The Centers for Medicare & Medicaid Services (CMS) sent an MLN Connects Special Edition newsletter this morning addressing Medicare claims processing and telehealth, among other Medicare operational issues. CMS acknowledges that the telehealth restrictions that are now in place due to the expiration of the flexibilities can impact requirements for meeting eligibility/continued eligibility for Medicare benefits. CMS goes on to provide guidance to practitioners who choose to perform telehealth services on or after October 1, 2025 including providing beneficiaries with an Advance Beneficiary Notice of Noncoverage (ABN) and possibly holding claims associated with telehealth services. It is important for Alliance members to note that this guidance applies only to practitioners. It does NOT apply to home health agencies or hospices.
The Alliance recognize the adverse impacts the lack of telehealth flexibilities has on patients and providers. Prior to the expiration of the telehealth flexibilities, the Alliance requested that CMS proactively provide guidance to home health agencies and hospices that it will exercise enforcement discretion related to the required face-to-face encounter until the telehealth waivers can be extended by Congress. No such guidance was provided, and CMS addressed the expiration in the above referenced MLN Connects newsletter.
Home health agencies do not provide or bill for the F2F encounter for their patients. While hospices complete the F2F encounter with their physicians or nurse practitioners, it is an administrative requirement that hospices cannot bill for. However, both home health agencies and hospices must comply with their respective Medicare billing requirements related to the F2F. The encounter must be performed at specified times and must meet the requirements at the time the encounter was performed. Until Congress acts to implement telehealth flexibilities again, home health agencies and hospices must ensure encounters are conducted in person and in compliance with the applicable timing and documentation requirements. Even if Congress retroactively reinstates the telehealth flexibilities to October 1, 2025, the F2F encounters conducted during the lapse in flexibilities would not be covered for home health or hospice as the flexibilities were not in place at the time of the encounter.
As providers know, a non-compliant F2F encounter impacts all services provided by the home health agency or hospice that are tied to that particular encounter. Therefore, the Alliance is reiterating to home health agencies and hospices its recommendation that F2F encounters be completed in person. Agencies accepting new patients or continuing to serve patients where a required F2F encounter is performed but is not compliant risk non-payment of all care tied to that encounter.
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Mary Carr
Vice President, Regulatory Affairs
National Alliance for Care at Home
Washington DC
+1 (202) 547-7424
mcarr@allianceforcareathome.org------------------------------