Updated on: March 13, 2020

Medicare Has Authority to Pay for More Telehealth Services during Novel Coronavirus (COVID-19) Crisis

Original story posted on: March 11, 2020

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Emergency spending bill signed by President Trump on March 6, paves the way for Medicare to pay for telehealth services.

Outbreak of the novel coronavirus (COVID-19) has forced Medicare to begin paying for telehealth services. Payment for telehealth was built into the emergency spending bill signed by the President on March 6. The change in rules appears in Division B of the Act, titled “Telehealth Services during Certain Emergency Periods Act of 2020.”

Section 102 gives the Secretary of the U.S. Department of Health and Human Services (HHS) authority to “temporarily waive or modify application of certain Medicare requirements with respect to telehealth services furnished during certain emergency periods.”

Payments “may only be paid to an originating site” that already is qualified to receive Medicare money. “Telehealth” does not include merely making a telephone call. In order to be paid by Medicare, “use of a telephone . . . [qualifies] only if such telephone has audio and video capabilities that are used for two-way, real-time interactive communication.”

The new law limits the types of providers that can be paid for providing telehealth. It states that a “qualified provider [is] . . . a physician or practitioner . . . who furnished [to the patient] . . . an item or service for which payment was made . . . during the three-year period [preceding the use of telehealth] . . . or . . . is in the same practice . . . of a physician or practitioner . . .  who furnished such an item or service” during that period.

This means that no new type of medical service will be paid by Medicare if delivered by telemedicine. Only if the patient has already been receiving the service during the immediately preceding three years will it qualify for payment.

It is not necessary, however, that the same provider deliver the healthcare. It can be delivered to the patient by any provider who “is in the same practice” as the provider who gave the healthcare previously. The patient must have previously received the healthcare. This leaves out new patients.

This modification in payment policy only applies in emergency areas and during the emergency period. Emergencies are declared by the President, and in addition, it must be a public health emergency declared by the HHS Secretary (not simply any type of national emergency)(§102(b)).

Readers of RACmonitor and others in the healthcare industry might wish to pay special attention to the level of success with telehealth services during this emergency. There may be important lessons for the future, and these might lead to a change in policy, making telehealth services more viable under Medicare.

Edward Roche, PhD, JD

Edward Roche is the director of scientific intelligence for Barraclough NY, LLC. Mr. Roche is also a member of the California Bar. Prior to his career in health law, he served as the chief research officer of the Gartner Group, a leading ICT advisory firm. He was chief scientist of the Concours Group, both leading IT consulting and research organizations. Mr. Roche is a member of the RACmonitor editorial board as an investigative reporter and is a popular panelist on Monitor Mondays.

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