Medicare Telehealth Services Now Included In Expanded Payment Protocol

medicare telehealth services

The Centers for Medicare & Medicaid Services (CMS) has decided Medicare will expand its payment protocol for professional Medicare telehealth services provided to beneficiaries in all areas of the country, in all settings. “Telehealth, telemedicine, and related terms generally refer to the exchange of medical information from one site to another through electronic communication to improve a patient’s health” (CMS, 2020). Due to the current Public Health Emergency (PHE) declared for 2019 Novel Coronavirus (COVID-19), this expansion was considered a necessary step to assist in healthcare reimbursement and only designed to last as long as this emergency

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Medicare Telemedicine Coding & Reimbursement Guidelines for COVID-19

telemedicine reimbursement guidelines

CMS released the Medicare telemedicine coding and reimbursement guidelines for healthcare providers to use during the COVID-19 pandemic (CMS, 2020). According to the CMS Medicare Telemedicine Health Care Provider Fact Sheet, reimbursement for these visits are considered the same as in-person visits and are paid at the same rate (CMS, 2020). The U.S. Department of Health & Human Services Office of Inspector General (OIG) is providing flexibility for healthcare providers to reduce or waive cost-sharing for telehealth visits paid by federal healthcare programs (CMS, 2020).

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Telemedicine Guidelines & COVID-19: Coding in Response to the 1135 Waiver Authority

telemedicine guidelines

Due to the stay-at-home orders put in effect by state governors and the highly contagious COVID-19 virus, CMS has expanded coverage for its Medicare recipients through the use of telemedicine (CMS, 2020). According to CMS, “The benefits are part of the broader effort by CMS and the White House Task Force to ensure that all Americans – particularly those at high-risk of complications from the virus that causes the disease COVID-19 – are aware of easy-to-use, accessible benefits that can help keep them healthy while helping to contain the community spread of this virus” (2020).

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CMS Increases List of Payable Medicare Telemedicine Services

Telemedicine

Adapting to the influx of telehealth services in response to the COVID-19 outbreak, CMS has adjusted the “List of services payable under the Medicare Physician Fee Schedule when furnished via telehealth” in order to provide as much support and care as possible (2020). In addition, CMS issued updated criteria for risk adjustment of Medicare telemedicine services, as well as guidelines on how to bill for telemedicine.

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