COVID-19 Recent Changes to Telehealth Regulations and Reimbursement

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Recent changes from the Administration have helped physicians see more patients through telehealth services. This has been welcome news for many physicians and their patients. In this story, we outline some of the most recent changes, but also the many challenges that remain related to telehealth administration.

Recent Changes

We have previously covered the telehealth changes and you can read more here. However, we also wanted to point out Attorney Susannah Vance Gopalan’s article on new CMS rules. More specifically, on April 9, CMS issued a COVID-19 Frequently Asked Questions document on Medicare Fee-for-Service billing. The document addresses many issues, including recent regulatory changes the agency made through its interim final rule with comment period. The interim final rule revised Medicare and Medicaid policy during the COVID-19 public health emergency.  Hospitals that own medical practices are adversely effected by the rules in that they are unable to recover their “facilities” fees under the current rule.

Not All Physicians Are Happy

MedPage Today published an interesting article looking at some of the challenges still facing physicians and their patients. In the April 16 article, Ryan Basen, their Enterprise & Investigative Writer looked at the issue from a number of angles. He writes: “Telehealth reimbursement during the COVID-19 pandemic has increased rapidly compared with its previously slow uptake, but providers say they’re not being paid to the extent they are being promised — or anywhere close to the amounts they made with in-person visits. That’s partially due to a lack of clear information and inconsistent policies across the country’s patchwork of insurance plans.”

More specifically, Basen’s article describes a physician’s office manager who called insurance companies about billing related to telehealth services. According to the article, half the companies could not give information because they did not have readily accessible policies. Some insurance companies also said they would reimburse for the visits, but ultimately did not pay the full amount.

Basen additionally notes: “Doctors also paradoxically find themselves spending more time per visit with telemedicine. It takes Maltese’s patients on average 10 minutes to get their software operational, and several times he has spent a half-hour serving as his clients’ IT consultant before starting an appointment.”

He also explains that Medicare is waiving copays during the pandemic, which means physicians are then making only 80% of what they would in a face-to-face visit.

Furthermore, “CMS also directed providers to designate a place of service when billing, initially asking them to enter a specific code. Providers say CMS then failed to reimburse to 100% when some of those bills were submitted; it was closer to 70%, Maltese said.”

According to a consultant, telehealth services that spent time and resources creating HIPAA compliant platforms when CMS dropped the HIPAA requirements for telehealth, are loosing users two to one to such free services at least one service is discontinuing and filing chapter 11.

In a related story, the AMA also issued a press release calling upon Congress and the Administration to take more steps to address COVID-19. Regarding telehealth, the AMA is thankful, but asks the government to still do more: “Both Congress and the Administration have expanded Medicare coverage substantially for telehealth services to improve access to care for patients with ongoing health care needs as well as for COVID-19. This includes coverage for telephone services, which is particularly important for patients with limited technological resources in their homes. In response, many private plans are mirroring the federal government’s policies. We urge Congress to also require ERISA group health plans to provide coverage for the same telehealth and telephone services being provided by Medicare for the duration of the COVID-19 pandemic, to ensure all insured patient have access to these services during this critical time.”

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