Medicare Coverage of Telehealth & Telemedicine Services

 Erika Regulsky Billing & Collections, Most Recent

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The COVID-19 pandemic has had devastating effects in our country. Some studies state that the loss of life during the pandemic has crossed the death toll reported during the Vietnam war, and sadly it continues to climb. In an effort to control the spread of the virus, the government had issued nationwide lockdown and people were urged to adhere to self quarantine protocols and social distancing. Though these methods helped in curtailing the spread of the virus, it impacted the economy in a dreadful manner. The lockdowns forced businesses to go under and the market took a sizable hit that can only parallel The Great Depression.

Healthcare like other industries has faced a significant dip in revenue. A lot of hospitals had to lay off employees and other medical practices were forced to close their doors as they could not manage without the cash flow. Apart from the considerable revenue loss during the pandemic, the providers also face the daily risk of exposure to the coronavirus by coming to work. The genial solution to aid the hospitals, providers, medical practices and especially the patients in need is by implementing Telemedicine & Telehealth services.

Telemedicine & Telehealth systems are not new to the industry, the technology’s inception can be traced back to a Lancet report in 1879, which discussed how using a telephone can reduce the number of office visits. The tech has slowly but surely evolved from then and currently, during the pandemic, it has become absolutely indispensable. The biggest advantage when it comes to telemedicine and telehealth services is that during the COVID-19 pandemic, it is the safest way to ensure that people have continuous and easy access to healthcare. 

The importance of telemedicine during COVID-19 pandemic was perhaps best expressed by Gary Price, M.D., President of the Physicians Foundation who said, “With our healthcare system confronting COVID-19’s unprecedented toll on the world, medical expertise is critical to flattening the curve and saving lives. Telehealth allows us to reach more patients while protecting our health care workforce.” He further added, “In this time of uncertainty, The Physicians Foundation and our partners are committed to bringing together medical organizations across the country to put practical resources and tools in the hands of all physicians, so they are able to remain on the frontlines of protecting healthy people and treating those infected with COVID-19.”

  • Increasing telehealth access to medicare beneficiaries, so they can receive treatment from the safety of their homes.
  • Expand the healthcare workforce by removing barriers for physicians, nurses, and other clinicians to be readily hired from the local community or other states
  • Ensure that local hospitals and health systems have the capacity to handle COVID-19 patients through temporary expansion sites (also known as the CMS Hospital Without Walls initiative)
  • Significant expansion at-home and community based testing for Medicare & Medicaid beneficiaries to ensure minimal transmission
  • Prioritizing patients over paperwork by giving providers, healthcare facilities, Medicare Advantage and Part D plans, and states temporary relief from many reporting and audit requirements so they can focus on patient care.

All of these action plans by the CMS are targeted to equip providers & health systems such that they can manage the stresses of the COVID-19 pandemic. 

Among all of the action plans, for now we are going to focus on the plan that increases access to telemedicine & telehealth services.

Increasing Telehealth Access To Medicare Beneficiaries

Telemedicine has been the single most safest way of ensuring that people have continuous access to healthcare during this pandemic. Rightfully recognising the benefits of virtual services, CMS has made an unprecedented decision to expand coverage for telehealth services and here’s a look at how:

For as long as the COVID-19 pandemic ensues, CMS is waiving limitations on the types of clinical practitioners that can furnish Medicare telehealth services. Prior to this change, only doctors, nurse practitioners, physician assistants, and certain others could deliver telehealth services. Now, other practitioners are able to provide telehealth services, including physical therapists, occupational therapists, and speech language pathologists.

For Medicare patients registered as outpatients, their home can now be considered as a temporary provider based department of the hospital and for any services furnished under these conditions the hospitals can bill as they are eligible for reimbursement. Examples of such services include counseling and educational service as well as therapy services. This change expands the types of healthcare providers that can provide using telehealth technology.

Hospitals may bill as the originating site for telehealth services furnished by hospital-based practitioners to Medicare patients registered as hospital outpatients, including when the patient is located at home.

Previously, Medicare would pay for certain services conducted by audio-only telephone between beneficiaries and their doctors and other clinicians. Now, CMS is broadening that list to include many behavioral health and patient education services. CMS is also increasing payments for these telephone visits to match payments for similar office and outpatient visits. This would increase payments for these services from a range of about $14-$41 to about $46-$110. The payments are retroactive to March 1, 2020.

When it comes to telemedicine, prior to these action plans being enacted, CMS only added new services to the list of Medicare services that may be furnished via telehealth using its rulemaking process. Now, in order to equip providers and healthcare professionals better handle the pandemic, they are expanding coverage of services on a sub regular basis by giving serious consideration to the requests of providers and healthcare professionals. This will considerably speed-up the process.

As mandated by the CARES Act, CMS is paying for Medicare telehealth services provided by rural health clinics and federally qualified health clinics. Previously, these clinics could not be paid to provide telehealth expertise as “distant sites.” Now, Medicare beneficiaries located in rural and other medically underserved areas will have more options to access care from their home without having to travel.

A lot of Medicare beneficiaries faced the problem of not having the right equipment to video conference their providers and can only afford to use the medium of phone calls, and for those visits the providers were not eligible for reimbursement. So taking into considerations the beneficiaries face and to ensure that they have access to healthcare, CMS is now waiving the video requirement for certain telephone evaluation and management services, and adding them to the list of Medicare telehealth services. As a result, Medicare beneficiaries will be able to use an audio-only telephone to get these services.

Prior to the 1135 waiver Medicare could only pay for telehealth on a limited basis:

  • when the person receiving the service is in a designated rural area
  • when a person leaves their home and goes to a clinic, hospital, or certain other types of medical facilities for the service.

But the expansion of this waiver authorizes Medicare to to pay for office, hospital, and other visits furnished via telehealth across the country and including in patient’s places of residence starting March 6, 2020.  A range of providers, such as doctors, nurse practitioners, clinical psychologists, and licensed clinical social workers, will be able to offer telehealth to their patients.  Additionally, the HHS Office of Inspector General (OIG) is providing flexibility for healthcare providers to reduce or waive cost-sharing for telehealth visits paid by federal healthcare programs.

Telemedicine and telehealth services are crucial tools that help in managing the pandemic. No one could have summed the importance of telemedicine services during COVID-19 better than Patrice Harris, M.D., M.A., President of the American Medical Association (AMA), “The use of telemedicine and remote care services are critical to the safe management of the COVID-19 pandemic, while also ensuring uninterrupted care for 100 million Americans with chronic conditions”. She further added, “ The AMA strongly encourages the adoption of telemedicine as a responsible way for physicians to meet anticipated demands for care and treatment.” She further illustrated the importance of CMS’s decision to back telemedicine by saying, “ The AMA also successfully advocated for revised federal policies that provide physicians with the maximum flexibility they need to provide remote care services. We applaud the Centers for MEdicare and Medicaid Services (CMS) for taking these important steps.” She further reinforced AMA’s support for telemedicine services by saying, ”The AMA stands ready to help physicians with resources that provide physicians with a proven path for integrating telemedicine and digital health technologies into patient care.”

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I’m a multi-certified revenue cycle management professional and compliance officer with 20+ years of experience. I contribute articles to leading healthcare publications and journals. I am currently working as Senior Transition Manager, in BillingParadise headquartered at Diamond bar, California. BillingParadise offers Medical Billing Services that intersect perfectly with the EMR/Practice management system you use.BillingParadise has offices in New Jersey, New York, Florida, Georgia, Minnesota, and Texas.

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