When the Coronavirus first made news in late 2019, the majority of the world viewed it as another common virus. In just 3 months, it has become the largest global health threat since the 1918 Spanish Flu. As of today, 730,000 people have tested positive worldwide, and the number of deaths has totaled more than 34,000. Due to the lack of testing, the number of cases is believed to be extremely under-recorded. The true number of active cases may only be accurately measured when comprehensive, worldwide testing is available.
The effects of the virus have crippled the face-to-face portion of the medical industry. Physical Therapists, Ophthalmologists, and Orthopedics alike have had their in-person businesses halted unexpectedly, suddenly unable to provide services to their own clients in their own offices. With an immediate need to adapt to the new landscape, Telemedicine has risen as the only solution forward. Luckily, pVerify has you covered with batch, API, and instant verification of telehealth benefits.
Developed in the 1950s and 1960s, Telemedicine started in the United States by NASA and the Nebraska Psychological Institute. It was the ARRA and HITECH Acts in 2009 and Meaningful Use regulation and the Affordable Care Act in 2010 that started telehealth on its nationwide trajectory.
Telehealth and Now
The global takeover of COVID-19 left many providers struggling to find their footing in the new Telemedicine Landscape. With near to no transition time, the industry scrambled to add the technology and equipment to provide telehealth services to patients. What has shown to be even more difficult is deciphering coverage of medical benefits for services mainly performed face-to-face previously. When US Government lifted restrictions on Medicare in March 2020 followed by the passage of the Families First Coronavirus Response Act that requires private payers and Medicaid cover coronavirus testing without cost-sharing.
According to Foley & Lardner LLP’s Telemedicine Survey 2017 findings reported a surging demand in telemedicine services, with three-quarters of surveyed providers stating they had already implemented or were planning to implement telemedicine services. Fast-forward another two years and, while reimbursement constraints remain a major frustration for telehealth, the policy landscape has significantly improved. While it is true that clarity of coverage and limitations on reimbursement remain major frustrations for telehealth growth, the legal landscape has materially improved. As of December 2019, 42 states and DC maintain some sort of state telehealth commercial payer law; a sea change compared to a decade ago.
These movements opened the playing field for Telemedicine coverage across the board. Different types of Specialists now have the ability to provide Telemedicine and Virtual consultations. While a good portion of the rules have been relaxed it is still turbulent waters and a high learning curve to which benefits payers include to various plans. One answer does not fit all. Further unsettling is the fluctuation of coverage rules payer to payer, week to week. The only current solution is to verify a patient’s coverage and hold for future reference. Time will be very telling and keeping good records will be more important now than ever.
Current Telemedicine Termanology:
Telehealth: Telehealth includes one-on-one video sessions and can be done with new or existing patients. Doctors can discuss all patient history to provide support and treatment so it will cost more.
eVisit: eVisit includes a telephone conversation and is only available to existing patients.
Televistis: Telephone communication with doctors contracted by a payer and located all over the USA.
Virtual Visit: Any Video Synchoronous communication between a patient’s regular doctors and the patient.
Medicare Relaxes Telehealth Rules
With the heightened risk for the elderly population, Medicare has relaxed its rules for reimbursement for telehealth / eVisits for COVID-19 as well as standard visits. Not only limited to MDs, non-Physician Healthcare Providers are now able to provide their basic services through telehealth and eVistis.
EXPANSION OF TELEHEALTH WITH 1135 WAIVER: Under this new waiver, Medicare can pay for office, hospital, and other visits furnished via telehealth across the country and including in patient’s places of residence starting March 6, 2020. A range of providers, such as doctors, nurse practitioners, clinical psychologists, and licensed clinical social workers, will be able to offer telehealth to their patients. Additionally, the HHS Office of Inspector General (OIG) is providing flexibility for healthcare providers to reduce or waive cost-sharing for telehealth visits paid by federal healthcare programs. (According to CMS.gov)
Commercial Payers Response
Following the updates within Medicare, many large health insurers have introduced an interim policy to pay for telehealth / virtual visits. Aetna, and others, have partnered national providers of Telemedicine (e.g. Teladoc in case of Aetna) to provide remote visit services for both COVID-19 related visits and those that are general in nature. Additionally, copays that are related to a COVID-19 diagnosis will be waived consistent with the recently enacted federal legislation. For non-COVID-19 related cases, many payers are charging the same copay as if they were seen in the office.
A comprehensive list of all insurance companies response can be found here: https://www.ahip.org/health-insurance-providers-respond-to-coronavirus-covid-19/
By the looks of it we are just cracking this egg open. My suggestion would be to verify the coverage of each patient as usual, including Telemedicine details if available, and keep a copy of the record easily accessible. Many Eligibility Verification Services preserve their records for future review and easy to read PDF printouts. Luckily verification services are adapting along with the industry and while we do not know where things are going, at least we are going together.