Let’s Talk Compliance Recap: The Telemedicine Cliff [VIDEO]

Within the October 8, 2021 session of our Let’s Talk Compliance sequence, Foley & Lardner’s T.J. Ferrante and PYA’s Valerie Rock shared their experience and answered questions relating to telemedicine.  One space of focus was the “telemedicine cliff” – except Congress acts, the telemedicine necessities will return to their prior restrictions after the Public Well being Emergency (PHE). With the uncertainty of what the Federal and State necessities can be after the PHE, and the uncertainty as to when the PHE will conclude, intently monitoring guideline modifications and growing a transition plan are key. A recording of the occasion is accessible here.

Not lengthy after our occasion, on October 15 the HHS Secretary prolonged the PHE by January 16, 2022, the sixth renewal because the PHE was first declared in January 2020. The following consists of key takeaways and assets to observe:

  • Most of the flexibilities permitting Medicare reimbursement are solely non permanent and can sundown as soon as the PHE ends. Congress should make a change legislatively to proceed flexibilities for eradicating geographic restrictions; permitting the situation of the affected person (together with the affected person’s house) to be an originating web site; and permitting Federally Certified Well being Facilities, Rural Well being Clinics, and Essential Entry Hospitals to furnish telehealth and be pretty reimbursed.

  • Flexibilities from different federal companies reminiscent of the Office of Civil Rights (OCR) referring to HIPAA and expertise/safety necessities and the Drug Enforcement Company (DEA) referring to managed substance prescribing necessities will expire after the PHE ends.

  • On the state degree, many states briefly suspended medical licensing necessities, permitting practitioners licensed in different states to ship telehealth companies throughout state strains. As these non permanent waivers start to sundown, well being care organizations should guarantee they’re as soon as once more ready to adjust to these state-specific guidelines.

  • Commercial payers will every have their very own necessities and can be certain by state necessities by legal guidelines, guidelines, and medical board insurance policies.

  • Identifying the services which can profit sufferers most by increasing entry to care and decreasing limitations to routine monitoring and therapy, , will enhance adoption and success of telemedicine applications. Guarantee these companies will not be negatively impacted by limitations of the bodily examination.

  • Billing and documentation necessities are presently included in Medicare FAQs, Interim Last Guidelines; nonetheless, control enforcement to interpret further necessities, together with Medicaid Steering See e.g., OIG Report.

Further Assets:

SSA, Section 1834(m)

Commercial Payer and State Policies Tool

Medicare recognition for interstate license compact

AMA Telehealth guidance



Medicare billing and documentation requirements

OIG Fraud and Abuse MonitoringSC Medicaid audit

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