Since mid-March, the AARC has pushed the Administration to include respiratory therapists as telehealth practitioners during the COVID-19 pandemic. Under their wavier authority, CMS announced that it would extend the types of practitioners who could furnish telehealth to those who could bill Medicare directly for their services. That, of course, left RTs out of the picture since they do not have direct billing authority.
In CMS’ latest interim final rule, however, the agency indicated that outpatient therapy services could be furnished by auxiliary personnel employed by the hospital via telecommunications and who did not have a specific benefit category if an individual was registered as an “outpatient” and the hospital designated the individual’s home as a provider-based department. AARC sent comments to CMS arguing that respiratory therapists should be allowed to furnish telehealth services under this authority.
We have just learned that CMS updated its list of Frequently Asked Questions regarding its many waivers, and in response to questions we have supplied via its website regarding respiratory therapists, we are excited to announce that CMS has acknowledged RTs can furnish outpatient therapy services via telehealth to outpatients in their homes. Because hospitals need to take certain actions to designate an individual’s home as an expanded provider-based department, we strongly recommend RTs check with their RT department or those who submit your hospital’s claims as to what telehealth services are covered under this authority. RTs who work in a physician’s office or clinic can also furnish telehealth services incident to the services of a physician or nonphysician practitioner who is eligible to bill Medicare.
While not yet official, we have heard that the Administration plans to extend the public health emergency which expires later this month through October.
Below is CMS’ response to AARC’s inquiries and comments:
Question: What types of health care practitioners are permitted to furnish telehealth services under broadened 1135 waiver authority granted by the CARES Act?
Answer: All health care practitioners who are authorized to bill Medicare for their professional services may also furnish and bill for telehealth services. This allows health care professionals who were not previously authorized under the statute to furnish and bill for Medicare telehealth services, including physical therapists, occupational therapists, speech language pathologists, and others, to receive payment for Medicare telehealth services.
Additionally, telehealth services performed by auxiliary personnel who cannot independently bill Medicare for their services, such as respiratory therapists, can be furnished and billed incident to the services of an eligible billing practitioner.
Hospitals do not bill for Medicare telehealth services. However, if a hospital employs certain practitioners who are not authorized to independently bill Medicare for their services, such as respiratory therapists, the hospital may bill for the outpatient hospital services provided by that staff using telecommunications technology. Hospitals should review requirements for providing hospital services in relocated provider-based departments including the patient’s home and temporary expansion locations as appropriate. We note that Medicare cannot pay for services that are furnished by a physician or practitioner located outside of the United States (see 42 CFR 411.9).