How can Medicare beneficiaries utilize telehealth during the coronavirus crisis?

How can Medicare beneficiaries utilize telehealth during the coronavirus crisis?

Medicare significantly expanded telehealth benefits for the duration of the coronavirus crisis.

Prior to the public health emergency, Original Medicare covered telehealth visits only if they took place through a video-based teleconference. (Telehealth also had to be delivered using HIPAA-compliant software.) Beneficiaries needed to live in a rural area to be eligible, and had to travel to a facility-based “originating site” to have their visit.

Due to the public health emergency, telehealth was temporarily available to all Original Medicare beneficiaries – not just those in rural areas – and Medicare enrollees could connect through software platforms such as FaceTime and Skype. However, after the public health emergency ends on May 11, 2023, enrollees will need to again utilize HIPAA-compliant software. Check with your healthcare provider to see whether they have a preferred platform for telehealth.

Can Medicare beneficiaries use video when connecting?

Due to technology and time constraints, not everyone is easily able to have a video-based visit. This is why the Centers for Medicare and Medicaid Services (CMS) temporarily reimbursed providers for audio-only phone calls at the same rate as in-person care during the public health emergency. (Visits using video-based telecommunications will are paid at the in-person rate).

Depending on your healthcare provider’s preference and your own comfort with technology, you may prefer the flexibility of an audio-only visit.

This will change as the public health emergency comes to an end on May 11, 2023. Providers will continue to be paid at in-person rates through December 31, 2024. Audio-only visits will continue through the end of 2024 as well, although only behavioral and mental health serviceswill be covered in 2025 and beyond.

Will I be charged for using telehealth to communicate with my doctor?

Medicare Advantage plans cover the same telehealth care Original Medicare covers, and some plans cover additional telehealth services as a supplemental benefit.

You’ll generally owe cost sharing for telehealth in both Medicare Advantage (which typically requires a co-pay) and Original Medicare (which requires the beneficiary to pay the Part B deductible and coinsurance) – unless the encounter is for Medicare preventive services, which would be covered in full. Visits to screen for COVID-19 had no cost-sharing during the public health emergency but will after the PHE ends on May 11, 2023. Keep in mind that Medigap can cover your coinsurance if you have Original Medicare (and if you have Medigap Plan C or F, it will also cover your Part B deductible).

CMS encouraged Advantage plans to waive co-pays for telehealth during the PHE, and many agreed to do this for services beyond just screening or treatment for COVID-19. (Advantage plans are required to waive co-pays for coronavirus screening visits, but not for treatment.)

What costs should I anticipate for a phone consultation?

As mentioned above, under its new policy Original Medicare will pay the same amount for a telephone visit as it would pay if you saw your doctor in-person, meaning you’ll owe 20% of the Medicare-approved rate if you have Original Medicare. (Costs will vary in Advantage plans.)

Because Medicare is currently paying higher rates for phone-based care, more people may have received bills for telephone interactions – something that was previously free of charge. This means you may owe cost sharing for “routine” provider calls that had previously been complementary. CMS allowed providers to waive co-pays for telehealth visits during the coronavirus emergency. If you’re concerned about your costs, talk with your provider.

Do I have to get an appointment to set up a session?

Telehealth visits with your primary doctor can be set up the same way you’d establish any other appointment – by calling your provider or contacting their office through its online portal. As with other healthcare visits, it helps to make a list of the topics you wish to discuss in your session.

What types of care can I receive via telehealth?

Original Medicare now pays for more than 250 (more than 80 with audio-only coverage) when provided using telehealth. In addition to primary care and other office visits, that coverage includes:

• Emergency room visits – Patients can have non-COVID-19 illnesses managed remotely to avoid exposure to coronavirus, for example.
• Observation and inpatient hospital care – Doctors can visit remotely with hospitalized patients if they’re potentially infectious.
• Physical and occupational therapy – Your therapist can work with you via videoconference.
• Licensed clinical social worker and clinical psychologist services – You can continue mental health or addiction counseling from home.

Home healthcare and hospice providers can also provide some services using telehealth, as long as they don’t replace necessary in-person care specified in the patient’s plan of care. CMS has also made clear that telehealth visits can fulfill “face-to-face” visit requirements for obtaining Medicare coverage for hospice or home health. Furthermore, CMS has implemented the provision in the CARES Act allowing nurse practitioners, certified nurse specialists, and physician’s assistants to certify and oversee a home healthcare plan of care, meaning more types of practitioners can now help you recover from injuries at home.

In April 2020, CMS said it was further expanding the types of providers that can offer services over telehealth to include all providers (this was previously restricted to only a few types of providers specified in the law). This means physical, occupational, and speech-language therapists can safely care for more patients during the emergency.

CMS is also temporarily allowing Medicare patients enrolled in partial hospitalization programs to receive the individual and group therapy and educational counseling components of those programs from home, either by phone or telehealth. Similarly, patients enrolled in an opioid treatment program (methadone clinic) can participate in therapy sessions and periodic assessments while at home.

Some providers may still prefer to meet with you in-person or prefer video-based teleconferencing to a phone call. This will be up to you and your provider.

Physical therapists, occupational therapists, speech language pathologists, and audiologists will be allowed to provide telehealth services through December 31, 2024. After that, they will not be approved providers for telehealth coverage.

Are only established patients eligible for telehealth?

Original Medicare is covering office visits via telehealth for both new and established patients during the public health emergency; until now only established patients were eligible. (Specifically, CMS said it would not check for compliance with the requirement that telehealth be provided only to established patients treated within the past three years. The requirement itself is unchanged.) Medicare Advantage plans are allowed to cover additional telehealth services beyond their approved 2020 benefits. It is best to check with your insurer if you have Medicare Advantage.

After the PHE ends, people receiving medical care must be established patients as they were before. However, anyone can continue to receive mental health services without an in-person visit, at least through December 31, 2024.

Will my doctor be able to examine me visually by computer?

Many types of healthcare can be provided using telehealth. Because of its promise during the coronavirus pandemic, organizations like Aledade are working with medical providers to help them scale their telehealth capabilities.

Although your doctor will be able to see you and you’ll be able to communicate about your symptoms during a telehealth visit, not all care can take place virtually. Your doctor will be unable to do things like physically examine you or check your temperature and blood pressure. (You may be asked to monitor these things yourself.)

Do I need to have complicated equipment, software, and a strong internet connection?

You’ll want to make sure you have a stable internet connection for your video call and give yourself time to install any software needed to communicate with your provider. The provider may send a link before your visit to download the teleconference software.

Are there other types of remote care available?

Providers can offer remote patient monitoring, where technology is used to keep tabs on health conditions, to more types of patients – including those with a single health condition. (This was previously limited to patients with multiple chronic needs.) If you’re being treated for COVID-19 and are at home, your provider will be able to remotely monitor your oxygen saturation using a pulse oximeter (a device that fits on your finger to measure the amount of oxygen in your blood). This could be an important way to check that your lungs and breathing are recovering.

Virtual check-ins (communication by phone or other device) and e-visits (communications with your doctor using an online patient portal) are also temporarily available to both new and established patients. These services had previously been limited to established patients only.