Billing Telehealth Visits Post Pandemic

COVID-19 pandemic and the accompanying social distancing protocols catalyzed a shift toward remote care hence resulting in the exponential growth of Telehealth services. Governments and private payers sought to maintain access to care during this period by removing regulatory barriers and reforming payment policies. But after the pandemic, in recent months, outpatient visits by telehealth have declined. Prior to the onset of the pandemic, telehealth use was a negligible share (rounding to 0 percent) of outpatient visits. Many enrollees have had increased access to telehealth services over the last two years. During this period, telehealth use soared from less than 1 percent of outpatient visits before the pandemic to 13 percent of outpatient visits in the first 6 months of the COVID-19 pandemic. But this rate was declined to 11 percent during the next 6-month period, and then to 8 percent a year into the pandemic i.e., March-August, 2021. Post pandemic, it’s not clear what role telehealth will play, and for what types of health services.  So far, telehealth use has been the highest for mental health and substance use services.

In-person outpatient visits in the first 6-months of the pandemic (March-August 2020) declined to 72 percent of outpatient visits a year earlier (March-August 2019). During this period, telehealth helped fill the gap, but in total there was only 83 percent as many outpatient visits between March and August 2020 as during the same period a year earlier. After an initial decrease in visits, utilization has now surpassed pre-pandemic levels; In-person outpatient visits have exceeded the 6-months immediately preceding the pandemic (106 percent in September 2019-February 2020 vs. 110 percent in March-August 2021), but with an additional boost from telehealth visits, the total number of outpatient visits between March-August 2021 was 19 percent higher than the number of visits before the pandemic in March-August of 2019. The number of outpatient visits delivered over telehealth has declined since the first 6-months of the pandemic. The share of outpatient visits delivered via telehealth is about 60 percent of what it was during the first six months of the pandemic.

Telehealth Policies Post Pandemic

Post pandemic, it’s not clear what role telehealth will play, and for what types of health services.  So far, telehealth use has been the highest for mental health and substance use services. Services delivered over telehealth may improve access for people with certain conditions, older people with chronic care management needs, rural residents without robust access to providers, people who need lower intensity health services, and for services that do not need in-person evaluations. Though older people and rural residents are less likely to have internet access at home, which may hinder access. Private and public payers’ telehealth coverage and licensing policies will unquestionably also affect telehealth use in the future. Some payers and employers have signaled continued coverage of more telehealth services beyond the pandemic.

  • Private payers: During the winter and spring of 2021, almost half of employers with 50 or more employees said telehealth would be ‘very important in providing access in the future compared to only 4 percent who said that telehealth would be unimportant. Private payers expanded coverage of telehealth services during the pandemic. Some private plans even paid for telehealth services in parity with in-person services and waived out-of-pocket cost-sharing telehealth services for a period of time. Though some of these policies may have already expired and it’s unclear to what extent private payers’ policies on telehealth will continue beyond the pandemic.
  • Federal policies: Early in the COVID-19 pandemic, CMS temporarily expanded coverage and payment for telehealth services beyond rural areas. CMS has announced that Medicare will continue covering this approved list of telehealth services beyond the Public Health Emergency through the end of 2023. Medicare is considering whether it will permanently cover certain telehealth services after 2023. Additionally, implementing the Consolidated Appropriations Act of 2021 (CAA), Medicare has permanently removed geographic restrictions for mental health and substance use services delivered over telehealth from a patient’s home. For mental health and substance use services, Medicare will also cover audio-only visits permanently in the future.
  • State policies: State regulators have authority over Medicaid coverage of telehealth services as well as providers’ licensure requirements to practice and prescribe during a telehealth consultation. Many states expanded coverage of telehealth services for Medicaid during the pandemic, including for mental health and substance use services. However, more recently, some states are moving in the opposite direction and reinstating licensing rules that limit telehealth use and providers’ ability to prescribe medications without an in-person visit.

MedicalBillersandCoders (MBC) is a leading medical billing company providing complete revenue cycle services. We shared this blog with the intention to share the changed billing scenarios of telehealth services post-pandemic. It’s a challenging task to receive accurate insurance reimbursement for telehealth services with so many regulatory changes and billing updates. As a leading medical billing company, we keep track of all revised billing guidelines for government and private payers. We can assist you in medical billing for telehealth services for your practice. To know more about our billing and coding services, contact us at 888-357-3226

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