Medicare Payment Rules for Telehealth Billing Services

Telemedicine is one of the greatest achievements in the healthcare system at large since it’s helping underserved communities in society get the medical attention they need even when a local doctor is unavailable or inaccessible. Telehealth has proven particularly important during the COVID-19 crisis as it allows healthcare providers to provide necessary medical services without becoming an additional burden on medical infrastructure or without disturbing social distancing requirements.

Although telehealth is not so new in recent times it boosted in popularity due to the COVID-19 pandemic. It has led to more use and acceptance. The medical billing guidelines for telemedicine are still not concrete since they may change from payer to payer. If you are one of the medical practitioners who is currently providing or planning to offer this widely popular service, we, 24/7 Medical Billing Services are bringing some essential tips and telemedicine billing requirements to consider.

This article brings a gist of Medicare coverage and payment of telemedicine.

Under the leadership of Trump, the Centers for Medicare & Medicaid Services (CMS) expanded access to Medicare telehealth services to offer beneficiaries with multiple services from their healthcare providers. These policy changes built the regulatory flexibilities granted under the President’s emergency declaration. CMS broadened this advantage on a temporary and emergency basis under the 1135 waiver authority and Coronavirus Preparedness and Response Supplemental Appropriations Act.

Telemedicine is using electronic information and communication ways to offer direct patient care, usually when the patient and physicians are not present in the same facility. Telehealth is highly valuable for individuals with acute emergencies that trigger the need for quick diagnosis and special care. And in some cases where the hospitals are not present immediately, such as a need for neurologists and other stroke specialists on staff, telemedicine becomes inevitable.

  • Currently, Medicare Part B covers physician services, pays for telemedicine services. But, federal law authorizes payment for telemedicine only when patients are present at an originating site, defined as a site that is located in an appointed rural health professional shortage area, situated in a county not included in a metropolitan statistical area, or participating in a Federal Telemedicine Demonstration Project.
  • Other healthcare facilities like urban hospitals with limited on-call specialty capabilities in their emergency departments or community health centers located in urban medically underserved neighborhoods, cannot qualify as originating sites.
  • Sometimes, these sites may render care to individuals in need, they don’t qualify for Medicare payment for improved patient access to telemedicine services even when these services would help patients with acute care needs. Medicare’s limited payment policy controls the utility of telemedicine in a non-rural healthcare environment in which beneficiaries experience documented and structural barriers to care like lack of specialists.
  • Medicare Advantage (MA) is Medicare’s managed care option that offers some flexibility that enables plans to change Medicare’s basic payment rules. Furthermore, the majority of MA plans follow the standard Medicare originating site rule.
  • While one of the MA plans maintains a payment policy that offers telestroke reimbursement in non-rural areas, other ones generally appear to follow traditional Medicare payment principles about telemedicine.

Medicare may be late to recognize the importance of telehealth services, the Centers for Medicare & Medicaid Services (CMS) is putting steps forward in the right direction by testing more flexible telemedicine programs as part of demonstration projects funded by the CMS Innovation Center established under the Affordable Care Act.

Commercial payers are following Medicare’s lead when it comes to coverage and policy.

At 24/7 Medical Billing Services, we follow every detail announced by leading regulatory authorities.

We help maximize your telehealth services.

With a trusted medical billing service provider to guide your practice through changes in policies and rules, you get a chance to focus more on your telemedicine practice.

By outsourcing medical billing to 24/7 Medical Billing Services, our clients find it easy to evaluate the current reimbursement options for telehealth services to avoid those denials and billing errors.

Contact us today on 888-502-0537 for a free consultation.

Read more: A Guide On Telehealth Billing Services & Challenges

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