MEDICARE AND COMMERCIAL CARRIERS EXPAND THE AVAILABILITY AND REIMBURSEMENT FOR TELEHEALTH DURING THE CORONAVIRUS CRISIS

Using its authority under the Coronavirus Preparedness and Response Supplemental Appropriations Act, on March 17, 2020, the Centers for Medicare and Medicaid Services announced it was expanding Medicare telehealth coverage to temporarily pay clinicians to provide these services without any limitations on where beneficiaries can receive them.

The changes are intended to keep patients at risk of contracting the coronavirus away from hospitals and other facilities. In announcing the telehealth service waivers, CMS Administrator Seema Verma stated: “These changes allow seniors to communicate with their doctors without having to travel to a healthcare facility so they can limit the risk of exposure and the spread of the virus.” The changes are effective for services starting March 6, 2020 and will be in effect for the duration of the coronavirus Public Health Emergency.

Medicare had previously paid for telehealth services but only when the patient was located in a designated rural area and when the patient went to a medical facility to receive the services. Under the waiver, Medicare will pay for telehealth services furnished anywhere in the country, including in a patient’s home. Physicians and other qualified practitioners will be paid the same amount for telehealth services as they would be if the services were furnished in-person. For services that are reimbursed at different rates based on site of service, Medicare will reimburse telehealth services at the facility payment rate.

Medicare generally covers three types of telehealth services: (1) Medicare telehealth visits; (2) virtual check-ins; and (3) e-visits.

Medicare telehealth visits are visits where a provider uses an interactive audio telecommunications system that allows real-time communication between the provider’s location and the patient. Although the waiver requires that the patient have an established relationship with the patient, the Department of Health and Human Services Office of the Inspector General has announced that it will not conduct audits to ensure the existence of an established relationship. To that extent, CMS’s Medicare Telemedicine Health Care Provider Fact Sheet indicates that Medicare telehealth visits may be used by new patients.

A virtual check-in allows Medicare patients to have brief communications with their providers using a variety of modalities, including smartphones and secure text messaging and emails, to have a discussion or to exchange information through video or image. Virtual check-ins are intended to be initiated by patients, but providers may educate patients about the capability. In order to be reimbursed, patients must have an established relationship with the provider and the service must not originate from a related evaluation and management service within the previous seven days or lead to an E&M service or procedure within the next 24 hours or the soonest available appointment. Patients must verbally consent to receive virtual check-in services.

  

An e-visit is a non-face-to-face patient-initiated communication with a patient’s physician or other qualified practitioner using an online patient portal. Communications can take place over a seven-day period. Patients must have an established relationship with the provider.

Several commercial carriers have also announced expansion of reimbursement for telehealth services during the Public Health Emergency. However, physicians and other providers have complained that the dramatic increase in demand for telehealth services has overwhelmed some telehealth service providers’ networks and created bottlenecks.

CMS’s Medicare Telemedicine Health Care Provider Fact Sheet is linked here and its Frequently Asked Questions is linked here.