ASA recognizes that many anesthesiologists, pain medicine physicians and their practice groups may have increased or explored the use of telehealth and telemedicine visits during the COVID-19 pandemic. Prior to the COVID-19 pandemic, telehealth services were, by law, limited to beneficiaries living in rural areas and the patient had to be in a specified originating site. During the COVID-19 public health emergency (PHE), Congress and the Centers for Medicare & Medicaid Services (CMS) have modified telehealth options, including requirement criteria, payment rates and technology requirements.
A majority of the telehealth expansions will expire after the termination of the PHE (currently set for late January 2021, although the PHE has already been extended several times). CMS has authority to make some of the expansions more permanent, but others will require legislative action.
Federal regulators have expanded the use of telehealth during the pandemic and have provided guidance on how telehealth and telemedicine visits may be conducted. In some cases, those visits may be billed and paid for by CMS and private payers. In other cases, the performance of some virtual visits and discussions may be part of a bundled payment. Please see the FAQs below for more information.
- What is the difference between telehealth and telemedicine?
The Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) defines telehealth as the use of electronic information and telecommunications technologies to support and promote long-distance clinical health care, patient and professional health-related education, and public health and health administration. Technologies include videoconferencing, the internet, store- and-forward imaging, streaming media, and landline and wireless communications.
Telehealth services may be provided, for example, through audio, text messaging, or video communication technology, including videoconferencing software. For purposes of payment, certain payors, including Medicare and Medicaid, may impose restrictions on the types of technologies that can be used. Those restrictions do not limit the scope of the HIPAA Notification of Enforcement Discretion regarding COVID-19 and remote telehealth communications.
Telehealth is different from telemedicine because it refers to a broader scope of remote healthcare services than telemedicine. While telemedicine refers specifically to remote clinical services, telehealth can refer to remote non-clinical services, such as provider training, administrative meetings, and continuing medical education, in addition to clinical services.
- Do I have to be a “meaningful user” of EHR to participate in telehealth services?
No. “Meaningful use” refers to a separate CMS program and is not related to telehealth services. Please check with your technology or billing vendors on ensuring compliance with telehealth requirements.
- Does ASA have a list of vendors or technology features that can be used to support telehealth?
ASA does not maintain a list of vendors or technology requirements related to telehealth. Each anesthesiologist and their groups are unique and should consider their needs and patient populations that may benefit from telehealth and telemedicine. If working within a hospital or facility setting, we recommend coordinating with facility administrators on best practices.
- Does ASA have any guidelines or materials for remote surveillance of surgical patients?
Please work with your hospital and facility on the materials needed for surveillance of surgical patients, those recovering in intensive care units, or patients in remote non-medical locations.
- What are the general requirements for billing telehealth?
Prior to the Public Health Emergency (PHE), telehealth services were limited to beneficiaries living in rural locations and the patient had to be in a specified originating site. Further, there were often restrictions including, but not limited to, whether the patient was new or established with the healthcare professional and the frequency in which specific services could be provided via telehealth or in a face-to-face manner. The US Department of Health and Human Services (HHS) has published information regarding telehealth requirements during the PHE. CMS has also provided general information on telehealth on their website. Some commercial payers are following Medicare’s lead and others are implementing their own policies on telehealth. If providing care via telehealth, be sure to check your commercial payers’ policies frequently as they are subject to change.
Please visit the Medicare website to see a listing of services that CMS will cover when providing care via telehealth, including whether the service is a temporary addition to the list for the duration of the PHE, if the service may be provided via audio-only interaction and if there are any Medicare payment limitations.
- Are there features of the pre-anesthesia evaluation that can be collected via telehealth technology prior to a patient entering a hospital or surgery center?
Some anesthesiologists may use phone calls to contact patients and conduct some portions of the pre-anesthesia evaluation. Many of the components of a pre-anesthesia evaluation can be accomplished in this manner but patients require some face-to-face time to complete the remaining important components of anesthesia care. The telephone call is part of the pre-anesthesia evaluation and not a separately reportable event.
A pre-anesthesia evaluation must be performed by someone qualified to administer anesthesia. Please review the ambulatory (PDF) and hospital (PDF) Conditions of Participation for more information on elements of the pre-anesthesia evaluation.
If the anesthesiologist provides care that is separate and distinct from the anesthesia pre-evaluation/examination as described above, a telehealth visit may be an alternative to a face-to-face encounter. The rules, criteria, and payment for telehealth services have been revised to adapt to conditions under the COVID-19 pandemic and those flexibilities are to remain in place throughout the declared public health emergency (PHE). Some commercial payers are following Medicare’s lead and others are implementing their own policies on telehealth. If providing care via telehealth, be sure to check your commercial payers’ policies frequently as they are subject to change. ASA will continue to monitor and inform our members when CMS issues additional information about use of telehealth for Medicare beneficiaries during and after the PHE.
Please see the “Distinguishing Between a Pre-Anesthesia Evaluation and a Separately Reportable Evaluation and Management Service” Timely Topic for more information.
- Where can I find more information on billing for non-anesthesia telehealth services?
The American Medical Association has published several resources that will help you understand how to implement telehealth services, policies for coding and billing and other resources to help you understand telehealth billing in providing non-anesthesia telehealth services.
- How do I collect informed consent for patients via telehealth?
State law and regulations govern informed consent requirements, including when, how and by whom informed consent can be collected. Please consult with your legal counsel, vendor or facility administration on how to collect informed consent from your patients.
- Are there any quality measures that use telehealth codes that I can report for MIPS?
CMS and measure stewards are assigning telehealth codes to several quality measures, especially for primary care physicians. There are no anesthesiology-specific measures that include telehealth codes for 2021.
- What telehealth provisions will be maintained after the public health emergency (PHE)?
All of the current waivers and flexibilities issued in response to the COVID-19 pandemic are tied to the PHE. Legislative and regulatory action is needed to further define telehealth after the PHE ends. Policymakers need to determine which features of telehealth may continue and in what form. Such features include, but are not limited to: 1.) Types of telehealth services paid for during the PHE; 2.) Coverage of audio-only services; 3.) Balancing payment rates of telehealth services versus in-person services; 4.) Ensuring HIPAA compliance for telehealth technology; 5.) Other safeguards to prevent fraud, waste and abuse while ensuring continued patient-physician relationships.
ASA expects that many telehealth provisions during the PHE will be continued in some form, however, we expect features of telehealth will be tightened or more closely regulated after the PHE.