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Some Major FAQ’s on Medicare Billing for Physicians regarding COVID-19 Outbreak

Overview:

CMS has recently revised some of its rules to make sure the availability of standard and quality healthcare services during this COVID-19 outbreak. Certain modifications have been made to promote telehealth services and payment modules. In this article, our focus will be on answering some of the questions raised by practitioners and physicians.

Summary:

  • For the improvement of the quality healthcare services, CMS has amended some of its already existing regulations.
  • These regulations were mainly modified to provide telehealth or virtual services during this COVID-19 pandemic.
  • Physicians and practitioners raised certain questions regarding the payment module, services, Medicare beneficiaries, and outpatient or inpatient care.
  • The effective utilization of telecommunication technology would help a lot in addressing medical healthcare challenges.

Medicare Billing:

The payment received by the physician after examining the Medicare patients is termed as Medicare Billing. This procedure involves the billing of a medical beneficiary in response to the healthcare service he/she has received from a particular medical facility.

Some Major FAQs on Medicare Billing for Physicians and Practitioners

What is the possible modification made to facilitate hospitals in accounting for the residents working at alternate locations?

CMS is currently revising its existing rules and regulations for the payments and billing of residents performing their duties at alternate locations. According to the current rules, if the resident is executing its task according to his expertise, whether in its own home or at a patient’s place, in that case, the hospital would not be able to claim the bills of the resident. The rules and regulations are still in revision by the CMS. As per the modification of new rules, the hospital would pay the salary of the resident according to IME and DGME payment rates.

Can residents furnish their virtual telehealth services?

During the pandemic situation created by COVID-19, CMS will allow Medicare payments on behalf of different services delivered by the teaching physicians or practitioners according to the finalized regulation as part of PHE. Medicare will be responsible for making billing statements and procedures by teaching physicians as per section 415.174 of primary care.

Can a doctor or non-physician practitioner (NPP) get paid at the beneficiary’s home through Medicare?

Yes, Medicare is responsible for paying all bills related to evaluation and management. It also includes other services e.g., paying for injections, etc. Medicare can claim all the benefits that are furnished in a beneficiary’s home, including virtual telehealth services. In case of emergencies, the practitioners and non-practitioners will both serve the patients despite the prevailing circumstances. Medicare will provide its services in all such matters, and other than this, it would also deliver services for the assessment and management of primary virtual care. It includes improving patient’s care, monitoring patients outside clinical settings, practicing interactive telecommunication technological service (virtual telehealth video visits, etc.)

In case of a health emergency, can the distantly located practitioner furnish Medicare Telehealth services from their home? Or is it a prerequisite to be in a medical facility?

The distantly located practitioner can deliver all Medicare Telehealth services from their place in case of a public health emergency. All the practitioners need to do is submit a report regarding the place of service (POS) code to enable the system for proper payment delivery at the same rates if they have been furnished in-person.

Will the Medicare pay additionally if a patient needs to be quarantined in a private room?

Yes, in case if the patient needs to be quarantined, then Medicare will pay for all its related diagnostic services and the charges for the entire stay. All these payments will be made according to the DRG (Diagnostic Related Group) rate.

Safe & Interactive Virtual Telehealth Services:

In this hour of Public Health Emergency (PHE), Telemedicine services are helping many people around the world as they are safe, reliable, and risk-free. The effective utilization of interactive communication technology for virtual Telehealth services is paving its way for addressing all the healthcare-related challenges during this COVID-19 outbreak. There is still a dire need for improvement in Medicare billing services and to address the upcoming challenges on the part of healthcare staff.

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