Not sure it's made the rounds yet (and correct me if I'm wrong here), but reading through the federal registrar it seems CMS is punting a decision on supervision rules until next year. Basically they state the current rule ends Dec 31 2021 or the end of the calendar year in which the PHE ends. US Department of health has already renewed PHE until mid January 2022, so sounds like we stay the same until end of 2022.
Supervision CMS
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I read the source document very closely in the sections pertaining to supervision and came to the same independent conclusions. However I was unaware the PHE had already been renewed until early 2022, so would agree that as written, would extend present virtual real time audio visual rules until end of 2022.
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1) Considering I have several follow-ups scheduled as Telehealth appointments in 2022, I am also banking on this being correct.
2) I am only aware of the q3month renewals of the PHE available here. I thought I had read that this was indeed enacted through the end of next year, but now I can't find that statement through an official source, so if someone has it I'd be grateful to see it.
3) I love the option to have Telehealth, especially for follow-ups, and hope it is a permanent option forever.
2) I am only aware of the q3month renewals of the PHE available here. I thought I had read that this was indeed enacted through the end of next year, but now I can't find that statement through an official source, so if someone has it I'd be grateful to see it.
3) I love the option to have Telehealth, especially for follow-ups, and hope it is a permanent option forever.
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So on treats can be seen virtually until at least the end of 2022?
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Does this supervision remotely apply to free standing centers as well? ie can you treat without a doc there?
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Yes, I believe so.
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Must have real time a/v communication availability but otherwise yes
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This has been under consideration by CMS to be made permanent (and/or with tweaks/mods) since 9/13/21
a. Expiration of PHE Flexibilities for Direct Supervision Requirements
Under section 1861 of the Act and at § 410.32(b)(3) of the regulations, Medicare requires certain types of services to be furnished under specific levels of supervision of a physician or practitioner, including diagnostic tests, services incident to physician services, and other services. For professional services furnished incident to the services of a billing physician or practitioner (see § 410.26) and many diagnostic tests (see § 410.32), direct supervision is required. Additionally, for pulmonary rehabilitation services (see § 410.47) and for cardiac rehabilitation and intensive cardiac rehabilitation services (see § 410.49), requirements for immediate availability and accessibility of a physician are considered to be satisfied if the physician meets the requirements for direct supervision for physician office services at § 410.26 and for hospital outpatient services at § 410.27. Outside the circumstances of the PHE, direct supervision requires the immediate availability of the supervising physician or other practitioner, but the professional need not be present in the same room during the service, and we have interpreted this “immediate availability” requirement to mean in-person, physical, not virtual, availability.Through the March 31st COVID-19 IFC, we changed the definition of “direct supervision” during the PHE for COVID-19 (85 FR 19245 through 19246) as it pertains to supervision of diagnostic tests, physicians' services, and some hospital outpatient services, to allow the supervising professional to be immediately available through virtual presence using real-time audio/video technology, instead of requiring their physical presence. In the CY 2021 PFS final rule (85 FR 84538 through 84540), we finalized continuation of this policy through the later of the end of the calendar year in which the PHE for COVID-19 ends or December 31, 2021. In that rule, we also solicited comment on issues related to the policy allowing virtual provision of direct supervision, specifically whether there should be any additional guardrails or limitations put in place to ensure patient safety/clinical appropriateness, beyond typical clinical standards, and whether we should consider potential restrictions to prevent fraud or inappropriate use. We also stated that we will consider this and other information as we contemplate future policy regarding use of communication technology to satisfy supervision requirements, as well as the best approach for safeguarding patient safety while promoting use of technology to enhance access.
We also note that the temporary exception to allow immediate availability for direct supervision through virtual presence facilitates the provision of telehealth services by clinical staff of physicians and other practitioners incident to their own professional services. This is discussed in the March 31st COVID-19 IFC (85 FR 19246). This is especially relevant for services such as physical therapy, occupational therapy, and speech language pathology services, since those practitioners can only bill Medicare directly for telehealth services under telehealth waivers that are effective only during the PHE for COVID-19. We note that sections 1834(m)(4)(D) and (E) of the Act specifies the types of clinicians who may furnish and bill for Medicare telehealth services, and include only physicians as defined in section 1861(r) of the Act and practitioners described in section 1842(b)(18)(C) of the Act.
We continue to seek information on whether this flexibility should be continued beyond the later of the end of the PHE for COVID-19 or CY 2021. Specifically, we are seeking comment on the extent to which the flexibility to meet the immediate availability requirement for direct supervision through the use of real-time, audio/video technology is being used during the PHE, and whether physicians and practitioners anticipate relying on this flexibility after the end of the PHE. We are seeking comment on whether this flexibility should potentially be made permanent, meaning that we would revise the definition of “direct supervision” at § 410.32(b)(3)(ii) to include immediate availability through the virtual presence of the supervising physician or practitioner using real-time, interactive audio/video communications technology without limitation after the PHE for COVID-19, or if we should continue the policy in place for a short additional time to facilitate a gradual sunset of the policy. We are soliciting comment on whether the current timeframe for continuing this flexibility at § 410.32(b)(3)(ii), which is currently the later of the end of the year in which the PHE for COVID-19 ends or December 31, 2021, remains appropriate, or if this timeframe should be extended through some later date to facilitate the gathering of additional information in recognition that, due to the on-going nature of the PHE for COVID-19, practitioners may not yet have had time to assess the implications of a permanent change in this policy. We also seek comment regarding the possibility of permanently allowing immediate availability for direct supervision through virtual presence using real-time audio/video technology for only a subset of services, as we recognize that it may be inappropriate to allow direct supervision without physical presence for some services, due to potential concerns over patient safety if the practitioner is not immediately available in-person. We are also seeking comment on, were this policy to be made permanent, if a service level modifier should be required to identify when the requirements for direct supervision were met using two-way, audio/video communications technology.
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Does that include facetime/iphone?
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iPhone, Facebook Portal, Microsoft Teams, broadcast TV satellite truck linkup, Zoom, GoToMeeting, Skype, Xbox Kinect, Nest Hub, Grandpad, Amazon Glow, Logitech Meetup, Meeting Owl, Lenovo Thinksmart, Cisco DX, POTS & a baby video monitor, etc
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Doximity Dialer is a good one.
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Yes but wouldn't risk it while scheduled off on vacation.
Doximity probably certified as HIPAA compliant I'm guessing or skype for business
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Key Telehealth Provisions in the Calendar Year 2022 Physician Fee Schedule Final Rule | JD Supra
On November 2, 2021, the Centers for Medicare & Medicaid Services (CMS) released the Calendar Year (CY) 2022 Medicare Physician Fee Schedule (PFS)...
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It's a generic ruling... Anything that's covered this year will continue to be allowed through 2023
CMS finalizes plans to hike price transparency penalties, extend telehealth flexibilities
The agency is also moving forward with a plan to stop the elimination of the Medicare inpatient-only list, which is a win for hospitals.
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Does this apply to simulation too? Can we supervise sim or “v sim” with a/v?
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Yes
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