Medical Billing Services

Telehealth landscape beyond a pandemic

Telehealth is rising drastically after COVID-19 due to mandatory social distancing and the safest interactive system between patients, both infected and uninfected, and clinicians. Now Vaccination is going on all over the country to win over pandemic and PHE.

But Telehealth will continue to stay here as an important care provider model and also, some steps were taken by legislation in this regard hence you should know the telehealth landscape beyond pandemic to priorities your practice. Let’s look at these steps taken by legislation in detail:

The CONNECT for Health Act

The CONNECT for Health Act of 2021 promotes a higher quality of care, increased access to care, and reduced spending in Medicare through the expansion of telehealth services which help to billing address Medicare telehealth the landscape beyond pandemic.

While during a pandemic, the federal government provided enhanced access to telehealth services but many of those services are tied to the temporary public health emergency (PHE) declaration for COVID-19. Hence expanded access requires legislative action along with specific waivers to continue post-pandemic.

These flexibilities are permanently extended with CONNECT for Health. Let’s look at some important provisions in detail.

Key provisions of the CONNECT for Health Act

  • Eliminate the requirement that the originating site of the telehealth service be (i) located in a rural health professional shortage area, (ii) located in a county not included in a Metropolitan Statistical Area, or (iii)  Participation of an entity in a federal telemedicine demonstration
  • Expand originating sites to include the home and allow the Secretary to establish requirements for other new permissible originating sites
  • Permanently allow for the waiver of telehealth restrictions during PHEs.
  • Allow the US Secretary of Health and Human Services (HHS), upon determining that there would be no “adverse impact to the quality of care,” to waive current statutory restrictions which prevent telehealth services Medicare reimbursement beginning January 1, 2022.

Additional Services

 Stakeholders could make requests under two categories:

  • Category 1 services are similar to the professional consultations, office visits, and office psychiatry services already included on the list.
  • Category 2 services are not similar to those services already on the list. CMS deeply reviewed requests for Category 2 services annually to check if the corresponding code accurately describes the service when delivered via telehealth. Moreover, CMS also checked the use of a telecommunications system to deliver the service produces demonstrated clinical benefit to the patient.

You can find slow adoption of new services due to the application of this two-category system and relatively rigid criteria for inclusion.

  • CMS adopted a standard allowing the temporary addition of a Category 3 telehealth service for payment when it has a “reasonable potential likelihood of clinical benefit and improved access to care.” Category 3 services were temporarily added to the list only through the end of the year in which the PHE ends.

CONNECT for Health empower the HHS Secretary to temporarily add services to the list based on a “reasonable potential likelihood of clinical benefit and improved access to care.”

After knowing the additional services, let’s look at some Barriers which will be removed for specific provider and service types.

Removing Barriers for Specific Provider and Service Types

  • Permanently allowing Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) to furnish telehealth services as distant site providers and establishing reimbursement for such services.
  • Removing originating site restrictions for Indian Health Services and Native Hawaiian Health Care Systems.
  • Removing restrictions for emergency medical care services.
  • Allowing telehealth for recertification of the beneficiary for the hospice benefit.

The Biden Administration will likely extend the PHE declaration through the end of 2021. Therefore, stakeholders should build support for a viable, permanent Medicare telehealth landscape beyond pandemic.

If you are still struggling with telehealth billing, we can help you. We are one of the trusted medical billing partners in the US and our HIPAA compliant experts reduce your denial rate and enhance your revenue.

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