The utilization of telehealth services during the COVID-19 pandemic is shedding light on an untapped resource within the healthcare service community. By combining advanced communication technologies, clinical health, and a delivery system across distance, telehealth ensures the distribution of healthcare in a safe environment by assisting and hastening communication between medical experts and patients. Insurance reimbursement, rural health access, and provider credentialing barriers are changing as the telehealth platform gains momentum amid the pandemic.
To facilitate the use of telehealth technologies as a safe substitute for in-person patient encounters during the COVID-19 Public Health Emergency (PHE), the Centers for Medicare and Medicaid Services (CMS) has modified many of its payment policies for services that were previously restricted from telehealth-type encounters but are now allowed during the PHE. Per the interim final rule[1], which dates the implementation of these policies back to March 2, 2020, CMS has instructed providers who bill for Medicare telehealth services to report the POS code that would have been reported had the services been conducted in person (only during the COVID-19 Public Health Emergency). This allows CMS to apply appropriate payment for services furnished via Medicare telehealth, which, if not for the PHE, would have been furnished in-person, at the same rate they would have been reimbursed if provided in clinic.
Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs) furnish services to rural and urban areas that have been determined to be medically underserved. CMS has expanded the services that can be included in the payment for HCPCS code G0071, which allows “payment for communication technology-based services for 5 minutes or more of a virtual (non-face-to-face) communication between an RHC or FQHC practitioner and a RHC or FQHC patient, during the pandemic. To add additional flexibilities and support to such underserviced areas during the COVID-19 PHE, CMS has added three CPT codes typically used by RHCs and FQHCs to the list of services allowed to be rendered via telehealth communications.
Under the CARES Act, CMS has waived the previous requirements that specified the types of practitioners that can bill for services and as a result broadened the range of professionals who are eligible to use telehealth. Physical and occupational therapists and speech language pathologists may now utilize telehealth services to reach a broader patient population.
With the introduction of the 1135 waiver[2] in 2020, Medicare telehealth visits, virtual check-ins and e-visits are part of a growing reimbursement platform in an arena where payments were previously made on a limited basis. Such expansions to Medicare compensation enhance a provider’s armamentarium, bridging the gaps created by social distancing. By offering synchronous and asynchronous telehealth modalities, the personalized encounter remains at the forefront of value-based care while both mitigating the spread of the disease and positively impacting the patient-provider experience. Adapting to the fluidity of healthcare allows providers to continue remote patient monitoring while expanding rural care access and adhering to best practices within their professions.
[1], [2] Medicare and Medicaid Programs; Policy and Regulatory Revisions in Response to the COVID–19 Public Health Emergency, CMS–1744–IFC (2020).