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  • CMS Moves to Allow Digital Communications by PTs

    The new regulatory waivers will allow PTs, OTs, and SLPs to engage in patient-initiated "e-visits" for purposes of assessment and management services.

    In the federal government’s rapidly evolving response to the coronavirus pandemic, the U.S. Centers for Medicare and Medicaid Services has announced that it is easing Medicare telehealth restrictions in ways that could allow PTs to provide "e-visits," a limited type of service that must be initiated by the patient. Prior to this change CMS did not recognize PTs among the health care professionals allowed to bill codes associated with the visits.

    The change, announced midday on March 17, is part of a set of loosened requirements that CMS has adopted to expand the provision of telehealth and patient-initiated digital communications, such as e-visits, to help blunt the spread of COVID-19. For the most part, PTs remain outside the reach of these so-called "1135 waivers" related to telehealth, with one exception: a type of remote interaction CMS calls an e-visit under Medicare Part B.

    In its 2020 physician fee schedule final rule, CMS describes e-visits as “non face-to-face patient-initiated digital communications that require a clinical decision that otherwise typically would have been provided in the office.” The code descriptors suggest the codes are intended to cover short-term (up to seven days) assessments that are conducted online or via some other digital platform, and include any associated clinical decision-making.

    Under the waivers guidance issued by CMS, Medicare beneficiaries can qualify for e-visits no matter their geographic region or physical location, meaning that the provisions have been expanded to nonrural areas and can take place with patients in their homes. The big news for PTs and their patients is that, for the first time, PTs will be allowed to bill for e-visits under codes associated with online assessment and management services (codes G2061, G2062, and G2063). To determine the reimbursement rates for G2061-G2063, visit the CMS Physician Fee Schedule lookup tool. Medicare coinsurance and deductible would apply to the services. A March 18 CMS MLN Matters article includes more information about the e-visits and telehealth waiver.

    To qualify as an e-visit, three basic qualifications must be met: the billing practice must have an established relationship with the patient, meaning the provider must have an existing provider-patient relationship; the patient must initiate the inquiry for an e-visit and verbally consent to check-in services; and the communications must be limited to a seven-day period through an "online patient portal."

    Although the patient must initiate, CMS writes in a fact sheet that "practitioners may educate beneficiaries on the availability of the service prior to patient initiation." For example, if a patient cancels treatment because they can’t come to the clinic or are concerned about leaving home, then the PT may advise the patient that she or her can reach out to the therapists as needed.

    Alice Bell, PT, DPT, APTA senior payment specialist, says that the waiver has some very practical implications for PTs, and offers a possible scenario in which the e-visit could be useful.

    "Let's say that, as a PT, I've been seeing a patient for an orthopedic condition and I am progressing the patient’s exercises," Bell said. "The patient is unable to come into the clinic but calls me to say she's having difficulty with one of the exercises and that the other two seem to be too easy. I could arrange an e-visit with the patient and discuss her performance of the exercises. And I could then make a determination — maybe I find that the patient is performing one of the exercises incorrectly — and I could direct the patient on the correct performance. Perhaps I also determine that two of the exercises can be progressed because the patient is improving, so I could instruct the patient in the two new exercises. After that I could advise the patient to contact me for a follow-up e-visit as needed until the patient can return to the clinic."

    The HHS Office of the Inspector General has also issued a policy statement that provides guidance on how it interprets the new telehealth waivers. APTA regulatory affairs staff will continue to monitor these waivers and other developments and share news with members.

    "As we've seen over the past few weeks, and especially during the past few days, we're dealing with an extremely fluid situation in terms of response to the coronavirus pandemic," said Kara Gainer, APTA's director of regulatory affairs. "This waiver and other changes have the potential to make a difference, and we hope that CMS continues to take steps that can help providers and their patients stay healthy."

    APTA has issued a statement on patient care and practice management during the COVID-19 outbreak, and offers a webpage to keep members up to date with the latest news on the pandemic.

    Coronavirus Update: March 17, 2020

    APTA provides a statement, resources, and guidance; CMS allows limited digital services by PTs; the CDC says gatherings should be fewer than 50 people, and more.

    Practice Guidance

    March 17: APTA Statement on Patient Care and Practice Management During COVID-19 Outbreak
    "Physical therapists have a responsibility to review CDC guidance, to understand who is at highest risk and how to best reduce exposures, and to use their professional judgment in the best interests of their patients and clients and local communities," writes the APTA Board of Directors.

    March 17: APTA Offers Template Letter to Advocate to Payers on Telehealth
    The association has developed a template letter for you to use in advocating to your payers — private, Medicare Advantage, and Medicaid (both fee for service and MCOs) — for coverage of telehealth furnished by PTs and PTAs to ensure that patients continue to have access to the rehabilitative care they need amid the COVID-19 pandemic. Instructions are included at the top of the letter.

    March 16: APTA Shares Guidance on Telehealth for PTs, PTAs
    The use of telehealth can help keep providers and patients safe, but the current regulatory and payer landscape can be confusing. We've created guidance and links to resources that can help you decide whether telehealth is appropriate — or even a possibility.

    From CMS

    March 17: CMS Moves to Allow Limited Digital Services by PTs
    New regulatory waivers will allow PTs, OTs, and SLPs to engage in patient-initiated "e-visits" for the purposes of assessment and management services.

    March 17: CMS Offers Coronavirus Partner Toolkit
    CMS has created a portal that centralizes updated resources related to COVID-19, including topical areas aimed at clinicians, Medicare beneficiaries, health care settings, and more, along with information from the CDC.

    March 16: National Health Emergency Triggers CMS Waivers for Medicare, Medicaid, CHIP
    The "blanket waiver" system now in effect eases a wide range of requirements, but CMS still won't reimburse for telehealth by PTs.

    From the CDC

    March 15: CDC Recommends Ban on Gatherings of More Than 50 People
    The Centers for Disease Control and Prevention has updated its guidance on mass gatherings and community events.

    In The Media

    March 16: White House Issues Advisory to Avoid Gatherings of More Than 10 People
    The guidelines also urge the elderly and individuals with serious underlying health conditions to stay home and avoid contact with other people.

    March 16: As Coronavirus Spreads, So Do Malware and Phishing Scams
    Beware emails and websites that offer information about the pandemic — an increasing number of seemingly helpful apps and emails are actually damaging ransomware or phishing attempts, including harmful hacks sponsored by nation states.

    March 15: Gov't Testing for COVID-19 Will Prioritize Medical Professionals, Elderly
    According to government officials, testing for individuals with COVID-19 symptoms will first focus on health care workers and older adults. According to an administration spokesman, testing sites could potentially screen anywhere from 2,000 to 4,000 per day.

    March 13: Experts Identify Risk Factors for More Severe Outcomes
    Patients with COVID-19 are at higher risk of developing acute respiratory dysfunction if they are of older age, have neutrophilia, and/or have organ and coagulation dysfunction.

    March 13: Researchers Learn More About SARS-CoV-2 Transmission
    Preliminary research findings indicate that the aerosolized virus could be found in the air up to three hours later. The virus was present for four hours on copper, two to three days on plastic and stainless steel, and up to 24 hours on cardboard. The article should not yet be used to guide clinical practice, as it has not yet been peer-reviewed.

    Visit APTA's Coronavirus webpage for more information and updates.