The Centers for Medicare and Medicaid Services (CMS) earlier in the current public health emergency (PHE) issued New & Expanded Flexibilities for RHCs & FQHCs during the COVID-19 PHE, establishing the billing rules/amounts for FQHC/RHC distant site telehealth during the PHE. On Dec. 3, CMS revised the document to clarify the Medicare cost-sharing rules. Effective Jan. 27, 2020, for telehealth services with cost-sharing, the coinsurance will be 20 percent of the lesser of the allowed amount ($92.03) or the actual charges, and payment will be 80 percent of the lesser of the allowed amount or charges. Before the change, coinsurance was 20 percent of charges and Medicare’s payment was $92.03 minus the coinsurance. MACs will be automatically reprocessing claims for telehealth services furnished on or after Jan. 27, 2020, based on this new “lesser of” methodology.
