[Note: Since publication of this article on May 11, CMS has reversed course and clarified that telehealth provided by hospital-based facilities will be permitted through 2023. No additional guidance has been issued regarding other facility-based settings.]
The national COVID-19 public health emergency is at an end, but despite advocacy from APTA that included meetings with staff at the U.S. Department of Health and Human Services, a major question around the post-PHE use of telehealth by therapists in a range of facility settings remains unresolved. APTA will continue to press CMS for answers — in the meantime, providers in certain settings should take a careful approach.
The problem: While PTs, occupational therapists, and speech-language pathologists in private practice settings (and some facility-based settings) are allowed to continue to provide services under Medicare via telehealth after May 11 (and most likely until Dec. 31, 2024), therapists in certain facilities that use a particular type of claim form — the UB04 — seemingly are no longer eligible. The problem affects a range of settings, including skilled nursing facilities, home health agencies, rehab agencies, and hospital-based outpatient departments.
APTA and other organizations caught the inconsistency early on and have been urging CMS to fix the exclusion — or at the very least, explain the rationale behind it — ever since. The call for a resolution to the problem has been reinforced through a statement signed by coalition of organizations including APTA, APTA Private Practice, the American Occupational Health Association, the American Speech-Language-Hearing Association, the National Association of Rehabilitation Providers and Agencies, and others.
Those efforts continued through the last day of the PHE, May 11, when APTA staff members met with staff from HHS Secretary Xavier Becerra's office. At that meeting, HHS staff acknowledged that the issue was important but warned that answers won't be coming quickly.
"Basically, we were told that this issue is a priority but that due to legal complexities, it's taking longer than anyone would like to perform a legal analysis," said Kate Gilliard, JD, APTA's director of health policy and payment. "There are three years' worth of waivers, legislation, and regulations that have to be untangled and, unfortunately, it's extremely complicated."
Until Final Guidance is Issued, Caution Is Key
APTA will continue to press for answers and make the case that the telehealth permissions should be extended to all PTs regardless of the forms used by their facilities. Until then, the association urges members working in facilities that use the UB04 form to be especially careful, and consider the following:
Be flexible with patients, but prioritize in-person physical therapy. There is no guarantee that telehealth claims will be paid, so avoid providing services via telehealth if possible.
If telehealth is the only way to provide services, consider getting an ABN from the patient. Should your patient insist on telehealth, or if telehealth is the only option, it may be advisable to obtain an advance beneficiary notice from the patient to make it clear that your services may not be covered by Medicare. APTA can't guarantee that an ABN would lock in a provider's ability to bill the patient in the event that Medicare doesn't pay for the services, but using an ABN may increase that likelihood.
Check with your MAC and document their responses. If you want to provide telehealth, confirm with your Medicare administrative contractor that these claims will still be payable. If CMS decides otherwise, you'll at least have it on record that your MAC gave you the green light to bill telehealth.
Stay informed. HHS didn't provide an estimated timeline for when guidance would be issued, but APTA is closely monitoring the situation. Keep up with the news via APTA's social media channels, weekly news email blasts, and other communications — better yet, simply make apta.org a regular stop.
