Telemedicine Pays: Billing and Coding Update

Abstract

Purpose of Review Telemedicine is a rapidly growing healthcare sector that can improve access to care for underserved populations and offer flexibility and convenience to patients and clinicians alike. However, uncertainty about insurance coverage and reimbursement policies for telemedicine has historically been a major barrier to adoption, especially among physicians in private practice (the majority of practicing allergists). Recent Findings The COVID-19 public health emergency has highlighted the importance of telehealth as a safe and effective healthcare delivery model, with governments and payers rapidly expanding coverage and payment in an effort to ensure public access to healthcare in the midst of an infectious pandemic. This comprehensive review of updated telemedicine coverage and payment policies will include a tabular guide on how to appropriately bill and optimize reimbursement for telemedicine services. Summary This review of current trends in telemedicine coverage, billing, and reimbursement will outline the historical and current state of telemedicine payment policies in the USA, with special focus on recent policy changes implemented in light of COVID-19. The authors will also explore the potential future landscape of telehealth coverage and reimbursement beyond the resolution of the public health emergency.

Telemedicine in Rheumatology at the Advent of the COVID-19 Pandemic

“…This was an important step to expand the use of telemedicine in a world of stay-at-home orders. Prior to the pandemic, telemedicine was limited by regulations and restrictions in geography, coverage, and payment [2]. However, commercial health insurance generally followed the lead of CMS in reimbursement of telemedicine services (variability exists at state and payor level).…”

The Use of Telemedicine and Other Strategies by Registered Dietitians for the Medical Nutrition Therapy of Patients With Inherited Metabolic Disorders During the COVID-19 Pandemic

“…Telemedicine implementation during COVID-19 was facilitated in the US by relaxation in Centers for Medicaid and Medicare Services (CMS) regulations about circumstances in which a healthcare provider can bill for telemedicine ( 19 , 20 ). Even though RDs reported being highly satisfied with virtual visits, it is not clear how sustainable telemedicine will be if CMS rules return to pre-COVID-19 status after the pandemic is over.…”

“…The types of patients seen via telemedicine included patients with positive results on newborn screening (45.8%), newly diagnosed patients other than newborn screening (40.6%), hospitalized patients seeking nutrition counseling (11.4%), follow-up patients (99.0%), and research participants (10.4%). However, approximately two-thirds of RDs (68.4%) reported that there are patient populations that cannot be seen via telemedicine, including newly diagnosed patients (45.5%), 19), patients with language barriers (n = 7), patients who lack knowledge of or comfort with technology (n = 4), patients using Palynziq R (pegvaliase-pqpz) (12) (n = 2), patients who need labs or exams that cannot be otherwise coordinated (n = 2), and children in foster care (n = 1). Patients seen via telemedicine who required a blood draw for monitoring received phlebotomy services at the following locations: the originating site (46.9%), a local laboratory (87.5%), their primary care provider's office (37.5%), and other (36.5%).…”

Telehealth in pediatric rehabilitation medicine: A survey of clinician reported utilization and experience

“…Interestingly, Sisk et al [9] also found that the condition most likely to lead to adoption of telehealth was being paid for services, with 53% of nonusers reporting they would consider using telehealth if they were adequately compensated. Relaxation of telehealth practice and billing regulations since COVID-19 as well as increased payments are likely contributors to the robust increase in telehealth adoption [17].…”