Copay For Telehealth Visits

HIPAA flexibility • Waivers from the Centers for Medicare & Medicaid Services • Cost-sharing for patients in federal health care programs • Billing and reimbursement • Additional flexibilities

Telehealth gives you access to health care providers from the comfort of your home. If you think you might have been exposed to COVID-19 or have symptoms such as fever, cough or difficulty breathing, be sure to call your doctor right away.
Also, you can get these visits at rural health clinics and federally qualified health clinics. Medicare pays for many medical visits through this telehealth benefit. Fraud alert: Watch out for providers you don’t know or haven’t met before contacting you to set up a telehealth appointment.

Additionally, where applicable, copays and cost share will be waived for telehealth visits, as well as telephone visits, members may need from their traditional healthcare providers. AvMed is extending COVID-19 benefits and coverage until July 31, 2020.

During the COVID-19 Public Health Emergency, HHS has taken steps to make it easier to provide telehealth services. Telehealth — sometimes referred to as telemedicine — describes the use of 2-way communication technology for certain health care services.

We encourage health care providers to adopt and use telehealth as a way to safely provide care to your patients in appropriate situations, including: routine health care, like wellness visits; medication consultation; dermatology (skin care); eye exams; nutrition counseling; mental health counseling.

Visit telehealth.hhs.gov for helpful information about telehealth for patients and health care providers.

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HIPAA flexibility during COVID-19

The HHS Office for Civil Rights (OCR) has issued guidance to empower health care providers to serve patients through telehealth during the national public health emergency.

HIPAA-covered health care providers may, in good faith, provide telehealth services to patients using remote communication technologies, such as commonly used apps – including FaceTime, Facebook Messenger, Google Hangouts, Zoom, or Skype – for telehealth services, even if the application does not fully comply with HIPAA rules.

However, providers should not use any platforms that are public-facing — for instance, Facebook Live, Twitch, and TikTok — to provide telehealth.

For more information on HIPAA flexibility for telehealth services during COVID-19, read:

Co Pay On Telehealth

Notification of Enforcement Discretion: Telehealth and HIPAA during COVID-19 Emergency | Notificación de discreción para telemedicina
FAQs: Telehealth and HIPAA during COVID-19 | Preguntas frecuentes sobre telemedicina y HIPAA

Telehealth waivers from the Centers for Medicare & Medicaid Services (CMS)

Temporary policy changes during the Coronavirus pandemic

CMS has issued temporary measures to make it easier for people enrolled in Medicare, Medicaid, and the Children's Health Insurance Program (CHIP) to receive medical care through telehealth services during the COVID-19 Public Health Emergency.

Some of these changes allow providers to:

Conduct telehealth with patients located in their homes and outside of designated rural areas
Practice remote care, even across state lines, through telehealth
Deliver care to both established and new patients through telehealth
Bill for telehealth services (both video and audio-only) as if they were provided in person

Temporary expansion of telehealth services during COVID-19

During the public health emergency, Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) may serve as distant telehealth sites and provide telehealth services to patients in their homes.

Fact Sheet:Flexibilities for Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) during COVID-19

CMS significantly expanded the list of covered telehealth services that can be provided in Medicare through telehealth to include:

Emergency department visits
Initial nursing facility and discharge visits
Home visits
Therapy services

For more information about changes to CMS policies during COVID-19, read:

Fact Sheet: Medicare and Telemedicine for Health Care Providers during COVID-19
FAQs: Medicare and Telehealth during COVID-19
Video:Common Questions about Medicare Telehealth Services during COVID-19
Toolkit: State Medicaid & CHIP Telehealth Toolkit
FAQs: State Medicaid and CHIP Flexibilities for COVID-19
Fact Sheet: COVID-19 Emergency Declaration Blanket Waivers for Health Care Providers

Cost-sharing for patients in federal health care programs

The HHS Office of Inspector General (OIG) is providing flexibility for health care providers to reduce or waive cost-sharing for telehealth visits and other virtual care paid for by Federal health care programs, such as Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP), during the public health emergency.

For more information on OIG’s flexibilities related to cost-sharing for telehealth visits and other virtual care during COVID-19, read:

Policy Statement: Cost-Sharing Obligations and Telehealth for Practitioners during COVID-19
Fact Sheet: Cost-Sharing Flexibilities for Telehealth during COVID-19
FAQ: Cost-Sharing Flexibilities for Telehealth during COVID-19

Billing and reimbursement for telehealth services

Private insurance

Check to see if the insurance plans you accept cover reimbursement for any telehealth services. Most health insurance plans cover at least some telehealth services.

FAQs: Telehealth and Private Health Insurance during COVID-19

Medicaid and Medicare

Medicaid covers some telehealth services, but coverage differs from state to state.

Medicare provides coverage for telehealth under certain conditions, some of which are temporarily different during the COVID-19 pandemic.

Fact Sheet: Medicare and Telemedicine for Health Care Providers during COVID-19

Additional flexibilities for telehealth during COVID-19

Federal and state governments are taking actions to remove barriers to telehealth services during COVID-19. Check with your state public health officials to see what flexibilities apply to where you live or practice.

For more HHS guidance on telehealth during COVID-19, read:

FAQs: Telehealth and Rural Health during COVID-19 (HRSA)
Letter: Caseworker Visits via Videoconferencing during COVID-19 (ACF)
Bulletin: Rural Health Care, Medicaid Telehealth Flexibilities, and Guidance for SUPPORT for Patients and Communities Act via Telehealth (CMS)
Guidance: Veterinary Telemedicine during COVID-19 (FDA)

On March 24, 2020, the US Department of Health and Humans Services Office of Inspector General (OIG) issued guidance regarding OIG’s March 17, 2020, policy statement on reductions or waivers of cost-sharing obligations owed by federal healthcare program beneficiaries for telehealth services. While the original policy statement set conditions which, if met by physicians or practitioners, would allow them to avoid administrative sanctions for granting such reductions or waivers, the March 24 guidance clarifies OIG’s position on the scope of telehealth services covered.

On March 24, 2020, the US Department of Health and Human Services Office of Inspector General (OIG) issued guidance (Guidance) regarding the policy statement permitting routine waiver of copays for telehealth services (Policy Statement) issued on March 17, 2020. The Guidance clarifies the scope of “telehealth services” that may be the subject of the copayment waivers and clarifies the type of providers to which the Policy Statement applies.

Through the Policy Statement, OIG notified physicians and other practitioners that they will not be subject to administrative sanctions for reducing or waiving any cost-sharing obligations that federal healthcare program beneficiaries may owe for telehealth services for arrangements that satisfy both of the following conditions:

A physician or other practitioner reduces or waives cost-sharing obligations (i.e., coinsurance and deductibles) that a beneficiary may owe for telehealth services furnished consistent with the then-applicable coverage and payment rules.
The telehealth services are furnished during the time period subject to the COVID-19 national emergency declaration.

OIG will not view the provision of free telehealth services alone as an inducement or as likely to influence future referrals (i.e., OIG will not view the furnishing of subsequent services occurring as a result of the free telehealth services, without more, as evidence of an inducement) for any free telehealth services furnished during the pendency of the emergency declaration. The Policy Statement, however, did not define the scope of the “telehealth services” subject to the waiver.

The Guidance clarifies OIG’s position on the scope of “telehealth services,” stating that such services are not limited to the narrow set of services referred to by the Centers for Medicare and Medicaid Services (CMS) as “telehealth visits” under the Medicare Part B program. Rather, OIG reported that it intends for the Policy Statement to apply more broadly to “non-face-to-face services furnished through various modalities, including telehealth visits, virtual check-in services, e-visits, monthly remote care management, and monthly remote patient monitoring.”

In addition, OIG clarified that the availability of the waivers is not limited to physicians and other practitioners who bill for their services; the availability of waivers also extends to hospitals or other eligible individuals or entities that bill on behalf of the physician or practitioner pursuant to a reassignment of his or her right to receive payments to such individual or entity.