Medicare Rules Change for Telehealth in COVID-19 Pandemic

Telehealth is the use of videoconferencing and phone communications to support and promote long-distance patient healthcare. Before the COVID-19 pandemic, the federal government had strict rules in place limiting Medicare payments for telehealth services. Generally, Medicare would only pay for telehealth services if the patient lived in a rural area with limited services and if the doctor provided the services from a specific site (i.e. physician’s office or hospital).

In response to COVID-19, the federal government relaxed the rules for telehealth services effective March 6, 2020. The rural and site limitations no longer apply. And healthcare professionals can provide telehealth services from anywhere to any established Medicare patient, regardless of location. This allows patients to communicate with their healthcare providers from home, reducing the risk of exposure to COVID-19. In addition to loosening the geographic restrictions, Medicare expanded the list of eligible services provided via telehealth.

There are three main types of virtual services physicians and other healthcare professionals can provide to Medicare beneficiaries: Medicare telehealth visits, virtual check-ins, and e-visits.

Medicare Telehealth Visits.

Medicare patients may now use teleconferencing for office, hospital visits, and other services that generally occur in person. Distant site practitioners who can furnish Medicare-covered telehealth services (subject to state law) include physicians, nurse practitioners, physician assistants, clinical psychologists, clinical social workers, registered dietitians, and nutrition professionals, among others.

Virtual Check-Ins.

Now, in all areas—not just rural—established Medicare patients may have a brief communication service with practitioners in their homes via telephone or teleconference. The Centers for Medicare & Medicaid Services (CMS) anticipates that these virtual check-ins will be initiated by the patient and should last about 5 to 10 minutes. CMS says that virtual check-ins can be conducted with a broader range of communication methods (via phone), unlike Medicare telehealth visits, which require audio and visual capabilities for real-time communication (teleconferencing).

E-Visits.

An e-visit is when a Medicare patient communicates with his or her doctor through a doctor’s online patient portal.
The relaxed reimbursement rules apply to each type of virtual service. The federal government has not set an end date for these revised rules.

Takeaway

Although certainly a reasonable responsible response to the ongoing COVID-19 pandemic, the rapidly changing telehealth payment rules will likely result in significant Medicare fraud. Unscrupulous providers are certain to upcode charges, the bill for telehealth services not provided, and engage in myriad other frauds to wrongfully obtain Medicare payments. If you have information about a provider violating the Medicare telehealth payment rules, you should contact an experienced whistleblower attorney at Florin Gray as soon as possible.