The world has never needed virtual and remote health care more than now! The global pandemic has accelerated the need for a safer and secure care delivery solution—giving rise to incremental telemedicine services. This comes at a time when self-isolation and shelter-in-place are considered amongst the effective measures to flatten the curve. However, the extensive adoption of telehealth has been stalled by several legal and regulatory challenges. The unprecedented health crisis has led to a host of emergency healthcare policies and federal government regulations to ensure frictionless access to care.

On April 6, 2020, the Centers for Medicare and Medicaid Services (CMS) released the Interim Final rule, allowing clinicians to be paid for an extended array of telemedicine services. Medicare and private insurers have expanded telemedicine coverage to facilitate providers and patients in delivering and accessing secure medical care. However, expanding telehealth has raised some serious questions regarding its technical implications, including hospital and practice reimbursement requirements. This blog is a deep dive into the intricacies and the nuances of the latest regulations and updates—helping Providers maximize their telemedicine reimbursements.

The federal government and CMS have implemented several rounds of regulatory changes in ensuring that the right care is delivered to patients during the pandemic. As per the latest announcements, here’s how the CMS regulations can help healthcare providers.

1. Expand telehealth services to Medicare patients
Following the declaration of a national emergency, CMS relaxed its requirements for telehealth options for the duration of the COVID-19 emergency. The CARES Act has further announced relaxations of Medicare telemedicine policies during COVID-19—allowing 80 additional telehealth services that can be covered under the health plan. Here are a few of the sweeping changes CMS has made:

• Telehealth visits can be billed at the same rate as in-person visits
• Phone-based telehealth can be provided. Telehealth will not be limited to audio-visual options
• Federally qualified health centers (FQHCs) and rural health clinics can serve as distant sites to provide telehealth services to patients in their homes and other locations

2. Apply for funding through the Public Health and Social Services Emergency Fund.
To prepare for the increasing surge of COVID-19 patients, the Coronavirus Aid, Relief, and Economic Security Act (CARES) has added $100 billion to the Public Health and Social Services Emergency Fund. Under the Secretary of Health and Human Services (HHS) management, this fund will reimburse eligible healthcare providers for expenses resulting from the COVID-19 pandemic.
The CARES Act defines eligible healthcare providers as “public entities, Medicare or Medicaid enrolled suppliers and providers,” in addition to for-profit and not-for-profit entities specified by the HHS Secretary. To qualify for funding, providers must take part in testing, diagnosing, or caring for possible or confirmed COVID-19 patients. The funds can be used for:

• Developing temporary structures
• Property Leasing
• Medical equipment, including personal protective equipment (PPE) and testing supplies
• Expanded workforce and training
• Emergency operation centers
• Retrofitting facilities
• Surge capacity

3. Get expedited Medicare reimbursements with the Accelerated and Advance Payment Program.
During this public health emergency, CMS has expanded the Accelerated and Advance Payment Program to expedite Medicare reimbursements for providers and suppliers who meet the following criteria:

• Have submitted for Medicare claims within 180 days prior to the signature date on supplier/provider’s request form
• Should not be in bankruptcy
• Mustn’t be under any program integrity investigation or medical review
• Shouldn’t have outstanding Medicare overpayments

For more details on this program, view the “Expansion of the Accelerated and Advance Payments Program for providers and suppliers during COVID-19 emergency” fact sheet from the CMS.

Also Read:
Top tactics to get upfront healthcare reimbursements during COVID-19

Post-Pandemic Predictions

The temporary regulatory changes in Medicare and Medicaid health plans may serve during the interim period—and are subject to changes on a permanent level post the expected pandemic’s end. These developments will differ with the state policies and telemedicine providers need to watch out for the future changes in the health plan policies to conform to the regulatory standards.

Sources: CMS.gov, CARES Act