The groundwork for getting paid for telehealth visits started a few years ago …prior to the public health emergency of the COVID-19 pandemic. Medicare (CMS) has long recognized the serious problem of access to healthcare in America. In response to this, they began to expand codes they would allow in the telehealth space. Potentially, telehealth could be another tool to help patients reach their physicians. However, many restrictions stood in the way for most providers to use these new tools.
When the pandemic hit hard, CMS moved quickly to open up what they would reimburse for telehealth visits. Thus allowing patients to get the care they needed while staying safe at home. By rule, CMS created an opening to enable doctors to bill for new and established visits. The list of codes grew exponentially to meet the scale of medical situations for many different specialties. CMS is allowing telehealth visits to be paid at the same level as face to face regardless of geographic location. This was an amazing leap forward for telemedicine!
The private payers were not far behind CMS. Medicare Advantage was well on the way to expanding telehealth codes prior to the PHE. Medicaid has always been forward thinking in using telehealth as a tool for better access for their patients. Now the 3rd party payers have finally recognized the many benefits of telehealth. The reaction from patients has been resoundingly positive. Surveys show high satisfaction with virtual visits. We now recognize the problems with reliable internet and devices that aid in these visits. With perseverance and help from family members, many patients are able to use the technology successfully. CMS has allowed telephone only visits, and audio only codes to be used to a great extent. Unfortunately, these will probably not be paid at the same level once the PHE goes away. The most restrictive requirements to Medicare telehealth are contained within Federal law. Therefore, any major reform to telehealth policy will require an act of Congress.
There are new rules and changes happening all the time in our “new normal” in healthcare. We needed a crisis to happen to shake things up in our broken healthcare system. Telemedicine has been waiting in the wings for many years and now the time is ripe. Innovation is the catch phrase of today and the future will be brighter with these new ideas. Telehealth can provide better access for patients to their healthcare providers. If permanent changes are made by Congress, then providers can be paid for telemedicine and thus a win for everyone. You can help these policies become permanent by contacting your insurance companies and your representatives. The voices and opinions of not only physicians, but also of patients, matter.
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