COVID-19 Federal Telehealth Reimbursement Policy Update in Telehealth

covid telehealth policy update

Amidst the pandemic, new policies surrounding telehealth services have come into place. The Center for Medicare and Medicaid services recently made updates to their telehealth policy along with private insurers. But what does this mean for providers?

Keep in mind these new policies could change frequently, but the following are the current policies as of May 2020.

Basic Policy Changes to Be Aware Of

There are some basic policy changes that all providers should be aware of. Live video and phone appointments will be allowed for E/M services, behavioral health counseling, and educational services.

covid telehealth policy changes

It is the responsibility of the health care professional to bill Medicare for all of its professional telehealth services. To do so, providers can choose from 180 different codes to use for reimbursement on their claims. The entire list, which is frequently updated, can be viewed here. This is done the same way as if the service was provided in-person, however, some rates have increased for some telehealth visits. Luckily, some states are stepping in to waive these fees.

Providers will need to include the modifier code “95” to illustrate that services were taken place using telehealth and not in person. Another change to the telehealth claim is that the provider does NOT need to put their home address on the claim.

What Patients Need to Know

Before the COVID-19 outbreak, there were limitations in place for the number of in-patient visits and critical care consults, which have now been removed.

Patients do need to be told that out-of-pocket costs along with co-pays still apply to telehealth services. However, health care providers have the opportunity to reduce or waive fees. In addition, all COVID-19 testing fees should be waived as well.

Current Medicare license requirements have also been removed when it comes to telehealth services, but state requirements may still be in place. 

Changes to Nursing Homes & Hospice

As for nursing homes and hospice, Medicare and Medicaid have made changes as well. 

CMS is waiving the requirement of in-person visits to nursing home patients and allowing them to be done via telehealth with their provider when appropriate. This is saving time and reducing the spread of germs with less contact with those in nursing homes, which is critical during this current pandemic. 

During emergencies, telehealth services are allowed for hospice patients. This also includes when providers need to determine the continued use of hospice care.

Medicare Advantage & Medicaid Changes

Policy changes regarding Medicare Advantage and Medicaid are also in place due to COVID-19.

Medicare Advantage Organizations are allowed to expand their telehealth service coverage and will continue to do so until these policies are no longer needed.  

It is hard to narrow down exactly what is covered, as that will all depend on the plan that is being used, which they all differ. Patients should check their plan to know exactly what is covered.

Regarding Medicaid, their programs have the authority to use telehealth services during certain conditions. License requirements are also waived, but remember, state requirements still apply, just like those with Medicare. Some states have actually encouraged providers to use telehealth to provide more services in their state, so always check with your state to know exactly what changes have been made. 

Prescription Policy Updated

There are some conditions that need to be met, but DEA-registered practitioners have the ability to prescribe controlled substances to patients without the need for an in-person evaluation. 

The conditions that do need to be met include: 

· The controlled substance prescription needs to be prescribed for a legitimate medical reason by the provider 

· Telehealth communicate uses audio-visual, real-time, and a two way-interactive communication system

· The prescriber is acting in accordance with current Federal and State laws

Have There Been Changes to HIPPA?

YES! Effective immediately there have been some changes regarding HIPPA. 

According to HIPPA, “The HHS Office for Civil Rights (OCR) will exercise enforcement discretion and waive penalties for HIPAA violations against health care providers that serve patients in good faith through everyday communications technologies, such as FaceTime or Skype, during the COVID-19 nationwide public health emergency.”

However, this will probably not impact any state laws and regulations that are in place regarding protecting and securing patients’ health information.

What About Private Insurers?

In addition to Medicare and Medicaid, health plans have also announced changes to their policies regarding telehealth, encouraging telehealth to be widely used and offering these services for free for a limited time.

The following insurance companies have made changes:

–      Aetna

–      Cigna

–      BlueShield BlueCross

Vice-President Mike Pence has also made the announcement to secure a commitment from health plans to in fact cover telehealth services. However, the details of the plans were not announced as of yet.

It is in the best interest of your patients to ask their insurance companies what exactly is covered regarding telehealth services during this period. Health care offices should also check with the different insurance companies to learn their current policies and should also know what changes are being made in their state.  

For example, the state of Montana’s health plans has agreed to cover all telehealth services. Some other states have followed suit.

These Other states include

  • Arizona
  • Colorado
  • Iowa
  • Massachusetts
  • New York
  • Ohio
  • Rhode Island
  • Texas

COVID telehealth policy changes infographic

Looking to Expand to Offer Telehealth Services? 

If you are looking to add telehealth services to your practice, Amplified Health can help you set up a practice management software to manage your telehealth services. 

A streamlined telehealth practice will attract top talent and patients. With the help of a full practice management suite, providers can easily keep track of their health services. From the schedule to patient vitals and appointment notes, everything can be easily stored and accessed from a safe portal.

The patient and provider friendly telehealth software can allow providers to conduct telehealth appointments and send patients crucial reminders. Patients can access their medical records and pay any bills securely.

Built for providers, the Amplified Health Platform is here to help providers care for their patients at any place and at any time.

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