CMS Issues Further Clarification on Use of Telehealth During PHE

The Society sought further clarification from CMS in regards to the use of telehealth for the initial visit in the nursing facility. The confusion stemmed from the April 7 memo that ended the blanket waiver for regulatory physician visits completed via telehealth. CMS sent the following e-mail communication to the Society:

“We [CMS] understand that you are asking about which nursing home visits can be performed via telehealth (such as from the list below), and which must be performed in-person. For example, can visit 99304 for Nursing facility care initial be performed via telehealth.

Review the CMS Telehealth list for nursing home visits and then read more.

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 Separate from the list of visits that may be performed via telehealth, CMS has the following regulatory requirements: 

483.30(c) Frequency of physician visits.

(1) The resident must be seen by a physician at least once every 30 days for the first 90 days after admission, and at least once every 60 days thereafter. [NOTE: “be seen” means in-person]

(2) A physician visit is considered timely if it occurs not later than 10 days after the date the visit was required.

(3) Except as provided in paragraphs (c)(4) and (f) of this section, all required physician visits must be made by the physician personally.

(4) At the option of the physician, required visits in SNFs after the initial visit may alternate between personal visits by the physician and visits by a physician assistant, nurse practitioner, or clinical nurse specialist in accordance with paragraph (e) of this section.

Based on the regulatory requirement, regardless of what is allowed to be billed as telehealth, the regulations require practitioners to see the resident in-person within the at least once every 30 days for the first 90 days after admission (and once every 60 days thereafter). So, a practitioner can continue conduct any telehealth visit and bill as allowed. But, they must see the resident in-person within the timelines specified above to be compliant with our requirements. For example, a practitioner could conduct visit 99304 via telehealth as the first visit to a resident of a SNF, but they still must visit the resident in-person at some point within the first 30 days. 

After the first 30 days, they must continue to conduct at least one in-person visit every 30 days for the next 60 days, and once every 60 days thereafter.”

If you have questions or concerns about this clarification please let us know through the PGN Forum or by sending an email to abardakh@paltc.org