On April 30, 2020, CMS published guidance in a second Interim Final Rule (“IFR”) addressing regulatory flexibilities available to hospitals to bill for hospital/critical access hospital outpatient therapeutic services on the UB-04 when such services are furnished in a temporary expansion location (including a beneficiary’s home) during the COVID-19 public health emergency (“PHE”). This increased flexibility is consistent with CMS’s primary goal of limiting the need for patients to receive care in the hospital itself, which could unnecessarily expose patients or providers to COVID-19. While the guidance offers greater flexibility for coverage and billing purposes, hospitals still need to ensure certain regulatory requirements are met in order to appropriately meet conditions for Medicare payment.
Hospital Outpatient Therapeutic Billing Flexibilities Include:
- The ability to bill for some hospital outpatient therapy, education and training services (e.g., psychoanalysis, psychotherapy, diabetes self-management training and medical nutrition therapy) on the UB-04 when the service is provided by hospital clinical staff via telecommunications technology and rendered in a “temporary expansion location” (including a beneficiary’s home) provided that: (1) the location is provider-based to the hospital; (2) the patient is registered as an outpatient of the hospital; and (3) the appropriate level of physician supervision is met. CMS published a list of the services that hospital clinical staff can furnish incident to a physician/qualified non-physician practitioner’s service in this manner during the PHE. A link to the file containing the list of services can be found on the CMS website here. Note the IFR guidance uses mental health services as the example of “therapy” services but the current CMS list of services includes HCPCS codes for physical therapy and occupational therapy services.
- CMS’s recognition of a temporary expansion site (including the patient’s home) as an outpatient provider-based department (“PBD”) in order for a hospital to bill and be paid for certain services (e.g., wound care, chemotherapy administration and other drug administration) rendered directly by hospital clinical staff provided that the service is furnished: (1) under the order of a physician or qualified non-physician practitioner (“NPP”); (2) in-person by clinical staff; (3) under the “general supervision” of a physician or qualified NPP as defined by regulation; and (4) the patient is a registered hospital outpatient.
- The ability for a hospital to bill for the originating site facility fee when professional telehealth services are furnished by a physician or practitioner who normally practices in the hospital outpatient department (“HOPD”) to a patient who is located at home or other applicable temporary expansion location that has been made provider-based to the hospital provided that the patient is a registered outpatient of the hospital. For additional information on professional telehealth services waiver expansion, see our recent article here.
Cautions
- The increased Medicare billing flexibilities discussed above assume that all other applicable regulatory requirements are met, including the hospital Conditions of Participation (to the extent not waived by a Section 1135 waiver).
- Hospitals should bill for these outpatient services as they would ordinarily bill for services along with any specific billing requirements for relocating PBDs during the COVID-19 PHE.
- Hospitals should be mindful of whether a patient is under a home health plan of care when services are being rendered in the patient’s home by hospital clinical staff. CMS will not consider a patient’s home as a provider-based HOPD and a “home” for purposes of the home health benefit simultaneously.
If you have additional questions, please contact:
- Regan E. Tankersley at (317) 977-1445 or rtankersley@wp.hallrender.com;
- Lauren Hulls at (317) 977-1467 or lhulls@wp.hallrender.com;
- Lisa A. Lucido at (248) 457-7812 or llucido@wp.hallrender.com; or
- Your regular Hall Render attorney.
Hall Render’s attorneys and professionals continue to maintain the most up-to-date information and resources at our COVID-19 Resource page, through our 24/7 COVID‑19 Hotline at (317) 429-3900 or by contacting your regular Hall Render attorney.
Hall Render blog posts and articles are intended for informational purposes only. For ethical reasons, Hall Render attorneys cannot—outside of an attorney-client relationship—answer specific questions that would be legal advice.
