Telemedicine Coverage and Reimbursement in 2022

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Telemedicine Coverage and Reimbursement in 2022
Increased Scope of Telemedicine Telemedicine and
telehealth describe the use of telecommunication
tools including the Internet, video, and email to
exchange information in the context of health
care between patients, providers, consultants,
and content for the purpose of education,
evaluation, decision-making, and treatment. Prior
to the COVID-19 pandemic, telemedicine
applications had evolved to broadly cover care
for chronic and emergent conditions. Psychiatry
broadly utilized telemedicine psychiatric
office visits in addition to emergency
care.  Primary care and internal
medicine demonstrated the value and utility of
telemedicine across venues and across credentials
from intensivists running command and control
centers remotely for multiple ICU stations to
physician assistants on video phone chats to a
patients home. Telemedicines historical role
has been to increase access to health care for
remote or sequestered populations like
inhabitants of rural areas. In this article,
lets understand telemedicine coverage and
reimbursement in the year 2022 and how it evolved
prior to and during Public Health Emergency
(PHE). Telemedicine Coverage and Reimbursement
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Telemedicine Coverage and Reimbursement in 2022
Prior to the pandemic fee-for-service, Medicare
reimbursement for telemedicine was restricted to
remote or very specific chronic care but CMS was
liberalizing its implementation in alternative
payment models such as accountable care
organizations (ACOs). At the start of 2020,
traditional Medicare and Medicare Advantage plans
expanded telehealth coverage, limiting
restrictions on patient location requirements and
expanding coverage for more diagnosis. Prior to
the pandemic, private payers were increasingly
covering telemedicine either by law or by choice.
During some or all of the public health emergency
period, most major private payers have provided
telemedicine reimbursement across the entire
nation. Large gaps still exist in telemedicine
reimbursement, but nonetheless, almost all states
provided Medicaid coverage for telemedicine prior
to the PHE and that coverage has improved since.
With the emergence of the COVID-19 public health
emergency (PHE) in early 2020, almost overnight
the adoption of telemedicine leaped several years
forward. As of March 1, 2020, during the PHE,
traditional Medicare has radically liberalized
access to telemedicine across effectively all
locations and all conditions. Prior to the PHE,
reimbursement was the largest obstacle to the
widespread adoption of telemedicine. Prior to the
PHE, 29 states and Washington DC had parity laws
requiring private payers to reimburse
telemedicine services on par with in-person
services. Three additional states provided
partial coverage.
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Telemedicine Coverage and Reimbursement in 2022
Blue Cross Blue Shield, Aetna, United Health, and
Cigna were the top payers, but the majority of
state employee plans covered some degree of
telemedicine services. During the PHE, private
payers almost universally have provided
reimbursement for telemedicine services, usually
with parity to in-office visits, although it is
unclear the extent to which this practice will be
maintained post-pandemic. Hospitals themselves
will provide reimbursement for telemedicine
coverage in instances where a specialty is not
otherwise available but is necessary for the
hospitals overall provision of services. All
states but Rhode Island provide Medicaid
reimbursement for some level of telemedicine
services, but the degree of coverage varies
greatly. Requirements vary for qualifying
distances to providers, eligible providers, and
technologies. In some states, the patient must be
in a physicians office or a federally qualified
health center. In half of the states, there is no
qualification regarding the location of the
patient. Currently, sixteen states have
restrictions on what type of facility qualifies
as an originating site. Store and forward is
covered in eighteen states (one more than
Medicare), including Alaska, Arizona, California,
Illinois, Minnesota, Mississippi, New Mexico,
Oklahoma, and Virginia. Prior to the PHE,
Medicare was the most restrictive payer regarding
telemedicine services. Fee-for-service Medicare
reimbursement was typically available only for
patients in remote locations that lack providers
or in certain restrictive long-term care
scenarios.
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Telemedicine Coverage and Reimbursement in 2022
During the PHE, CMS dramatically liberalized
reimbursement for telemedicine services.
Audio-visual, as well as audio-only, are
reimbursed effectively at parity to in-office
encounters regardless of the site of service.
Virtual check-ins are reimbursed as well. During
the PHE the list of covered telehealth services
was expanded significantly. Some of these are set
to expire after the PHE while others were added
to the permanently covered services. To
Summarize For the time being, many of the
restrictions associated with originating sites
will revert back to pre-PHE rules when PHE
expires. This means that services covered on the
PHE list, including EM codes, will be restricted
to those in rural areas (health shortage regions)
and at approved facilities. Legislation is
expected to bring positive change in this regard,
as there is a strong push to permanently
eliminate originating site restrictions. We
referred American Urology Associations telemedici
ne guidance page to discuss telemedicine coverage
and reimbursement in 2022. Medical Billers and
Coders (MBC) is a leading medical billing company
providing complete medical billing and coding
services. We can assist you in receiving accurate
insurance reimbursement for telemedicine services
from government and private payers. To know more
about our telemedicine billing services, email us
at info_at_medicalbillersandcoders.com or call
us 888-357-3226.