Medicare Payment Rules for Telehealth Billing Services
Telemedicine
is one of the greatest achievements in the healthcare system at large since it's
helping underserved communities in society get the medical attention they need
even when a local doctor is unavailable or inaccessible. Telehealth has proven
particularly important during the COVID-19 crisis as it allows healthcare
providers to provide necessary medical services without becoming an additional
burden on medical infrastructure or without disturbing social distancing
requirements.
Although
telehealth is not so new in recent times it boosted in popularity due to the
COVID-19 pandemic. It has led to more use and acceptance. The medical
billing guidelines for telemedicine are still not concrete since they may
change from payer to payer. If you are one of the medical practitioners who is
currently providing or planning to offer this widely popular service, we, 24/7
Medical Billing Services are bringing some essential tips and telemedicine billing requirements to consider.
This
article brings a gist of Medicare coverage and payment of telemedicine.
Under
the leadership of Trump, the Centers for Medicare & Medicaid Services
(CMS) expanded access to Medicare telehealth services to offer
beneficiaries with multiple services from their healthcare providers. These policy
changes built the regulatory flexibilities granted under the President’s
emergency declaration. CMS broadened this advantage on a temporary and
emergency basis under the 1135 waiver authority and Coronavirus Preparedness
and Response Supplemental Appropriations Act.
Telemedicine
is using electronic information and communication ways to offer direct patient
care, usually when the patient and physicians are not present in the same
facility. Telehealth is highly valuable for individuals with acute emergencies
that trigger the need for quick diagnosis and special care. And in some cases
where the hospitals are not present immediately, such as a need for
neurologists and other stroke specialists on staff, telemedicine becomes
inevitable.
Ø Currently, Medicare Part B
covers physician services, pays for telemedicine services. But, federal law
authorizes payment for telemedicine only when patients are present at an
originating site, defined as a site that is located in an appointed rural
health professional shortage area, situated in a county not included in a
metropolitan statistical area, or participating in a Federal Telemedicine
Demonstration Project.
Ø Other healthcare
facilities like urban hospitals with limited on-call specialty capabilities in
their emergency departments or community health centers located in urban
medically underserved neighborhoods, cannot qualify as originating sites.
Ø Sometimes, these sites may
render care to individuals in need, they don't qualify for Medicare payment for
improved patient access to telemedicine services even when these services would
help patients with acute care needs. Medicare's limited payment policy controls
the utility of telemedicine in a non-rural healthcare environment in which
beneficiaries experience documented and structural barriers to care like lack
of specialists.
Ø Medicare Advantage (MA) is Medicare's managed care option
that offers some flexibility that enables plans to change Medicare's basic
payment rules. Furthermore, the majority of MA plans follow the standard
Medicare originating site rule.
Ø While one of the MA plans
maintains a payment policy that offers telestroke reimbursement in non-rural
areas, other ones generally appear to follow traditional Medicare payment
principles about telemedicine.
Medicare
may be late to recognize the importance of telehealth services, the Centers for
Medicare & Medicaid Services (CMS) is putting steps forward in the right
direction by testing more flexible telemedicine programs as part of
demonstration projects funded by the CMS Innovation Center established under
the Affordable Care Act.
Commercial
payers are following Medicare’s lead when it comes to coverage and policy.
At
24/7 Medical Billing Services, we follow every detail announced by leading regulatory
authorities.
We
help maximize your telehealth services.
With
a trusted medical
billing service provider to guide your practice through changes in
policies and rules, you get a chance to focus more on your telemedicine
practice.
By
outsourcing medical billing to 24/7 Medical Billing Services, our
clients find it easy to evaluate the current reimbursement options for
telehealth services to avoid those denials and billing errors.
About
24/7 Medical Billing Services:
We
are a medical billing company that offers ‘24/7
Medical Billing Services’ and support physicians, hospitals, medical
institutions and group practices with our end to end medical billing solutions.
We help you earn more revenue with our quick and affordable services. Our
customized Revenue Cycle Management (RCM) solutions allow physicians to attract
additional revenue and reduce administrative burden or losses.
Contact:
24/7
Medical Billing Services
Tel:
+1 888-502-0537
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