Medicare’s geographical restrictions for billing telehealth services will be eased during public health emergencies through a bipartisan emergency spending deal expected to pass through both Houses of Congress.
Billing Telehealth Services During Public Emergencies
According to Eric Wicklund of mHEALTHIntelligence, the telehealth provision known as “Telehealth Services During Certain Emergency Periods Act of 2020” will enable providers to use telehealth in urban and rural areas as well as in the patient’s home, “all defined within the scope of an ‘emergency area.’” As well, the provision will allow the use of telephones to deliver care, as long as the phone includes audio-visual capabilities.
“To protect public health, the bill will allow Medicare providers to extend telemedicine services to seniors regardless of where they live, at an estimated cost of $500 million,” House Speaker Nancy Pelosi said in a statement released Wednesday.
The proposed spending bill was negotiated in response to the coronavirus known as COVID-19, which is gaining traction here in the US. In addition to funding expanded telehealth services, the $8.3 billion bill also will pay for development of treatments and a coronavirus vaccine; a prevention, preparedness and response effort; and low-interest SBA loans to small businesses impacted by the epidemic.
Medicare’s Restrictive Telehealth Guidelines
While telehealth is a growing segment of the healthcare industry–from 2014 to 2018, use of non-hospital-based provider-to-patient telehealth grew 1,393 percent–this lifting of telehealth restrictions that was lobbied for by industry organizations like the American Telemedicine Association (ATA), the Alliance for Connected Care (ACC) and the Health Information and Management Systems Society (HIMSS) also highlights how restrictive the Medicare telehealth guidelines are.
Just last fall, the Centers for Medicare and Medicaid Services (CMS) released a video outlining the steps for providing and billing telehealth services. That video was produced in response to a report by the Health and Human Services Office of Inspector General (OIG) that found as many as a third of all telehealth services were paid incorrectly because they did not meet the strict Medicare guidelines. The OIG estimated that Medicare could have saved approximately $3.7 million if practitioners had provided telehealth services in accordance with Medicare requirements.
Basically, Medicare’s telehealth coverage is limited …
- To certain services,
- By certain eligible providers,
- In originating sites in either a county outside a Metropolitan Statistical Area (MSA) or a rural Health Professional Shortage Area (HPSA) in a rural census tract (except in cases of acute stroke, treatment of a substance use disorder or a co-occurring mental health disorder, and certain renal dialysis facilities.)
- Using an interactive audio and video telecommunications system that permits real-time communication between the provider at the distant site, and the beneficiary at the originating site.
As mentioned above, the emergency spending bill loosens two of those restrictions, including the locale of the patient’s originating site and the technology used for the visit when patients and providers are in an area and period declared a public health emergency.
For more information about billing telehealth services to Medicare, including during a public health emergency, check out the following resources:
- Draft Emergency Spending Bill
- “Breaking: Telehealth Coverage Included in Coronavirus Spending Bill” by Eric Wicklund for mHEALTHIntelligence.com
- Pelosi Statement on Coronavirus Emergency Response Bill
- A Multilayered Analysis of Telehealth: A FAIR Health White Paper, July 2019
- CMS “Medicare Telehealth Services” YouTube video
- OIG Report: “CMS Paid Practitioners for Telehealth Services that Did Not Meet Medicare Requirements”
- Medicare Learning Network Telehealth Services Booklet
- List of Medicare-covered Telehealth Services
- Medicare Telehealth Payment Eligibility Analyzer
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