By Melody W. Mulaik
After three long years, the COVID-19 public health emergency (PHE) will officially end on May 11, 2023. This ending begins the transition back to many pre-COVID regulations, some go into effect immediately on May 12, while others will phase out at the end of 2023 or 2024. To assist in understanding which waivers and provisions are ending, changing or remaining, the Centers for Medicare and Medicaid Services (CMS) has begun to release updates to their extensive frequently asked questions (FAQs) document. Most of the waivers and provisions don’t impact radiology services but there are a few that should be reviewed, as they may impact your organization.
The biggest area of impact for radiology relates to the relaxation of direct supervision requirements. To account for physicians who may have been covering areas due to quarantining, the overwhelmed health care system due to high patient volumes, and limited physicians to supervise, CMS allowed for direct supervision of diagnostic tests, physicians’ services which included services provided incident to in the office setting, and some hospital outpatient services, to be provided using real-time audio/video capabilities. CMS reiterated in the CY 2022 Medicare Physicians Fee Schedule (MPFS) final rule, on December 31 of the year the PHE ends the physician will be required to be physically present to meet the direct supervision guidelines as they were prior to the public health emergency. In short, this means that unless CMS makes a regulatory update this year, effective January 1, 2024, direct supervision must be provided in accordance with the guidelines that were in effect prior to the PHE. There is the potential that CMS will address this issue during the CY24 rule making process so be on the look out for information and updates.
Another factor that impacts the relaxation of current guidelines is the Consolidated Appropriations Act of 2023, the government budget for the year, that was signed into law on December 29, 2022. This Act contains several provisions regarding the end of the PHE and several of these related to telehealth services changed components which were finalized in the Consolidated Appropriations Act of 2022.
The impact of all of the changes may vary based on your organization’s scope of practice and focus. Following are items that may impact radiology services and should be evaluated to ensure compliance.
Ending May 12, 2023
- Virtual check ins and e-visits for new patients
- Telehealth via any non-public facing application
Even though telehealth visits will continue for another 18 months after the end of PHE, the technology used to conduct the visit will be required to be HIPAA compliant. The waivers and extensions which allowed telehealth visits to be performed with non-HIPAA compliant technology will end on May 12. Providers who expect to continue providing services will need to verify the technology they are using is HIPAA compliant and document this, or they may be subject to legal fines and penalties.
Some other specific waivers ending as well include:
Ending December 31, 2023
- Telehealth visits performed from provider’s home reporting the facility address
Ending December 31, 2024
- Telehealth services available in any geographic area in the United States
- Patients able to continue receiving telehealth services from their home
- Audio-only encounters via telephone evaluation and management services
CMS updated the telehealth list of services on February 13, 2023 to remove the column designating the different phase out timelines for the approved codes. The full list can be found at, https://www.cms.gov/Medicare/Medicare-General-Information/Telehealth/Telehealth-Codes.
Other Changes
Virtual presence of the teaching physician which has been allowed for all teaching settings will change. Teaching physicians only in residency training sites located outside of a metropolitan statistical area may direct, manage and review care furnished by residents through audio/video real-time communications technology. This change definitely impacts many radiology residency programs.
Practitioners wishing to practice in any particular state must adhere to the state guidelines regarding licensure, the waivers initially setup by CMS could not and do no overrule any state specific requirements.
The modification for the same locum tenens to provide coverage longer than 60 consecutive days during the PHE, whether the arrangement is reciprocal billing arrangements or fee-for-time compensation arrangements, will revert to original guidelines. On the 61st day after the PHE ends, the regular physician must use a different substitute physician or return to work at their practice.
As it gets closer to May 11, it is likely there will be more information from CMS regarding the ending of the waivers and extensions. It is important to discuss and address any relevant items within your organization to ensure understanding by providers and staff as this may be significant changes for some organizations as compared to the last three years.
Melody W. Mulaik, MSHS, CRA, RCC, RCC-IR, CPC, COC, FAHRA, is the president of Revenue Cycle Coding Strategies LLC.
