Medicare Telehealth Surges with COVID-19

At this point most American health care consumers, especially seniors with Medicare, have become more aware of their telehealth options. With shelter at home regulations being implemented across the nation, telehealth visits surged by 50% in March and according to research from Frost and Sullivan consultants, telehealth visits will increase by 64% in 2020. In addition to shelter at home regulations, reimbursement from private insurers, state Medicaid programs and most importantly Medicare have improved. Some CMS regulations and rules on physicians, hospitals and other providers to provide telehealth services are being waived temporarily and other waivers are permanently being modified. Frost and Sullivan are predicting a five-year compounded annual growth rate of 38.2% for telehealth care. 

Changes in Medicare Telehealth

CMS has been very aggressive about implementing changes to enable increased utilization of telehealth to protect patients, physicians and other providers during the COVID-19 crisis. The following bullets outline the changes in Medicare Telehealth, also known as Medicare telemedicine, made over the past few months.

• Beneficiaries can access telehealth visits from their home.

• Telehealth visits can be delivered via smartphones, via FaceTime, or Skype without regard for certain HIPAA regulations that would prevent the use of those services.

• Removes the requirement for a preexisting relationship between the provider and patient. Prior regulations required that the provider would have treated the patient in the last three years before providing a telemedicine visit.

• Some services can be provided via audio-only phone.

• Beneficiaries living in any geographic area can receive telehealth services, not just rural service areas. 

Medicare Advantage Telehealth Expands Benefits

Medicare Advantage plans have been able to offer additional Medicare Advantage Telehealth also known as Medicare Advantage telemedicine benefits not covered by traditional Medicare, and have flexibility to waive certain requirements with regard to coverage and cost sharing in cases of disaster or emergency, such as the COVID-19 outbreak. In response to COVID-19, CMS has advised the MA plans that they may waive or reduce cost sharing for Medicare Advantage Telehealth services, as long as plans do this uniformly for all similarly situated enrollees. This guidance, however, is voluntary and plans will vary in their responses to this new flexibility. United Healthcare, Humana and CVS Health have all publicly stated that they will follow new Medicare Advantage Telehealth guidelines and expand Medicare Advantage telemedicine benefits to protect patients and providers.

Medicare Reimbursement

 CMS previously announced that Medicare would pay for certain services conducted by audio-only telephone between beneficiaries and their doctors and other clinicians. Now, CMS is broadening that list to include many behavioral health and patient education services. CMS is also increasing payments for Medicare telehealth visits to match payments for similar office and outpatient visits. This would increase payments for Medicare telemedicine services from a range of about $14-$41 to about $46-$110. The payments are retroactive to March 1, 2020. The chart below from the CMS website outlines the types of services and the codes to be used for Medicare telehealth reimbursement.

“Established patient AWV codes G0438 and G0439 are both on the Medicare Telehealth Code List, so, yes, an AWV can be performed via telehealth. Note these codes generally cannot be billed more than once within 12 months. However, CMS is waiving limitations for many E/M codes during the PHE for COVID-19 pandemic.

The initial preventive physical examination (IPPE) or Welcome to Medicare visit (G0402) is not on the Medicare Telehealth Code List, so it cannot be performed via telehealth.” According to Bruce Pegg in an article published on the AAPC (American Association of Professional Coders) website.

Private Insurers and Medicaid Reimbursement

On a state level, many state governments have focused on expanding their Medicaid programs. In some cases, they are implementing and mandating that the fully-insured private plans cover and reimburse for Medicare telemedicine services equally to how they reimburse for in-person care. Meanwhile, many commercial insurers, like Aetna, Humana and United Healthcare, have voluntarily broadened their coverage and expanded their in-network coverage of telemedicine providers.

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Blog by: The ForeSee Medical Team