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Telehealth Post the COVID-19 Public Health Emergency (PHE)

Rahul Varshneya, Co-Founder and President of Arkenea

When the coronavirus pandemic wreaked havoc across the United States last year, healthcare providers across the country started looking for ways they can care for patients while still maintaining the government-imposed COVID-19 protocols. Several waivers and alterations to existing policies of the Center for Medicare and Medicaid (CMS) followed soon thereafter.

Today, more than a year later, these changes are still being defined.  

CMS/Medicare has a ‘Current Emergencies’ page on its website that posts all the important resources and information needed for comprehending what providers should be aware of for their documentation, what billers need to know in applying new rules for submitting claims for Telehealth services, and what coders need to consider while coding these services.

As the nation is now rapidly being vaccinated, questions around the changes in PHE protocols continue to linger amongst care providers. When it ends, and what it means for providers of Telehealth services, is a crucial part of planning for your practice in the future. 

But before that, let us look at:

Telehealth Waivers Sanctioned during COVID-19 in the United States

The administration has been taking aggressive actions and exercising regulatory flexibilities to help healthcare providers contain the spread of the novel coronavirus since the beginning of 2019. 

As a result, the following telehealth-related blanket waivers have been put in effect, with a retroactive effective date of March 1, 2020 through the end of the emergency declaration:

  • Originating Site Expansion

Under this particular waiver, healthcare providers authorized to furnish Medicare telehealth services during the public health emergency, including physicians and certain non-physician practitioners such as physician assistants, certified nurse midwives, and nurse practitioners are also allowed to provide covered telehealth services to patients outside of remote rural regions, including treating patients in their own homes.

  • Covered Services

In March last year, CMS announced that Medicare will now pay for a little over 80 additional services when furnished through means of telehealth. Some of these include initial nursing facilities and discharge visits, emergency department visits, and home visits.

  • State Parity

The coronavirus public health emergency has caused certain late adopters to require payment parity for telehealth/telemedicine services.

Under the terms of this particular waiver, it is mandated that all Carriers ensure rates of payment to in-network providers for services delivered through means of telehealth are not lower than the rates of payment established by the Carrier for services delivered through in-person methods.

  • Modalities

Under this particular waiver, healthcare providers were allowed to evaluate beneficiaries who have audio phones only, as opposed to the pre-pandemic gold-standard Medicare requirement that all telehealth visits be conducted using real-time audio/video communication technology.

  • Waiver of Prior Patient-Physician Relationship Requirement

This particular waiver discards the initial requirement that a patient have a prior established relationship with a particular practitioner. HHS will no longer conduct audits to ensure that such a prior relationship existed for claims submitted during this public health emergency.

  • HIPAA Enforcement Discretion

Under this waiver, covered healthcare providers have been allowed to use popular video chat applications, including Facebook Messenger video chat, Apple FaceTime, Skype or Google Hangouts video to provide telehealth during the COVID-19 nationwide public health emergency. 

The HIPAA Omnibus Rule expanded the simple earlier definition of business associates to include subcontractors, like software developers or cloud hosting providers. However, during the public health emergency, the office of civil rights (OCR) has announced that penalties and sanctions for noncompliance with certain provisions of HIPAA Rules will not be imposed on healthcare providers and their business associates for good faith provision of healthcare services during the COVID-19 public health emergency.

  • Controlled Substance Prescribing

In March last year, the Drug Enforcement Agency (DEA) published a COVID-19 related information page on its website, which included a section addressing telemedicine and sanctioned the ability to prescribe controlled substances via telehealth without a previously conducted in-person exam.

  • Licensure Waivers and Exceptions

CMS waived the requirement that healthcare professionals need to be licensed in the state in which they are furnishing services, provided that they have equivalent licensing in another state (and are not affirmatively barred from practice in that state or any state a part of which is included in the emergency area).

While there’s still uncertainty with respect to the continuance of these waivers, a few of these trends might just stay around even after the pandemic subsides. 

What Telehealth Utilization Trends can Remain the Same Post PHE?

1) Relaxations Pertaining to Telehealth Licensure Might Be Underway 

One of the most notable benefits of telehealth adoption is that it can connect patients and providers irrespective of their physical locations. 

On the contrary, licensure laws limit the geographic footprint of aspiring virtual care providers, while also restricting patients to only be able to choose between doctors that have a license in their state of residence. 

A few states have, in the past, already made attempts to get past the artificial barriers employed in place at the state boundaries by joining the Interstate Medical Licensure Compact. 

As more and more care providers adopt telemedicine and attempt to make virtual care delivery more seamless, healthcare experts are now predicting that states may soon relax telehealth licensure requirements across the country.

2) Telehealth Coverage May Go Down to Become a Widely Accepted Practice

While the waivers currently in effect will be rendered invalid once the emergency subsides, elected officials will have reason to think about more enduring regulatory changes. This is especially true since the country can use telehealth expansion to achieve huge market savings. 

These savings can primarily be achieved by lifting restrictions on telehealth coverage and reimbursement and prohibiting commercial payers from imposing similar coverage and reimbursement restrictions.

Telehealth has effectively exhibited its potential on all fronts of medicine: right from making specialized care more accessible for people with chronic diseases to streamlining primary care visits. Therefore, healthcare leaders are now urging that post-COVID, Congress address the geographic expansion for greater telehealth access. 

Once this has been achieved, reimbursement will soon follow. 

3) Telehealth Services May Be Billed at Rates Similar to In-Person Visits

While generally, telehealth services have almost always been reimbursed at rates that are far lower when compared with in-person visits, the former is slowly catching pace, especially since the onset of the coronavirus pandemic. 

This has mainly been made possible because in March 2020, CMS allowed providers to offer many additional healthcare services via telehealth (as mentioned above) and charge for a telehealth visit at the same rate as an in-office visit.

This waiver has served as a wake-up call of sorts for providers who weren’t initially favoring telehealth, or did not see it as an effective solution. 

As more and more providers continue to move towards telehealth to maintain contact with patients during the pandemic, they are also experiencing its benefits firsthand – from being able to acquire a patient base beyond geographical barriers, to sustaining or even growing their practice further, and more. 

In addition, there are many economical benefits for both patients as well as providers that come alongside the implementation of telehealth, such as less administrative and staffing costs and negligible to no commute costs. 

As such, a lot of industry experts are hopeful that Congress will permanently adopt billing for telehealth services that are well within the range assigned for in-office or in-person visits, even after the public health emergency subsides.

Closing Words

All in all, virtual care delivery is a valid care mechanism and has, now more than ever, exhibited immense potential as an invaluable means to make the shift toward patient-centric, value-based care seamless. 

Telemedicine can help provide much needed care to those in rural areas and also offer cost effectiveness in doing so. It is about time that regulatory bodies stop restricting providers from embracing it. We’ve come this far and there should be no going back from here. 

Efforts should only be made to better this technology moving forward, and not restrict it.