As telehealth is granted unprecedented freedoms during the COVID-19 crisis, your providers are not only eligible to
add additional services to their list but they can now provide direct supervision electronically as well.
That's according to the
interim final rule CMS released March 31, where the agency said is was revising the definition of direct supervision for the duration of the public health emergency (PHE) for the COVID-19 pandemic. During the PHE, CMS will allow direct supervision "to be provided using real-time interactive audio and video technology."
"We recognize that in some cases, technology would allow appropriate supervision without the physical presence of a physician," the agency states.
CMS adds that "the use of real-time, audio and video telecommunications technology allows for a billing practitioner to observe the patient interacting with or responding to the in-person clinical staff through virtual means, and thus, their availability to furnish assistance and direction could be met without requiring the physician’s physical presence in that location."
How that plays out in practice, however, remains an open question. CMS described several scenarios in which the allowance of virtual supervision might occur. But the supervision section of the rule "was not very clear," says Betsy Nicoletti, CPC, president of Medical Practice Consulting in Northampton, Mass.
The rule seems to leave several questions unanswered. For instance, can the non-physician pracitioner (NPP) who is treating the patient -- and potentially billing under incident to rules -- conduct the encounter via telehealth? Also, does the supervising physician have to be connected on a live audio-and-video channel during the encounter, or must they simply be available on the channel?
Here's how CMS describes a situation where telehealth-enabled direct supervision might happen:
"We consider the possibility that patients routinely receiving medically necessary physician-administered drugs at the office of a physician may lose access to the provision of that drug should the physician who regularly supervises the provision of that drug be isolated for purposes of minimizing exposure risks," the rule states. "Likewise, should that same patient need to be isolated for purposes of exposure risk based on presumed or confirmed COVID-19 infection, administering such a drug in the patient’s home would require the billing professional to accompany the clinical staff to the patient’s home, presumably with the necessary personal protective equipment (PPE) available to both the physician and the clinical staff."
In that scenario, the at-home visit requires the services of an NPP, with the physician supervising through telehealth. And the visit would be billable under Medicare's incident to rules, where the payment would be 100% of the fee schedule.
Turning to the pre-COVID-19 definition of direct supervision suggests the physician may only have to be available via telehealth to meet the billing requirements. This is the previous description:
"Direct supervision means that the physician must be present in the office suite and immediately available to furnish assistance and direction throughout the performance of the procedure. It does not mean that the physician must be present in the room when the procedure is performed."
At present, CMS has not responded to a request for additional information. Stay tuned to the Part B News blog for further details.