Telehealth Part 2: New Rules and Regulations from CMS

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Telehealth Part 2: New Rules and Regulations from CMS

Telehealth: New Rules from CMS and Resources

During these unprecedented times, many adjustments are put into action to accommodate the new normal of social distancing. As previously discussed in our New Rules for Telehealth Technology blog post, the COVID-19 pandemic is causing a large spike in virtual healthcare visits. In these times of rapid change, normal rules and regulations are relaxed to increase accessible care. The Centers for Medicare & Medicaid Services (CMS) recently adjusted its policies so more practitioners can use telehealth during the COVID-19 outbreak. 

How CMS is Responding to COVID-19

Public health emergencies, such as the COVID-19 pandemic, require the U.S. healthcare system work quickly to make sure people are receiving necessary care. As the largest health insurer in the nation, CMS plays a critical role in enforcing new safety and billing guidance during these uncertain times. CMS has implemented temporary changes during our country’s state of emergency. Here is a quick summary of the timeline so far:

Timeline: 

March 13 – The United States declares COVID-19 as a national emergency. CMS publishes an initial emergency declaration fact sheet for healthcare providers.

March 17 – CMS announces an expansion of telehealth services covered for Medicare beneficiaries. CMS also approves the first state request for 1135 Medicaid waiver in Florida.

March 27 – 34 states officially approved for a Medicaid waiver under Section 1135 (see the CMS Newsroom for updated numbers).

March 30 – 80 additional telehealth services added under Medicare coverage.1  

These dates are only a few noteworthy occasions of the many changes made in the past month by our country. CMS reports that Medicaid waiver requests are being approved in historic turnaround times. Fulfilling waiver requests quickly grants states ample flexibility to serve individuals on Medicaid, who are often underserved in communities. CMS reports, “Other types of Medicaid waivers can require months of negotiation, but in light of the urgent and evolving needs of states during COVID-19 CMS developed a streamlined template for facilitate expedited application and approval of Medicaid 1135 waivers.”2  

What does a Section 1135 waiver mean?

The Medicaid-specific waivers approved to many states are under Section 1135 of the Social Security Act. These waivers specifically provide the healthcare system greater flexibility for providing care to individuals. Some of the temporary flexibilities include:

  • Waiving requirements in the authorization for fee-for-service program
  • Out-of-state providers can provide care to another state’s Medicaid population if they have been impacted by the national emergency
  • Waiving requirements that providers be licensed in the specific state they are providing care in (as long as they have equivalent licensure in another state)
  • Suspending requirements relating to pre-admission or annual screenings (specific to nursing homes)

CMS changes are evolving each day. It is important now more than ever to stay up to date with the facts. Regulations differ on a state and local level. As always, follow the guidance of your local health authorities. For further details on the Section 1135 waivers (specific to state Medicaid), please visit Medicaid.gov or trust reliable news sources, such as the CMS Newsroom. Furthermore, CMS is regularly updating this webpage to keep beneficiaries and healthcare professionals up to date.

Further Expansion for Telehealth

Telehealth is continually seeing an expansion during the COVID-19 pandemic. CMS is now allowing 80 additional services to be provided through telehealth, specifically for Medicare patients. Covered healthcare professionals may use any non-public facing product, such as FaceTime, Skype and Facebook Messenger to provide telehealth during this public health emergency. Penalties won’t be imposed on covered providers who have not entered into a HIPAA BAA with these vendors.

Billing has also been adjusted, allowing healthcare professionals to bill telehealth visits at the same rate as in-person visits. New and existing patients can now be at home while receiving various forms of healthcare.

As always, see CMS.gov for more information on the temporary regulatory changes and other changes that might be implemented. 

Patagonia Health is Here for You

There is so much information out there about COVID-19. Patagonia Health is here for you as a resource. We are regularly updating resource pages to specifically help you sift through the noise. 

State-Specific Telehealth Coding and Billing Cheat Sheets and other Educational Resources

COVID-19 Resources for Public & Behavioral Health

As a trusted Public and Behavioral Health EHR, practice management, and billing solution, we understand the importance of combating the ongoing pandemic of COVID-19. Our team is currently collaborating with customers to develop a fully integrated telehealth solution. If we can be a service or resource for you, please contact us today. 

References:

1 https://www.beckershospitalreview.com/telehealth/cms-adds-85-more-medicare-services-covered-under-telehealth.html

2 https://www.cms.gov/newsroom/press-releases/trump-administration-approves-34th-state-request-medicaid-emergency-waivers

Additional Resources:

The National Council’s COVID-19 Resources

CMS Emergency Information on COVID-19

Medicare Telemedicine Health Care Fact Sheet

Historic Expansion of Telehealth Announcement from HHS

Why Health Information Exchange is Important for EHR Use

Health Information Exchange is Important for EHR Use

Electronic Health Records (EHRs) are an integral part of today’s healthcare system. Despite initial hesitation to switch to an EHR, an overwhelming majority of organizations that have made the change cannot imagine going back to paper. EHRs improve efficiency and increase reimbursements while improving patient care. As providers become more fluent with the technology, EHRs help them with decision making and influence the way a client is treated. Additionally, EHRs enable connectivity, or to use the current buzzword, interoperability.

Interoperability refers to health information technology that enables electronic health information to be easily exchanged. It lets authorized professionals access, exchange and use the health information. In our journey to transform healthcare, Health Information Exchanges (HIEs) have been established. Connecting an EHR to an HIE allows health information to flow seamlessly to the right people at the right place at the right time.

What is an HIE?

But what exactly is an HIE? Historically, when a patient visited a healthcare facility, the provider had two paths to understand the medical history of the patient:

  • Check the facility’s own EHR system for prior visit information, such as allergies, medications, procedures, etc.
  • Ask the patient to fill in any missing information not already documented.

As you know, there are several problems with this process. Not only do patients rarely remember information from prior visits, but they are seen in multiple facilities using various EHR systems, as well. Also, consider a patient who comes into the ER and is unresponsive. How would a provider find out about his or her missing information?

A Health Information Exchange addresses this issue. An HIE is a secure central repository of patient data aggregated across multiple facilities and EHR systems in the same region. The goal is to provide a holistic view of the patient’s electronic health record through a secure, standardized system. EHRs connected to an HIE can share information via the federally defined standards of CCR (Continuity of Care Record) and CCD (Continuity of Care Document). This is the standard all federally-certified EHRs must follow.

Any federally-certified EHR connected to an HIE can (if permitted) send and/or receive information between the EHR and the HIE. Thus, the provider can send and receive electronic information with any community provider also connected to the HIE.

Benefits of Health Information Exchange

Benefits of Using an EHR for Health Information Exchange

Using an HIE streamlines information and connects a practitioner to all aspects of a client’s medical history. Practitioners can receive health information from the HIE, such as a patient discharge summary from a community hospital. This information can be brought into a patient’s chart as electronic health data after it has been reviewed. Using an HIE helps facilitate coordinated patient care, enabling an organization to:

  • Save time by minimizing readmissions
  • Increase efficiency by moving away from paper and fax machines
  • Save money by avoiding duplicate testing
  • Provide clinical decision support tools to improve care and treatment
  • Minimize medication and medical errors
  • Engage consumers about their own personal health information
  • Improve healthcare quality and outcomes.

HIEs reduce the amount of time patients spend completing paperwork and briefing their providers on their medical history. This frees up more time for discussions about health concerns and treatments between the patient and provider. By saving time for patients and providers along the continuum of healthcare delivery, HIEs have the potential to both reduce costs and improve health outcomes.

Health Information Exchange Challenges

The push for nationwide interoperability and improved health data exchange have increased HIE and EHR use. In some cases, organizations have been mandated to make the adoption. But, that doesn’t mean HIE connectivity doesn’t come without challenges.

HIE and Data Security

One of the biggest concerns with HIEs is ensuring health data privacy and security are maintained throughout the entire data exchange process. Participating organizations must follow all federal and state requirements related to data security, but they still need to allow information to be exchanged freely for patient care. While information exchange between EHR systems and HIEs is HIPAA compliant, the growing number of cybersecurity attacks have piqued concern about health data security.

A 2017 Black Book survey confirmed these fears extend to patients. Patients surveyed were nervous their digital health information might be shared beyond their physician and hospital. Furthermore, they are not confident their physician will be able to keep their personal information secure. 69% felt their primary care physician “does not demonstrate enough technology prowess” to reassure them that their data is safe.

Physician Burnout

Another major challenge HIE connectivity brings to the forefront is information overload. Physicians are already experiencing burnout. Providers are further burdened with copious amounts of data flooding them, which can lead to less effective care.

While the Patients Over Paperwork initiative is promising to reduce administrative burden and physician burnout, it doesn’t fully account for the volume of data providers will be faced with.

Many providers have lamented that their EHR system is not built with an easy to use clinical workflow. Adding another step to incorporate data from an HIE is just that – another step.

Regardless of the challenges, EHRs and HIEs aren’t going away. They are a major part of the digitization of healthcare and the shift toward value based care. Learning to utilize these tools effectively will help your organization provide more streamlined, effective patient care. And, of course, we recommend working with an EHR vendor who will help you navigate this process with training, support and best practices!

https://www.healthit.gov/faq/what-are-benefits-health-information-exchange

https://ehrintelligence.com/news/what-are-potential-benefits-challenges-of-hie-use

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What is HL7?

HL7, FHIRE and interoperability

As interoperability becomes a more pressing issue for providers, EHR vendors are paying attention to the standards that work to enable seamless health data exchange. Terms used frequently are HL7 and HL7 FHIR (which is pronounced “fire”), but many providers don’t really know what these things mean.

To start, what is HL7? Health Level Seven International (HL7) is an accredited standards organization. They focus on providing a framework and standards for the exchange, integration, sharing and retrieval of electronic health information. As an organization, their mission is to provide standards that empower global health interoperability. Their goal is to improve care delivery, optimize workflow and enhance knowledge transfer among healthcare providers, government agencies and patients, to name a few.  

HL7, FHIR and your EHR

HL7 Compliance

If your Electronic Health Record (EHR) solution is HL7 compliant, it means it conforms to the requirements of the standard. There are specific requirements an EHR software must meet. For example, the HL7 EHR Behavioral Health Functional Profile includes the functions and conformance criteria that is important for behavioral healthcare providers’ clinical records system. For providers, HL7 compliance tells them their EHR will work toward:

  • Improving the health of at-risk populations by improving care coordination between specialty behavioral health, primary care, and related human services providers, through systems interoperability
  • Improving provider performance accountability
  • Supporting emerging Accountable Care Organizations (ACOs)

HL7 FHIR

HL7 FHIRE Bringing greater connectivity

HL7 Fast Healthcare Interoperability Resources (FHIR) is the next generation standard that provides a framework for interoperability. It’s designed to facilitate the exchange of electronic healthcare information (EHI) between organizations. It was created to make it easier to connect different healthcare data elements using a web-based approach. Using this framework, data elements will each have a tag that acts as a unique identifier, just like the URL for an individual web page.

By using the internet as a platform, users can access the same URL regardless of the type of device they’re using — Apple or Windows, smartphone or desktop. FHIR is aiming to do this for health information. Their goal is to enable developers to create applications that allow access to data no matter which EHR solution is being utilized.

Get Excited about FHIR

FHIR is exciting for both patients and providers because it will make healthcare information easier to utilize. Not only will it make the experience much more like other online experiences people are used to, but it will also make wearable devices more clinically relevant.

With FHIR, all kinds of health and wellness products — think fitbit, iHealth and an array of wearable medical devices — could theoretically tie into a patient’s EHR. Going one step further, this patient-generated health data could be parsed by another app that is built on FHIR and performs an analysis of the data. This analytical data would enable providers to access relevant patient-generated health information and use it in a way that could support the overall wellbeing of the patient.

From the patient perspective, FHIR aims to provide a single personal health record. So, rather than logging into portals for various providers, patients will be able to access a comprehensive record that shows all of their medications, diagnoses, health concerns, and more. Basically, a one-stop-shop for their personal health information.

What the Future Holds with HL7

With standards like this in place, it is easy to see the direction healthcare is going in. One that provides easy access to health information for both patients and providers. One that aggregates data to be a useful tool for supporting, and even predicting, health outcomes. One that brings healthcare to a point of truly delivering whole person care.

https://healthitanalytics.com/news/4-basics-to-know-about-the-role-of-fhir-in-interoperability

https://healthitanalytics.com/news/as-fhir-matures-healthcare-interoperability-comes-into-focus

https://www.hl7.org/implement/standards/product_brief.cfm?product_id=307

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