5 Most Common Non-Face-to-Face Gray Area Situations for Medicare Programs

The profitable programs from the Centers for Medicare and Medicaid Services (CMS) are extremely beneficial but can be confusing at first glance.

Many of the Medicare programs allow for or require the provision of non-face-to-face services, which is often a gray area that isn’t clearly defined.

For example, Chronic Care Management includes care coordination activities that are not typically part of a face-to-face encounter with the patient. These activities can include but are not limited to such items as phone calls, review of medical records, education and support, and coordination and exchange of health information with other practitioners and health care professionals.

We have worked with hundreds of healthcare providers across the country and have consistently been met with questions and concerns about non-face-to-face time.

Our sales representatives and support staff have happily helped many practices navigate the rules and regulations of Medicare programs, allowing them to keep the focus on their patients.

This advice has assembled from a collection of best practices by top providers we have worked with over the years.

Some of the most common questions we receive include “What constitutes non-face-to-face time?” and “Who is allowed to provide this time toward patient care?”

In this article, we will provide our advice on these questions and cover the top 5 most common gray areas that providers run into when logging non-face-to-face time.

What Constitutes Non-Face-to-Face Time?

Medicare does not have a set task list in any of its regulations for their programs. In a case that's left up to your own interpretation, we ask that you use your best judgment.

Our advice is to never do anything that you feel uncomfortable with. If you believe that you can justify counting a certain task as non-face-to-face time towards the patient’s care, then you should bill for it.

Who Can Provide Non-Face-to-Face Time?

Throughout a patient’s care, they will have interactions with a variety of both clinical and non-clinical staff.

Per CMS guidelines, only time spent by certified resources (e.g., Certified Medical Assistant, Certified Nursing Assistant, or higher) or higher should count towards non-face-to-face billable time. So if a non-clinical resource completed a task, we suggest that you do not count that time

The one exception to this is if the program’s CMS requirements allow for non-clinical staff to administer care in some capacity.

5 Gray Areas Regarding Non-Face-to-Face Time

To help out a little more, we’ll dive into the 5 most common gray areas when it comes to logging non-face-to-face time for Medicare programs.

1) Voicemails / No Answer

One of the most common tasks for several Medicare programs is to talk to the patient over the phone. In fact, the majority of a care manager’s day is usually spent on the phone talking with patients. Naturally, it can be difficult at times to reach the patient.

If you leave a voicemail for the patient, should you include the time spent leaving that voicemail as time towards the patient’s care that month? Well, it depends.

We suggest counting time when leaving a voicemail ONLY IF you are conveying important information regarding a patient's health (i.e. lab results, medication info).

We do not suggest counting the time spent waiting for the patient to answer or leaving a voicemail with non-clinical information.

2) Emails / Texting

As Medicare patients become more tech-savvy, we're seeing more communication between the care team and the patient through email and text.

While this may seem like a mundane task, it can still count towards billable time for the patient.

We suggest counting the time that it took to compose the communication as well as any follow-up emails or texts after the initial communication.

3) Post-Call Notes / Action Items

After your patient calls are finished, you may need to update and document various patient data in your care management software and/or your EHR.

This can include information you may have missed or didn’t have time for during your call. This time documenting post-call notes and data should count towards your monthly billable time for the patient.

4) Program Enrollment

Enrolling patients is an important step in managing a sustainable and profitable Medicare program. Unfortunately, all Medicare program time must be counted after the patient agrees to consent to the program.

You are not able to log non-face-to-face time towards a program before or during the patient's enrollment, even if the enrollment took place out of the office.

Once the patient does enroll, any time spent managing the patient’s care can be counted as billable non-face-to-face time.

5) Face-to-Face Time

Traditionally, most Medicare programs only count time spent with your patients in a non-face-to-face manner. If time is occasionally provided face-to-face for convenience or other reasons, the time may be counted towards the program and billed accordingly.

Take CCM for example. Medicare’s explanation states that "If the practitioner believes a given beneficiary would benefit or engage more in person, or for similar reasons recommends a given beneficiary receive certain CCM services in person, they may still count the activity as billable time. In all cases, the time and effort cannot count towards any other code if it is counted towards CCM."

Again, use your best judgment when it comes to logging face-to-face time just as you would non-face-to-face time. Also, in this instance, you would want to be sure that you aren't billing simultaneously with CCM and another billable CPT code.

Protecting Yourself In The Event of An Audit

As you’ve seen, CMS has purposely left much open to interpretation when it comes to billable time for their Medicare programs. Our general advice to providers is to always use your best judgment - if you can justify billing the time you spend managing the patient’s care, then you should satisfy CMS requirements.

The advice in this article should give you peace of mind in managing your programs effectively, but there’s still more you can do on that front.

This is where care management software comes into play. During an audit from CMS, they typically look for a few key pieces of information:

• Patient eligibility, consent, and enrollment
• Time logging and proper billing codes
• Documentation of the care provided

Intuitive care management software will make capturing all of that required information easy and efficient. ThoroughCare is one such software that has several features that specifically aid the audit process:

• Automates the proper billing codes according to the amount of time you log with each patient to ensure proper billing
• Provides consent forms and patient agreement templates, and supports VERBAL consent with Date/Timestamps
• Guided-interview that automates the Patient-Centered Care Plan for you
• Simplified workflow to allow for monthly updates to the care plan
• Easily generated and shareable reports and summaries

If shopping for quality care management software intimidates you, you’re not alone. That is why we’ve created a FREE buyer's guide that is designed to ease the buying process for you, equipping you with the knowledge needed to select the best care management software for your practice.

If you’d like to learn more about ThoroughCare software and how it can greatly benefit your practice, request a software demo with us today and book a live demo!