Reassigning Claims? Make sure to complete the CMS 855-R Form

July 2, 2020

The best way to mitigate risk is to call a MAC, read the laws, and the telehealth waivers over COVID-19.

The designation of the COVID-19 pandemic as a national emergency led to both changes in and an increase in the use of telehealth services. Telehealth encompasses a broader away of remote healthcare services than telemedicine because it includes both clinical and non-clinical services. For purposes of this article, we’ll focus on telehealth during the COVID-19 pandemic, with the caveat that providers need to stay abreast of the following:

  1. the end date of the pandemic;
  2. permanent changes to existing state and federal laws after the end of the pandemic; and
  3. reimbursement codes and settings for providing telehealth services.

In 2018, the Department of Health and Human Services Office of the Inspector General (“OIG”) published a report, CMS Paid Practitioners for Telehealth Services that Did Not Meet Medicare Standards. This related to the telehealth before the COVID-19 waivers. Notably, there were no concerns with physicians reassigning billing rights to hospitals. But the OIG did find that “[f]or seven claims, institutional providers billed outpatient claims for telehealth services performed at distant sites for beneficiaries located at rural originating sites, but the distant sites were not CAHs, and the services provided were not MNT services.” Therefore, underscoring that billing under Medicare Part A or Medicare Part B is material. This should not change under the COVID-19 pandemic.

Periodically, the Centers for Medicare and Medicaid (“CMS”) releases updates related to different waivers and telehealth coverage. A good example is the alert that was posted on May 11, 2020, which included a video update the types of services and correct billing for telehealth services.

A related issue which physician practices and hospitals should be aware of is the reassignment of Medicare benefits through utilizing a CMS-855R Form. First and foremost, providers should refresh themselves that telemedicine services are meant to prohibit kickbacks for referrals. Medicare Audit Contractors (“MACs”) have confirmed that a hospital can submit claims for a physician’s distant site telehealth services when the physician has reassigned his or her benefits to the hospital. The restrictions found in the regulation and Medicare Manual, simply state that the hospital cannot be the distant site provider. 66 Fed. Reg. 55332, 55282 (Nov. 1, 2001). In order to obtain reassurances that the hospital and the physician’s office are acting in accordance with the relevant laws and regulations providers should contact their MAC.

Overall, providers on both sides of the agreement should ensure that all actions associated with telehealth are above-board. The best way to mitigate risk is to call a MAC, read the laws, and the telehealth waivers over COVID-19.

About the Author

Rachel V. Rose, JD, MBA, advises clients on compliance and transactions in healthcare, cybersecurity, corporate and securities law, while representing plaintiffs in False Claims Act and Dodd-Frank whistleblower cases. She also teaches bioethics at Baylor College of Medicine in Houston. Rachel can be reached through her website, www.rvrose.com.