Prior to March 2020, telehealth was of minor importance for most medical practices, in part because existing regulations made it difficult and inconvenient for patients, physicians, and staff.
When the pandemic hit, telehealth suddenly became the only safe option for many types of visits. Fortunately, emergency regulatory changes made telehealth far more convenient for all parties. These changes primarily affect:
Technology Used
Billing & Regulations
HIPAA & Compliance
This guide covers the most important changes in each area, to help you can make effective use of the new regulations in your practice.
Let’s get started:
Technology
Prior to March 2020, telehealth regulations forced doctors to conduct telehealth visits using dedicated software & apps. In general, these were ordinary video calling services, with a few features added on for HIPAA compliance. Among dozens of startup telehealth services, there was no clear market leader. Patients were often confused & had difficulty using these services.
To make things more convenient, the emergency telehealth guidelines allow physicians to conduct telehealth visits via “non-public facing remote communication products.”
What is a “non-public facing” remote communication product?
The HHS Telehealth FAQ clarifies that a “non-public-facing remote communication product is one that, as a default, allows only the intended parties to participate in the communication.”
By way of example, the FAQ specifically mentions:
Apple FaceTime
Facebook Messenger video chat
Google Hangouts video
Whatsapp video chat
Zoom
Skype
Signal
Jabber
Facebook Messenger
Google Hangouts
Whatsapp
5 iMessage
The guide then provides some general criteria for selecting an appropriate platform:
“Typically, these platforms employ end-to-end encryption, which allows only an individual and the person with whom the individual is communicating to see what is transmitted. The platforms also support individual user accounts, logins, and passcodes to help limit access and verify participants. In addition, participants are able to assert some degree of control over particular capabilities, such as choosing to record or not record the communication or to mute or turn off the video or audio signal at any point.”
The guide then clarifies what types of platforms are considered “public-facing” and therefore unacceptable for use in telehealth:
“...public-facing products such as TikTok, Facebook Live, Twitch, or a public chat room are not acceptable forms of remote communication for telehealth because they are designed to be open to the public or allow wide or indiscriminate access to the communication.”
In general, as long as the service is designed for 1-to-1 calling, i.e. it’s not a social media app that can be discovered on the public internet, it’s allowed for telehealth visits.
Dedicated Telehealth Software & Apps
While many physicians & patients have now discovered that telehealth visits are convenient when conducted via apps they are already comfortable using, there are still advantages to dedicated telehealth apps in certain circumstances.
In our experience, a dedicated telehealth app should:
Include a “waiting room” feature, so that patients can check in & be ready for their appointment once the provider is available
Be accessible by a browser URL & not require download of an app
The “waiting room” feature is particularly convenient for practitioners, and in our opinion is probably the best reason to choose a dedicated telehealth software.
One specific telehealth software that we would recommend is doxy.me, which includes both waiting rooms & URL access, and also offers a robust free plan as well as affordable full-featured paid plans.
Billing & Reimbursement
In the past, reimbursement for telehealth was low relative to in-person visits. Additionally, billing for telehealth visits was more complicated than in-person visits, requiring the use of modifier codes or specialized telehealth codes.
The COVID emergency measures changed this. The latest regulations, enacted April 30 and applying retroactively through March 1, allow many types of telehealth visits to be reimbursed at the same rate as in-person visits, often without additional paperwork or recordkeeping.
As of June 2020, telehealth visits now fall into three general categories:
Telehealth visits
Virtual check ins
E-visits
As you’ll see below, there is some variation in regulations for each:
Telehealth Visits
Telehealth visits are treated as identical to regular in-person office visits, for billing purposes. Some key
Identical billing codes with no modifiers, with existing offices as place of service
Can be used for both existing and new patients - “To the extent that the 1135 waiver requires an established relationships, HHS will not conduct audits to ensure that such a prior relationship existed for claims submitted during this public health emergency.”
Any type of healthcare practitioner may perform telehealth visits
Virtual Check-Ins
The “virtual check-in” category applies to physician-patient interactions that aren’t related to an official appointment. For example, a text-messaging interaction with a patient regarding dosage of a new medication, spread over the course of a week, could potentially be considered a “virtual check-in” and be billed as such.
The “virtual check-in” category allows physicians to be compensated for services that were previously provided for free.
Billed for cumulative time over a 7 day period
Must not relate to an appointment (or telehealth visit) within the previous 7 days nor lead to an appointment within the next 24 hours
Established patients only
Patients must specifically agree to receive these services
E-Visits
The "e-visit" telehealth category specifically applies to communication between a patient & practitioner via a patient portal.
Based on cumulative time over 7 day period
Must be specifically agreed to by patient
Established patients only
No geographic limitations
HIPAA & Regulatory Compliance
Effective immediately, the HHS 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.
What Comes Next
The sweeping changes to rules governing telehealth, which came as part of the government’s response to the pandemic, actually made implementation & usage of telehealth much easier and more practical for most physicians. So, while most of these changes were initially enacted as “temporary” measures, it’s quite possible that many of these rules will become permanent
Regardless, we’re encouraging all of our clients & acquaintances to take full advantage of the temporary telehealth rules during the COVID-19 pandemic, to ensure the safety of their patients, staff, family members, and themselves, as well as to ensure their practice remains viable during this crisis. In our opinion, it’s likely that telehealth is here to stay, and therefore investment in a robust telehealth program is likely to be valuable well into the future.
If you’d like assistance in setting up an effective telehealth solution for your practice, click the button below: