[Transcript] Episode 509: Medicare’s Telehealth In-Person Visit Requirements: What You Need to Know

 

Evan Dumas 

You’re listening to Group Practice Tech, a podcast by Person Centered Tech, where we help mental health group practice owners ethically and effectively leverage tech to improve their practices. I’m your co-host, Evan Dumas.

 

Liath Dalton 

And I’m Liath Dalton, and we are Person Centered Tech.

 

Liath Dalton 

This episode is brought to you by Therapy Notes. Therapy Notes is a robust online practice management and electronic health record system to support you in growing your thriving practice. Therapy Notes is a complete practice management system with all the functionality you need to manage client records, meet with clients remotely, create rich documentation, schedule appointments and bill insurance all right at your fingertips. To get two free months of Therapy Notes as a new Therapy Notes user go to therapynotes.com and use promo code PCT.

 

Evan Dumas 

Hello and welcome to episode 509: Medicare’s Telehealth, In-Person Visit Requirements: What You Need to Know.

 

Liath Dalton 

Yes, this is a topic and consideration that has understandably generated a lot of concern and questions, because, like much in our current sort of regulatory landscape, there are a number of unknowns, and there currently is a waiver for the in-person requirement for telehealth visits for behavioral and mental health care, but it’s set to expire on March 31.

 

Liath Dalton 

And prior to the end of 2024 and the new administration coming in, there had been proposed legislation that would extend that waiver and actually make it permanent, which would be wonderful, but currently there is no action around that proposed legislation. There’s a lot going on, in the sort of chaotic context. So, you know, Congress is focused on other things, which means, at this point in time, the waiver is indeed set to expire.

 

Liath Dalton 

So we thought we would talk about what that means, what it doesn’t mean. Which some of the sort of concern that had been generated was equating the requirement for an in-person assessment to mean that Medicare was no longer covering telehealth, which is not the case.

 

Evan Dumas 

No, not at all.

 

Liath Dalton 

We want to dispel that myth. And a lot of the other extensions or or sort of waivers for how Medicare originally covered telehealth and behavioral and mental health via telehealth have in fact, been made permanent. Such as, it is going to continue, what is permanent, is that folks can continue to receive telehealth sessions in their home or or a care home. The originating and distance site provisions that were originally so kind of convoluted and restrictive. Those are gone. Those are permanent.

 

Evan Dumas 

Yeah.

 

Liath Dalton 

The other thing that is permanent for mental and behavioral health care is that it can be via audio only.

 

Evan Dumas 

Oh, it’s just great.

 

Liath Dalton 

So it does not have to be by video. So these are awesome things.

 

Liath Dalton 

But, there is this in person requirement that, as of now, is going to go into effect on April 1, because the actions to extend the waiver, or make it permanent beyond March 31 2025, are kind of dead in the water at the moment. So what that means is that after expiration, an in-person visit will be required within six months prior to an initial telehealth visit, and then every 12 months thereafter. So just, and so, within 12 months, its kind of funny when we’re talking about telehealth for mental or behavioral health, but I think it’s oriented more actually towards medical practices, right?

 

Liath Dalton 

Like, if you’ve seen someone in person once, then within six months, you can switch to telehealth or do a telehealth visit.

 

Evan Dumas 

Yeah.

 

Liath Dalton 

But for mental health care providers, means that the initial visit, or like your intake appointment, would be in-person for new patients or clients, and then after every 12 months, you would need to do an in-person appointment. However, there are some exceptions, and we’re going to talk about those.

 

Liath Dalton 

But first, what’s most impactful is what this means for established telehealth patients. Because I know people are worried that, oh, as of April 1, when this waiver expires, that means I can’t see existing Medicare telehealth clients, unless I see them in person first, which would be very disruptive to care and likely logistically impossible. So good news. That’s not the case.

 

Evan Dumas 

No.

 

Liath Dalton 

Established Medicare patients who started telehealth services under the waiver don’t need an in person visit within six months of the waiver ending.

 

Evan Dumas 

Yep.

 

Liath Dalton 

However, they will need an in person visit every 12 months, starting April 1 2025. So what that means, is that that in-person requirement needs to be done within the time period that starts April 1, so of 2025, by April 1, 2026. So there’s a whole window within which to do that in-person visit.

 

Liath Dalton 

Now for new Medicare patients, after the waiver expires, so starting April 1, new Medicare patients will need to have an in-person visit within six months, and there are no exceptions to this requirement for new patients.

 

Evan Dumas 

Yeah.

 

Evan Dumas 

Nope, no.

 

Liath Dalton 

Right? So the reality is, it is going to make it more challenging to, if you are a telehealth based practice, to take on new telehealth clients who are under Medicare.

 

Evan Dumas 

Yeah.

 

Liath Dalton 

Right? Since there is no exception for that. Thankfully, though, there are exceptions to the annual in-person visit requirement, right?

 

Evan Dumas 

Yeah.

 

Liath Dalton 

So some some clients may qualify for an exception to the 12 month in-person visit requirement if the risks and burdens outweigh the benefits. So some examples that they give of qualifying circumstances are, you want to go through the list, Evan?

 

Evan Dumas 

Oh. like if the in person visit would disrupt their care or worsen their condition, or if traveling would create undue hardship, say, like they lived out of state. Let’s see another one is if they’re in partial or full remission, in partial or full remission, and they only need maintenance care. And if you know, a risk of patient disengagement, if an in-person visit is required. Like, if they’re like, no longer want to see you, because you require the in-person visits.

 

Liath Dalton 

Exactly. So the undue hardship for for travel or risk of client disengagement, or if they aren’t in a high acuity state and are just needing maintenance care, Those are all exceptions that are highly likely to be applicable and reasonable to to make a case for and document for many Medicare telehealth clients for mental and behavioral health care, right?

 

Liath Dalton 

So the those are qualifying circumstances, and then the key requirement for utilizing this exception to the in-person visit requirement is that you must document the rationale in the client’s record, right?

 

Liath Dalton 

So some compliance and documentation best practices: It’s really essential to ensure proper documentation to support exceptions in case of a Medicare audit.

 

Evan Dumas 

Exactly.

 

Liath Dalton 

Right? And you really do want to, ideally, manage to, I’ll say this. You at least need to have some sort of option for being able to see Medicare clients annually in-person available, right? It, it is going to make your use of the exceptions all the more valid if you actually have the option to see them in-person, and you are seeing at least a portion of them in-person on an annual basis, right?

 

Liath Dalton 

So figuring out what that, what that looks like, and what that option is, particularly if, at present, you are kind of a dispersed practice and you don’t have a central facility.

 

Evan Dumas 

Yeah.

 

Liath Dalton 

Right. So figuring out a plan. And you have some time to do that, that’s part of why we’re talking about this now, is you want to lay that groundwork now.

 

Liath Dalton 

Note that the in-person visit can be with the treating provider or another provider of the same specialty or licensure type within the same practice. So for a group practice, let’s say you have a dispersed team and don’t have a central office. Maybe your solution is that you obtain one office, in as central a location as possible, for one team member, and that team member becomes the one who is managing the in-person visits, right? Or maybe even you don’t have to get your own office, but could sublease from another mental health professional for the purposes of doing these in-person visits.

 

Liath Dalton 

But make a plan. Think through how to manage that logistically, you know, budget wise, and what is, is going to be the most sort of streamlined, efficient and effective way to to provide for that.

 

Evan Dumas 

Yeah. You got some time.

 

Liath Dalton 

And then you need to look to reviewing the practice workflows, like your operational workflow for scheduling those annual in-person visits and communicate this new requirement with your clinical team and your administrative staff. Because it’s going to be important for everyone to be aware of this, and for admins or anyone who’s doing scheduling to know that if someone is a Medicare client, that if they are seeking to become a new client, that they will first have to have that in-person visit and then set up a system for tracking who are established Medicare telehealth clients and when the one year in person requirement would fall for them, and, which, at this point, it’s kind of easy, because there’s going to be the same date for for everyone, because the countdown for that starts on April 1 2025, ends on March 31, April, or March 31 2026. So, the initial round will be very easy to to track.

 

Liath Dalton 

And then I would recommend creating sort of a rubric that you can use and train your team on about the exceptions and how to document the rationale and make sure that your your team, is really equipped with how to make that determination in the first place and be able to justify it and then document that correctly.

 

Evan Dumas 

Yeah.

 

Liath Dalton 

So those are, are the, the main, main things. And it’s highly recommended to contact your local MAC, or Medicare Administrative Contractor, for some additional guidance.

 

Liath Dalton 

So just just a review of those action steps: Review your Medicare caseload and identify which clients will need in-person visits and when.

 

Liath Dalton 

Develop a system for tracking the annual in-person visits you know, maybe consider automated reminders or scheduling protocols for that.

 

Liath Dalton 

Educate your team. Make sure all of your team members, both clinicians and admins, understand the updated requirements.

 

Liath Dalton 

And then you’re going to need to communicate with clients and prepare some messaging to inform them about the upcoming changes.

 

Liath Dalton 

And I think with that, it’s going to be important to include that there are exceptions for those who it would cause undue hardship for. Because we don’t want the, like to send out a mass communication to all Medicare beneficiary clients, saying you’re going to have to come see me in- person, or your care is going to be stopped, right?

 

Evan Dumas 

Yeah, no.

 

Liath Dalton 

So, being being thoughtful about how that communication is crafted, and letting them know that there are exceptions and that that’s something that you’ll work with them on. So that it doesn’t feel disruptive, or like it’s a threat to their ability to continue to receive care.

 

Evan Dumas 

Yeah, you don’t want that.

 

Liath Dalton 

No.

 

Liath Dalton 

So, yes, this, this does mean that there are more things to do in order to provide telehealth to Medicare beneficiary clients, but they are manageable. Thankfully, there is the exception, and that’s something that I think, again, is going to be very applicable to a number of Medicare beneficiary clients that are receiving telehealth, and also to dispel some of the concern that we’ve seen floating around and gotten questions about Medicare is absolutely still covering telehealth.

 

Evan Dumas 

Oh, yeah.

 

Liath Dalton 

Want to, want to emphasize that that is that part is set in stone.

 

Evan Dumas 

Yeah.

 

Liath Dalton 

Oh, and if anything changes, if there is some Hail Mary, last minute action taken that miraculously extends the waiver or makes it permanent, we, we will, of course, let you know.

 

Evan Dumas 

Of course.

 

Liath Dalton 

But as of now, there, there is nothing to indicate that that will actually be the the case.

 

Evan Dumas 

No, there’s not.

 

Liath Dalton 

So just follow, follow those action items and make a plan. You’ve got time to be proactive, thankfully. But the kind of most immediate impact is going to be with scheduling any new Medicare beneficiary clients. Like that’s what’s going to be most significant in the short term, so just be aware of that piece.

 

Liath Dalton 

All right, folks, we hope that was helpful. Thanks for listening, and we’ll talk to you next week.

 

Evan Dumas 

Yeah, talk toyou next week, everybody.

 

Liath Dalton 

This has been Group Practice Tech. You can find us at personcenteredtech.com. For more podcast episodes, you can go to personcenteredtech.com/podcast, or click podcast on the menu bar.