Check Out These Medicare Telehealth Coverage Updates

by | Last updated May 16, 2023 | Published on May 8, 2020 | Medical Billing

Medicare Telehealth Coverage Updates
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This blog is an update to “Expansion of Telehealth for Medicare Patients during the COVID-19 Emergency – Key Points

On April 30, 2020, the Centers for Medicare & Medicaid Services (CMS) issued a press release, which announced regulatory waivers and rule changes to deliver expanded care to the seniors of the nation and provide flexibility to the healthcare system during the COVID-19 pandemic. This announcement also introduced key changes to telehealth and mHealth coverage. Along with making it easier for Medicare and Medicaid beneficiaries to get tested for COVID-19, these changes also highlight the agency’s efforts to further expand beneficiaries’ access to telehealth services. Physicians providing telehealth services can rely on professional medical billing companies to submit claims and get reimbursed without hassles.

With this historic expansion for telehealth and mHealth reimbursement during the COVID-19 crisis, coverage is provided for more care providers and for services delivered over audio-only phones. Doctors and other providers can deliver a wider range of care to Medicare beneficiaries in their homes, while beneficiaries don’t have to travel to a healthcare facility and risk exposure to COVID-19.

Key changes made by CMS are –

  • Earlier, only doctors, nurse practitioners, physician assistants, and certain others could deliver telehealth services. For the duration of COVID emergency, these limitations are waived and other practitioners such as physical therapists, occupational therapists, and speech language pathologists can also provide telehealth services.
  • Services including counseling and educational service as well as therapy services can be billed. Practices can bill for services provided remotely by hospital-based practitioners to Medicare patients registered as hospital outpatients. Services can be given when the patient is at home when the home is serving as a temporary provider-based department of the hospital. Hospitals can also bill Medicare as the originating site for telehealth services furnished to those patients.
  • Earlier it was announced that CMS would pay for services conducted via audio-only telephone between beneficiaries and their doctors and other clinicians. Now the list is broadened to include many behavioral health and patient education services. Payments for these telephone visits are also increased from a range of about $14-$41 to about $46-$110. The payments are retroactive to March 1, 2020.
  • CMS is now adding new telehealth services on a sub-regulatory basis, based on the requests by practitioners now learning to use telehealth as broadly as possible, which will speed up the process of adding services.
  • Medicare beneficiaries located in rural and other medically underserved areas are now provided more options to access care from their home without having to travel.
  • CMS has waived the video requirement for certain telephone evaluation and management services, and those services are also added to the list of Medicare telehealth services. As a result, Medicare beneficiaries will be able to use an audio-only telephone to receive these services.

Such changes will help to meet the CMS’ goals of increasing access to telehealth for Medicare patients, so they can get care from their physicians and other clinicians while staying safely at home. Healthcare practices as well as companies providing medical billing and coding services must stay abreast with such coverage updates in the industry.

Julie Clements

Julie Clements, OSI’s Vice President of Operations, brings a diverse background in healthcare staffing and a robust six-year tenure as the Director of Sales and Marketing at a prestigious 4-star resort.

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