HEALTHCARE 2021 - Telemedicine: Reimbursement Update

Website https://www.mentorhealth.com/webinar/telemedicine:-reimbursement-update--802292LIVE | Edit Freely

Category HEALTHCARE 2021

Deadline: March 22, 2021 | Date: March 22, 2021

Venue/Country: Online Event, U.S.A

Updated: 2021-02-15 19:07:27 (GMT+9)

Call For Papers - CFP

Under the Social Security Act, reimbursement for telehealth under Medicare has been subject to stringent restrictions.

Only patients in certain identified practice settings in rural, physician-underserved areas were eligible. Care into the patient's home was not covered.

Only certain providers were eligible. With rare exceptions (demonstration sites in Hawaii and Alaska), only real-time, audio-video communications were eligible. And, only a rather modest number of CPT codes were eligible. These provisions are still good law. In 2015, however, the first modification of these rules appeared, allowing reimbursement, still subject to extensive restrictions, for chronic care management. Because a co-pay had to be charged, patient consent was required, for services that the patient had previously received at no charge.

Plenty of other limitations were imposed as well. For example, the patient has to have access to care management services 24/7, a comprehensive care plan has to be developed, only 1 practitioner/month is eligible for reimbursement, and providers have to document that clinical staff spent 20 minutes of non-in-person time in a given month.

For the first time, however, distance care services provided by staffers, as opposed to qualified HCPs, and delivered by email or phone, for example, as opposed to by videoconferencing, could satisfy Medicare's requirements for reimbursement. In 2018, CMS developed the highly creative concept of communication technology-based services ("CBTS"), distinguished from telemedicine on the theory that these are not simply substitutes for in-person care, but are inherently electronic in nature and thus outside the scope of the telemedicine reimbursement rules of the Social Security Act.