The Centers for Medicare and Medicaid Services (CMS) is expected to issue new rules for telehealth in the release 2021 Physician Fee Schedule in the autumn of this year. Today, Medicare reimburses for specific services when delivered via live video. These new rules are expected to specify what Medicare will cover regarding telehealth services, details of telehealth billing going forward, and which documentation will be required for telehealth reimbursement. It is highly probable that private payers will adopt the Medicare rules, but how quickly they will follow suit is unknown, can differ by state as well as by carrier.
All providers may want to review these new Medicare billing rules as well as any state-specific legislative or regulatory telehealth reimbursement requirements. While the Office of Inspector General has deferred random audits during the PHE, expect them to resume at the end of the emergency.
It is also recommended to review individual payer websites for any changes in telehealth policies for 2021. It can be expected that post-PHE, payers will enact policies to limit the scope of coverage. Many patients appreciate the convenience of telehealth, and it is likely the number of telehealth visits will continue to increase post-PHE. As patients use telehealth to interact with their physicians more often, payers will be expected to reimburse more visits.
When it comes to telehealth reimbursement, an important consideration for providers is whether they use the CMS-approved CPT codes for reimbursement. CMS publishes a list of currently approved telehealth codes. The American Medical Association (AMA) compiles the CPT handbook, in which the “starred appendix” includes those codes that are telehealth eligible. Post-PHE, providers will also want to check that the telehealth service is a covered benefit under a patient’s insurance policy. It is also important for providers to understand their state’s parity regulations. In some states, parity regulations require that the payer reimburse the same amount for a telehealth visit as an in-person visit. ** From: : https://telehealth.org/telehealth-reimbursement-3/?awt_a=7Wrn&awt_l=7eDKv&awt_m=3mYNLoScG298Trn