Updated on: March 31, 2020

NEWS ALERT: CMS Allows Remote Delivery

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Original story posted on: March 26, 2020

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Federal authorities have decided that telephonic communications is an acceptable alternative to in-person meetings.

EDITOR’S NOTE: With looming shortages of personal protective equipment (PPE) and an unknown asymptomatic period associated with COVID-19 infection, hospitals around the country have been doing everything possible to preserve stocks of PPE and minimize contact with patients, taking precautionary measures including the use of telehealth by doctors to communicate with patients. RACmonitor asked Dr. Ronald Hirsch, vice president of R1 RCM, to summarize the recent guidance from the Centers for Medicare & Medicaid Services (CMS).

One area of contention in the healthcare industry of late has been the delivery of federally mandated notices to patients, including the Important Message from Medicare (IMM) and the Medicare Outpatient Observation Notice (MOON), according to Dr. Ronald Hirsch.

“These notices are generally delivered in person, with a verbal explanation and a signature obtained to document delivery,” Hirsch said, noting that with COVID-19, “it made little sense to deliver such notices in person. Many hospitals had already chosen to deliver the notice explanations verbally by telephone, and then have a caregiver deliver a copy of the form the next time the room was entered.”

Hirsch said that others felt that this was a violation of patient rights, and insisted their staff members enter the room – even though at least one social worker was reported to have developed COVID-19 after meeting with a patient who was in the asymptomatic phase.

“To quote one case manager director from a user group, ‘as part of the patient care team, I (and my CNO) believe an in-person assessment by social workers or case managers can reveal much more than a phone call,” Hirsch said, referring to a post on the user group listserv. “Facial expressions, body language, physical condition (unkempt, frailty, etc.) can show if someone is having grief issues, loneliness, self-care deficits, whether they are really comprehending what you are talking to them about, etc. Also, how much do older people especially trust someone over the phone? How do you have an end-of-life/hospice/DNR (do not resuscitate) talk with a patient over the phone? It just doesn't seem right to me.’”

Fortunately, CMS has now released guidance in an MLN Connects special edition on March 26, stating:

If you are treating a patient with suspected or confirmed COVID-19, CMS encourages the provider community to be diligent and safe while issuing the following beneficiary notices to beneficiaries receiving institutional care…

In light of concerns related to COVID-19, current notice delivery instructions provide flexibilities for delivering notices to beneficiaries in isolation. These procedures include:

Hard copies of notices may be dropped off with a beneficiary by any hospital worker able to enter a room safely. A contact phone number should be provided for a beneficiary to ask questions about the notice, if the individual delivering the notice is unable to do so. If a hard copy of the notice cannot be dropped off, notices to beneficiaries may also delivered via email, if a beneficiary has access in the isolation room. The notices should be annotated with the circumstances of the delivery, including the person delivering the notice, and when and to where the email was sent.

Notice delivery may be made via telephone or secure email to beneficiary representatives who are offsite. The notices should be annotated with the circumstances of the delivery, including the person delivering the notice via telephone, and the time of the call, or when and to where the email was sent.

“It should be noted that these notices must still be delivered; even a national emergency does not allow hospitals to violate patient rights unilaterally,” warned Hirsch. “But the mode of delivery was what was in question here. As this pandemic was unfolding, David Glaser, a RACmonitor editorial board member, stated (that) ‘extraordinary times requires extraordinary measures.’”

Hirsch said it was clear to him that the hospitals that preserved PPE while also protecting beneficiary rights by delivering the notices by phone were doing the right thing, even without the specific CMS authorization.

“I hope all others will follow, now that CMS has spoken,” said Hirsch.

Chuck Buck

Chuck Buck is the publisher of RACmonitor and is the program host and executive producer of Monitor Monday.

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