You'll find flexibility in waiving cost-sharing requirements beyond telehealth services during the national emergency brought on by the coronavirus. You can waive fees across "a broad category of non-face-to-face services," such as virtual check-ins, OIG clarifies in a new transmittal.
Let's recap what's happened so far. On March 17, in response to the telehealth expansion under Medicare, OIG issued a policy statement that said the agency would permit providers to reduce or eliminate cost-sharing amounts for "telehealth services" that took place during the COVID-19 emergency.
But in a frequently asked questions (FAQ) document released March 24, the agency said it "has received questions regarding the scope of the policy statement" that it originally issued on the telehealth cost-sharing waivers. It appears that providers are interested to know if other virtual or phone-based services also apply.
The answer, in short, is: Yes, they do apply. The first March 17 policy statement "is not limited" to telehealth visits, the agency explains in the new FAQ.
"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," the FAQ states.
That means that a range of services — such as the virtual check-in (G2010) and chronic care management (99487-99491) — are eligible for cost-sharing reductions. That also means you don't have to worry about liability concerns when waiving those fees.
As OIG explains: "Ordinarily, routine reductions or waivers of costs owed by federal health care program beneficiaries, including cost-sharing amounts such as coinsurance and deductibles, potentially implicate the federal anti-kickback statute, the civil monetary penalty and exclusion laws related to kickbacks and the civil monetary penalty law prohibition on inducements to beneficiaries."
In short, you won't face the threat of OIG sanction should you choose to reduce or eliminate your patients' cost-sharing requirements for non-face-to-face services provided during the COVID-19 crisis.
The new FAQ also clarifies that hospitals are provided the same leeway as individual physicians and non-physician practitioners, in a situation where "the physician or other practitioner has reassigned his or her right to receive payments" to the hospital or other entity.
Here's an example of some non-telehealth codes that should apply to the OIG's cost-sharing waivers:
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99421 (Online digital E/M service, for an established patient, for up to seven days, cumulative time during the seven days; 5-10 minutes)
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99422 (…; 11-20 minutes).
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99423 (…; 21 minutes or more).
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G2010 (Remote evaluation of recorded video and/or images submitted by an established patient [e.g., store and forward], including interpretation with follow-up with the patient within 24 business hours, not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment).
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G2012 (Brief communication technology-based service, e.g. virtual check-in, by a physician or other qualified health care professional who can report evaluation and management services, provided to an established patient, not originating from a related E/M service provided within the previous 7 days nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion).
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G2061 (Qualified nonphysician healthcare professional online assessment, for an established patient, for up to seven days, cumulative time during the 7 days; 5-10 minutes).
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G2062 ( …; 11-20 minutes).
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G2063 ( …; 21 or more minutes).
For more on the patient-initiated E/M services, click here (premium content).
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