The Center for Connected Health Policy (CCHP) has created this video primer on how Medicare policy gets created, who can act to make changes and the difference between "telehealth" and "communications technology based services (CTBS)".
Medicare Telehealth Billing Resources:
- CCHP has also created Billing for Telehealth Encounters: An Introductory Guide on Medicare Fee-For-Service (March 2022)
- The Medicare Learning Network has put together:
- The Center for Medicare and Medicaid Services (CMS) has created a List of Telehealth Services payable under the Medicare Physician Fee Schedule when furnished via telehealth. This list was updated in February 2023. Everything on the list will be covered through the end of Calendar Year (CY) 2023. Updates for CY 2024 will be addressed through the normal Physician Fee Schedule update process. The fee schedule is updated annually and takes effect on January 1 or each year. Proposed changes are published in the Federal Register by November of each year.
- Any interested party (public or private) may submit requests for adding services to the list of Medicare telehealth services. To be considered, each request must address this list of items.
Resources Related to the Unwinding of the Public Health Emergency (PHE): During the PHE, individuals with Medicare had broad access to telehealth services, including in their homes, without the geographic or location limits that usually apply as a result of waivers issued by the Secretary, facilitated by the Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020, and the Coronavirus Aid, Relief, and Economic Security Act. “Telehealth” includes services provided through telecommunications systems (for example, computers and phones) and allows health care providers to give care to patients remotely in place of an in-person office visit.
The Consolidated Appropriations Act, 2023, extended many telehealth flexibilities through December 31, 2024, such as:
- People with Medicare can access telehealth services in any geographic area in the United States, rather than only those in rural areas.
- People with Medicare can stay in their homes for telehealth visits that Medicare pays for rather than traveling to a health care facility.
- Certain telehealth visits can be delivered audio-only (such as a telephone) if someone is unable to use both audio and video, such as a smartphone or computer.
Medicare Advantage plans may offer additional telehealth benefits. Individuals in a Medicare Advantage plan should check with their plan about coverage for telehealth services. Additionally, after December 31, 2024 when these flexibilities expire, some Accountable Care Organizations (ACOs) may offer telehealth services that allow primary care doctors to care for patients without an in-person visit, no matter where they live. If your health care provider participates in an ACO, check with them to see what telehealth services may be available.
The PHE officially come to an end on May 11, 2023. Here are a number of resources to help you prepare for the unwinding of the PHE which takes place in different stages between May 11 and December 31, 2024. Guidance and policies continue to be somewhat of a moving target so check back frequently for updates and changes and make sure you check the update date for all documents!
- Preparing for the End of the PHE - Provider Communication(the blog post is up to date, the timeline graphic is being revised)
- Frequently Asked Questions: CMS Waivers, Flexibilities and the End of the COVID-19 PHE
- Provider-Specific Fact Sheets about PHE Waivers and Flexibilities
- AAMC PHE Waivers and Flexibilities: Status Update
- PYA End of the PHE Compliance Checklist
- CTeL Telehealth Compliance Audit Checklist
CCHP has put together this video recapping state and federal telehealth policies in 2022 and what to look forward to in a post-PHE environment:
Medicare and the Anti-Kickback Statute and Stark Laws: There are several Federal fraud and abuse laws that apply to health care professionals. Two that have potential implications for telehealth include the Anti-Kickback Statute and Stark Law.
- Anti-Kickback Statute: This law prohibits the knowing and willful payment of "remuneration" to induce or reward patient referrals or the generation of business involving any item or service payable by Federal health care programs (e.g., Medicare). This practice is often known as "paying for referrals". For telehealth, this could mean "giving away:" software licenses, telehealth equipment, peripheral devices and more.
- Physician Self-Referral Law (Stark Law): This law prohibits physicians from referring patients to receive "designated health services" payable by Medicare ore Medicaid from entities with which the physician or immediate family member has a financial relationship, unless an exception applies.
- Office of Inspector General Special Fraud Alert: This special fraud alert asks practitioners to exercise caution when entering into arrangements with purported telemedicine companies.
- Comparison of the Anti-Kickback Statue and the Stark Law: This simple side by side comparison chart provides a good overview of each of these laws.