Medical Billing Services

Telemedicine reimbursement and healthcare fraud prevention laws

Policymakers of the US quickly took action in this COVID-19 pandemic to relaxed long-standing healthcare regulations which include telemedicine reimbursement and healthcare fraud prevention laws. Moreover, the government and aligned organizations have developed temporary health policies to support the industry’s response to the pandemic.

Telemedicine reimbursement policy

During this pandemic, most of the practices opt for all in-person visits to virtual care services to minimize unnecessary exposure to the novel coronavirus. Also, to manage an unexpected surge in patients the hospitals are converted into hotels and even sports stadiums are temporarily converted into healthcare facilities

New York and Massachusetts are considered the hotspots for the COVID-19 however providers have helped to flatten the curve in these places due to proper and timely execution. This pandemic has transformed the way healthcare is delivered, and consequently the policies that govern care delivery.

During this healthcare emergency, providers are offered regulatory flexibilities and waivers which include telemedicine. The policies are mainly focused on expanding access to telephonic and virtual care services by reimbursing providers for more telemedicine services which include services delivered through FaceTime, Zoom, Skype, and other video and chat-based applications.

Though these flexibilities are temporary and designed to pay providers to boost the telemedicine use during the pandemic. However, now, providers are aware that public and private payers are willing to pay for virtual care owing to this; reimbursement is likely to stick for telemedicine.

COVID-19 pandemic is the main driving factor for virtual care also; various industry stakeholders realize many clinician-patient interactions can occur remotely and at a lower cost. These remote interactions bring convenience to patients which can boost telemedicine.

Telemedicine has the potential to lower costs and improve outcomes via virtual care coordination, enabling providers to earn shared savings or performance-based payments. Due to the allowance of Telemedicine coverage flexibilities during a pandemic, nurse practitioners, physician assistants, and other advanced practice providers are likely to play a larger role in the delivery of healthcare after COVID-19.

Healthcare fraud prevention laws

Healthcare industry and related stakeholders were demanding changes to healthcare fraud, waste, and abuse of laws way before this pandemic. However, Stakeholders received temporary regulatory flexibilities and waivers during the public health emergency. These flexibilities indicate HHS is aiming for updates to healthcare fraud and abuse laws.

The government is willing to relax or refocus on various healthcare fraud, waste, and abuse laws for instance; the government is focusing on Stark Law and Anti-Kickback Statute requirements, as well as those patient inducement regulations, to allow for more coordination of care, more sharing of information, or the joint investment in infrastructure. While law enforcement agencies are likely to focus on fraud and abuse more acutely.

With the help of the CARES Act, policymakers allocated approximately $180 billion to healthcare providers to offset financial losses incurred due to COVID-19, and some providers have received loans through the Payroll Protection Program to support small businesses during the unprecedented COVID-19.

This pandemic brought to light new areas of healthcare regulation and policy that require attention. For instance, Medical liability is a major regulatory issue, warning states to enact protections for providers who offer care for patients in emergency situations. Some state governments have passed Medical liability protections to stick in some form moving forward, also other regulations and policies that enabled providers to meet the demand of a healthcare system in crisis.

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