On April 9, 2020, the Centers for Medicare & Medicaid Services (CMS) issued COVID-19 Frequently Asked Questions (FAQs) on Medicare Fee-for-Service (FFS) Billing (“ COVID-19 FAQs”). This guidance document, addresses, among other issues, recent regulatory changes CMS made through its April 6, 2020 interim final rule with comment period (“Interim Rule”) that revised Medicare and Medicaid policy during the coronavirus (COVID-19) public health emergency.  Among the impacts of the Interim Rule on FQHCs were the following: 1) it temporarily expanded “virtual communication services” to include online digital evaluation and management services using patient portals; 2) it waived the established patient requirement and relaxed the informed consent requirement relating to virtual communication services; and 3) it revised the Home Health Agency Shortage Area shortage area standards relating to visiting nursing services furnished by FQHCs/RHCs.  For more information about the CMS Interim Rule’s FQHC Flexibilities to Serve Medicare patients during the public health emergency, please see FTLF’s prior blog post.

Inclusion of Online Digital Assessment Services to Virtual Communication Services

Since Calendar Year (CY) 2019, FQHCs have been authorized to provide “virtual communication services” under Medicare.  Prior to the Interim Rule, FQHCs were only authorized under the auspices of virtual communication services to provide “virtual check-ins” and “remote evaluation services”—brief (at least 5 minutes) real-time or asynchronous consultations to determine if a visit to the office is necessary. The 2019 bundled rate for these services was $13.69.

In the Interim Rule, CMS temporarily authorized FQHCs/RHCs to furnish more extensive virtual services, “online digital evaluation and management services” (CPT codes 99421-99423), for the duration of the COVID-19 emergency, as part of the “virtual communication services” bundle.[1] The COVID-19 FAQs clarify some important aspects for incorporating this change, such as the following:

• The new bundled payment rate for virtual communication services is $24.76.
• This bundled rate applies to services provided on or after March 1, 2020 and is effective for the duration of the public health emergency.
• Online digital evaluation and management services (CPT 99421-99423) must be initiated by the patient through digital communication using a patient portal.
• A chief feature distinguishing online digital evaluation and management services from virtual check-ins and remote evaluation services is that the newly added services require the physician or practitioner to provide a clinical decision that would typically be provided in the office.
• FQHCs should continue to use the HCPCS code G0071 when using an FQHC claim to bill for all virtual communication services. That code is associated with the bundled rate that now includes online digital evaluation and management services, as well as virtual check-ins and remote evaluation services.

Other Medicare FQHC Flexibilities during COVID-19 Public Health Emergency

Additionally, the COVID-19 FAQs address other flexibilities from the interim rule that apply to all FQHC virtual communication services, such as:

• FQHC physician or practitioner does not need to be physically in the FQHC to provide virtual communication services.
• The virtual communication services may be provided to both new and established patients during COVID-19 public health emergency.
• FQHC physicians may obtain consent at the time the services are provided instead of prior to the services.

NOTE: These FAQs do not address Section 3704 of the Coronavirus Aid, Relief, and Economic Security (CARES) Act,  which temporarily recognizes FQHCs and RHCs as Medicare distant site telehealth providers during the duration of any HHS public health emergency relating to COVID-19.  For more information, please visit FTLF’s prior blog, Senate-Approved CARES Act Would Provide Temporary “Fix” for Federally Qualified Health Centers. As of today, CMS has not yet issued program guidance implementing this provision.

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If you have any questions about this update or other matters, please contact Susannah Vance Gopalan (Partner), Brittney Rudolph (Associate), or call (202) 466-8960.

[1] CMS, Interim Final Rule with Comment Period, Medicare and Medicaid Programs; Policy and Regulatory Revisions in Response to the COVID–19 Public Health Emergency, 85 Fed. Reg. 19,230, 19,253 (Apr. 6, 2020).