The Centers for Medicare & Medicaid Services (CMS) issued the review copy of the Fee Schedule, Friday, Nov. 1. Usually, the final copy appears about three weeks after the review copy, but for some reason there’s a long delay this year, with the Federal Register version set to appear on Dec. 9.
One good thing in the Final Rule is that CMS continues to permit physicians using telehealth from their home to use their office address, rather than their home address, on claims. For reasons I don’t understand, CMS is calling this permission a “temporary extension” through the end of 2025.
One reason that puzzles me is that I am not aware of any statute or regulation that would suggest the physician’s home needs to appear on the claim. As we’ve discussed before, Medicare regulations don’t specify where a service has occurred. If the patient is in Sacramento while the physician is in Los Angeles, where did the service occur? I would argue that it’s the patient’s location of Sacramento. Given the regulatory silence, I don’t think the Fee Schedule needs to offer special dispensation, and consequently, it won’t expire at the end of the year. It seems that CMS disagrees.
The Final Rule also addresses the definition of “direct supervision,” which is used for a variety of services incident to a physician, and diagnostic tests. Hopefully you know that the longstanding requirement that a physician be present in the office suite has been changed to permit supervision via smartphone or other audio-visual equipment. That definition is extended for another year, through the end of 2025. CMS is refusing to make it permanent while it considers patient safety implications. I find this somewhat strange, because if there truly were patient safety implications, permitting unsafe care through 2025 would be odd. But once again, I’m not in charge.
There are a handful of services for which CMS is going to permanently allow audio-visual supervision, including 99211s. But the key point is that through the end of 2025, direct supervision can be by smartphone.
There are several situations where the Fee Schedule focuses on the difference between “temporary” and “permanent” provisions. CMS has indicated that some telehealth codes are “permanent” and others that are “provisional.” But a permanent rule can be changed at any time. It’s no more “permanent” than life itself, so this seems like a distinction without a difference.
We are in a period of considerable uncertainty with respect to telehealth. Absent congressional action, many telehealth flexibilities expire Jan. 1. In particular, telehealth in urban areas for Medicare patients will become a near impossibility. CMS believes it lacks statutory authority to change that, and that we’re relying on action from the lame-duck Congress to fix it. Zelis folks like Matthew, Cate, and Adam will be keeping us up-to-date on that, and they have suggested that the odds of some congressional action are high.
I will close with a reminder. Direct supervision requires the ability to monitor visually, but you don’t need to actually use it. In short, the physician needn’t be like The Police, saying “every breath you take, I’ll be watching you.” As long as you have the ability to do it, you are good to go. (And CMS also said that if the patient’s technological challenges are the barrier to audio/visual communication, that generally doesn’t interfere with coverage.)
We have been talking a lot lately about the malfeasance of Medicare Advantage (MA) plans, and deservedly so. But malfeasance can be a two-way street.
While President-elect Trump’s pick for U.S. Department of Health and Human Services (HHS) Secretary, Robert F. Kennedy, Jr., put the agency in even international newspapers
Please log in to your account to comment on this article.
Join Beth Wolf, MD, CPC, CCDS, for an in-depth webcast on the FY2025 spinal fusion MS-DRG updates. Discover key changes in DRG classification, understand impacts on documentation and CMI, and learn strategies to ensure compliance.
Join Angela Comfort, DBA, MBA, RHIA, CDIP, CCS, CCS-P, as she presents effective strategies to strengthen collaboration between CDI, coding, and quality departments in acute care hospitals. Angela will also share guidance on implementing cross-departmental meetings, using shared KPIs, and engaging leadership to foster a culture of collaboration. Attendees will gain actionable tools to optimize documentation accuracy, elevate quality metrics, and drive a unified approach to healthcare goals, ultimately enhancing both patient outcomes and organizational performance.
Optimize your outpatient clinical documentation and gain comprehensive knowledge from foundational practices to advanced technologies, ensuring improved patient care and organizational and financial success. This webcast bundle provides a holistic approach to outpatient CDI, empowering you to implement best practices from the ground up and leverage advanced strategies for superior results. You will gain actionable insights to improve documentation quality, patient care, compliance, and financial outcomes.
Enhancing outpatient clinical documentation is crucial for maintaining accuracy, compliance, and proper reimbursement in today’s complex healthcare environment. This webcast, presented by industry expert Angela Comfort, DBA, RHIA, CDIP, CCS, CCS-P, will provide you with actionable strategies to tackle complex challenges in outpatient documentation. You’ll learn how to craft detailed clinical narratives, utilize advanced EHR features, and implement accurate risk adjustment and HCC coding. The session also covers essential regulatory updates to keep your documentation practices compliant. Join us to gain the tools you need to improve documentation quality, support better patient care, and ensure financial integrity.
Dr. Ronald Hirsch provides critical details on the new Medicare Appeal Process for Status Changes for patients whose status changes during their hospital stay. He also delves into other scenarios of hospital patients receiving custodial care or medically unnecessary services where patient notifications may be needed along with the processes necessary to ensure compliance with state and federal guidance.
Healthcare organizations face complex regulatory requirements under the No Surprises Act and Price Transparency rules. These policies mandate extensive fee disclosures across settings, and confusion is widespread—many hospitals remain unaware they must post every contracted rate. Non-compliance could lead to costly penalties, financial loss, and legal risks. Join David M. Glaser Esq. as he shows you how to navigate these regulations effectively.
Protect your facility from unwanted audits! Join Becky Jacobsen, BSN, RN, MBS, CCS-P, CPC, CPEDC, CBCS, CEMC, and take a deep dive into both the CMS and AMA guidelines for reporting post operative pain blocks. You’ll learn how to determine if the nerve block is separately codable with real life examples for better understanding. Becky will also cover how to evaluate whether documentation supports medical necessity, offer recommendations for stronger documentation practices, and provide guidance on educating providers about documentation requirements. She’ll include a discussion of appropriate modifier and diagnosis coding assignment so that you can be confident that your billing of post operative pain blocks is fully supported and compliant.
During this RACmonitor webcast Dr. Ronald Hirsch spotlights the areas of the OIG’s Work Plan and the findings of their most recent audits that impact utilization review, case management, and audit staff. He also provides his common-sense interpretation of the prevailing regulations related to those target issues. You’ll walk away better equipped with strategies to put in place immediately to reduce your risk of paybacks, increased scrutiny, and criminal penalties.
Copyright © 2024 RACmonitor. Powered by MedLearn Media.
Happy National Doctor’s Day! Learn how to get a complimentary webcast on ‘Decoding Social Admissions’ as a token of our heartfelt appreciation! Click here to learn more →
