Emergency healthcare policies and funding are being created and implemented as we move through this pandemic, which has fortunately included telehealth. The different payers – commercial, government and private – have not completely decided how they are going to pay the claims submitted to them.
The Centers for Medicare and Medicaid Services (CMS) has been lobbying for providers to receive the same amount from payers that they would for an in-person visit. Here’s everything we know that qualifies for a telehealth visit from Center for Connected Health Policy:
- Location of the patient: rural and site limitations have been removed. Telehealth services may be provided regardless of where the patient is located geographically and the type of site, allowing the home to be an eligible originating site.
- Eligible services: Medicare expanded the list of eligible services provided via telehealth. Here’s the list of codes.
- Modality: CMS clarified in its Final Interim Rule that for telehealth services, a “telecommunications system” means “multimedia communications equipment that includes audio and video equipment permitting two-way, real-time interactive communication between the patient and distant site physician or practitioner.
- Out-of pocket costs/co-pays: still applies; OIG is providing providers flexibility to reduce or waive fees.
- Prior existing relationship to provide care via telehealth: services via telehealth and remote patient monitoring and virtual check-in can be provided to new and established patients.
- Supervision: physician supervision can be provided using live video. Review the CMS Provider and Practitioner Guidance for additional information.
- Virtual check-ins: a brief (5-10 minutes) check in between a practitioner and patient via a telecommunications device (such as a phone) to decide whether an office visit or other service is required. A remote evaluation of recorded video and/or images submitted by an established patient.
- Telehealth visits: a visit with a provider that uses telecommunication systems between a provider and a patient
- E-visits: a communication between a patient and their provider through an online patient portal.
The Federal Communications Commission (FCC), in efforts to fund telehealth services and devices for medical providers, developed and approved a $200 million program. Who is eligible for this funding? Medical schools and teaching hospitals, community health and mental and migrant care centers, local health agencies and departments, not-for-profit hospitals, rural health clinics and skilled nursing facilities are eligible for this funding and may apply for up to $1 million to cover the cost of new devices, services and personnel.