The healthcare industry has faced substantial changes since the onset of the COVID-19 pandemic. It had to adopt alternatives to traditional office visits to keep patients and healthcare workers safe. Telehealth services have become a valuable tool in the delivery of healthcare.
The state and federal governments have adjusted policies and procedures related to telehealth billing practices, including additional options for reimbursement. This makes it possible for medical providers to continue offering telehealth services to their patients. As a result, telehealth services have become more accessible and affordable to patients who benefit from them.
Know your options when it comes to billing for telehealth amid the challenges of the COVID-19 pandemic.
How Has Telehealth Changed with COVID-19?
During the pandemic, reimbursements for telehealth continued to evolve. The federal government, state Medicaid programs, and private insurers have expanded telehealth coverage. These expansions have increased accessibility for patients and simplified the billing process for medical providers.
Changes in Reimbursement for Telehealth
Changes to the reimbursement policies during the COVID-19 pandemic are:
- Medicare will reimburse telehealth services the same as an in-person visit. These services will be paid according to the physician’s fee schedule.
- Reimbursement will be issued for telehealth services provided regardless of geographic location.
- Telehealth services will be reimbursed whether the service is administered in a healthcare facility or the patient’s home.
- Medical providers and patients can now use a wider range of communication tools. Certain services such as behavioral health can be provided via audio only.
Expansion of Telehealth Coverage
Telehealth has expanded to improve patients’ continuity of care during the pandemic. Healthcare staff and patients increasingly rely on it to reduce in-person contact. Services now provided via telehealth include:
- Management of COVID-19 symptoms
- Behavioral health and counseling
- X-ray and lab consultation
- Urgent care needs
- Medication management
- Physical, speech, nutritional, and occupational therapies
- Postoperative follow-ups
- Management of chronic illnesses
- Skin conditions
Reimbursement of Services for Uninsured Patients During COVID-19
Through the Health Resources and Services Administration (HRSA), the federal government has reimbursed uninsured patients for testing and treatment for COVID-19 via telehealth. This program also covered vaccinations for the uninsured.
The HRSA COVID-19 Uninsured Program depended on the availability of funds. Unfortunately, there are no longer sufficient funds to continue this program. As of March 22, 2022, HRSA is no longer accepting claims for these services on behalf of the uninsured.
Telehealth apps capable of connecting patients to qualified medical providers are available. Commonly used telehealth apps are:
- MDLIVE
- Lemonaid Health
- LiveHealth Online
- PlushCare
- Doctor on Demand
- Amwell
- Teladoc Health
However, these apps usually require the patient to pay out-of-pocket for these services. The fees for using healthcare services via these apps are usually per appointment.
Uninsured patients who would benefit from telehealth should have the opportunity to apply for insurance coverage to mitigate out-of-pocket costs.
Medicaid and Medicare Payment Policies During COVID-19
The Centers for Medicare & Medicaid Services (CMS) have made it easier for people enrolled in Medicare or Medicaid to obtain care with telehealth during the coronavirus pandemic via audio or video. These changes also let medical providers bill for these services the same as in-person services. CMS provided an updated list of telehealth services that medical providers can bill to Medicare.
Medicaid covers telehealth services, although they differ from state to state. Most of the coverage for telehealth under Medicaid is provisional. Check your state profile to view the policies in your state.
Asynchronous telehealth, also known as “store and forward,” allows healthcare staff and patients to share information before and after the appointment. Medicare is limited in what aspects of asynchronous telehealth it covers.
Private Insurance Coverage for Telehealth
Most private health plans are now updating their telehealth coverage in response to the COVID-19 pandemic. Since the pandemic, 47 states have implemented requirements for telehealth coverage to encourage utilization by patients and medical providers. Federal and state governments encourage private insurance companies to notify their policyholders and beneficiaries of the availability of coverage for telehealth services.
Medical providers in most states are allowed to examine patients via telehealth and write prescriptions even if they have not had an in-person visit. They may also see patients in states where they are not licensed to practice. These flexibilities vary with each state.
Check if the insurance plans you accept cover reimbursement for any part of telehealth services.
Cost-Sharing for Patients in National Medical Care Programs
The Office of Inspector General for the U.S. Department of Health and Human Services (HHS-OIG) gives medical providers flexibility to lower or eliminate cost-sharing for telehealth visits and virtual care paid for by federal healthcare programs such as Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP). Medical providers can waive cost-sharing such as co-pays and deductibles for telehealth services. This reduces the financial burden on the patients who receive help from these services. Additionally, this reduces or eliminates the loss of revenue from healthcare practices.
Additional Flexibilities for Telehealth During the Pandemic
Government agencies are removing barriers to telehealth services in the COVID-19 pandemic. One of these barriers was HIPAA regulations on what communication methods to use during telehealth visits. HIPAA now permits the following platforms for telehealth, even if they do not fully comply with its guidelines:
- Facebook Messenger
- FaceTime
- Google Hangouts
- Zoom
- Skype
Healthcare providers must make every effort to protect patients’ privacy while using these platforms. Information exchanged between the healthcare provider and the patient should be kept out of public view.
Certain platforms are not appropriate for providing telehealth. Public-facing platforms providers should not use include:
- Facebook Live
- Twitch
- TikTok
Some flexibilities impact insurance issuers as well. CMS will not take any action against a health insurance issuer that adjusts its plans to provide telehealth pre-deductible coverage during the coronavirus pandemic, even if the specific telehealth services covered are not related to COVID-19. This will apply while the COVID-19 public health emergency declaration is in effect.
CMS can act on insurance issuers who limit or cut coverage to offset costs to provide pre-deductible coverage for telehealth.
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