CMS: Hospitals Can Continue to Bill for Remote Outpatient Therapies

In a Frequently Asked Questions (FAQs) document, the Centers for Medicare and Medicaid Services (CMS) stated that hospitals could continue to bill for various outpatient therapies delivered via remote care technologies in patients' homes through the end of calendar year (CY) 2023.

Released at the end of last month, the document addresses numerous FAQs regarding changes in policies and regulations following the expiration of the COVID-19 public health emergency (PHE) on May 11.

CMS states that until the end of the year, hospitals can bill for outpatient physical therapy (PT), occupational therapy (OT), speech-language pathology (SLP) services, Diabetes Self-Management Training (DSMT), or Medical Nutrition Therapy (MNT) provided at home to beneficiaries through telecommunication technology by hospital-employed staff.

The agency further noted that therapists and other practitioners who provide these services are still on the list of distant site practitioners for Medicare telehealth services. But hospital clinicians who are not eligible distant site practitioners for Medicare telehealth services can also sometimes provide DSMT services.

"To allow these services to continue to be furnished to patients in their home through telecommunication technology through the end of CY 2023, we are exercising enforcement discretion in reviewing the telehealth practitioner status of the clinical staff personally providing any part of a remotely furnished DSMT service, so long as the practitioner is otherwise qualified to provide the service," CMS stated.

Thus, through the end of the year, providers offering PT, OT, SLP, DSMT, and MNT services remotely can continue to bill "in the same way they have been during the PHE," the agency added.

But other flexibilities associated with remote care have ended with the PHE.

For instance, regulatory flexibilities provided through the Hospital Without Walls Initiative, which allowed hospitals to bill for services furnished by hospital-based staff to beneficiaries in their homes using telecommunications technology, ended because "the beneficiary's home is no longer considered a provider-based department of the hospital after the end of the PHE."

But in some circumstances, hospitals will permanently be allowed to continue to bill for mental and behavioral health services provided in patients' homes through telecommunications technology.

Further, patients who received remote monitoring or other communications technology-based services while the PHE was in effect will continue to be considered an "established patient."

"This rule applies as long as the patient consented to receive subsequent remote monitoring and other communication technology-based services," CMS stated. "This consideration would be the case even if the patient did not have an in-person or telehealth-eligible initiating service."

As the PHE drew to a close, healthcare stakeholders called for telehealth flexibilities to be made permanent.

But their request was only partially granted, with Congress extending certain telehealth and hospital-at-home waivers within the Medicare program through Dec. 31, 2024. As a result, stakeholders have continued to call for the regulatory flexibilities to be made permanent.

Earlier this month, the Telehealth Access for America campaign, which includes the American Telemedicine Association, Ascension, and CVS Health, sent a letter to United States Senate and House leaders urging Congress to "make telehealth a permanent piece of the health care puzzle."

Last week, the Department for Health and Human Services (HHS) released a factsheet detailing the changes to telehealth-related regulations following May 11. These include the HHS Office for Civil Rights reenforcing penalties for HIPAA noncompliance against providers using remote monitoring technology and the Drug Enforcement Agency ending the flexibility allowing providers to prescribe controlled substances, like Adderall and Oxycodone, without a prior in-person medical examination in November 2023.