Recent Developments in Reimbursement for Telehealth Including COVID-19 Guidelines: An Update

This webinar by Physician Attorney Joseph P. McMenamin, will focus on changes in reimbursement for telehealth services in the United States with emphasis on changes in the Medicare program, which of course is a dominant player in reimbursement generally. Although the statutorily imposed restrictions on Medicare reimbursement under § 1834 (m) remain good law, since 2015 multiple changes have been made that substantially increase opportunities for reimbursement. Some of these appear to reflect a conscious effort on the part of CMS to expand access to care through distance care technologies.  These changes include the advent of chronic care management, the relaxation in a number of circumstances of the restrictions on where the patient is (including both the zip code and the building he is in at the time), the addition of new reimbursable codes, the ability of MA plans to offer telehealth as a basic benefit, promotion of remote patient monitoring, the initiation of reimbursement for communications technology based services, and new efforts to combat substance use disorder, renal failure and stroke by expanding access to telehealth.

During the webinar, Joe will also discuss developments in Medicaid reimbursement, examining the variability from state-to-state with respect to services covered, permissible modalities, geographic limitations, establishment of the provider-patient relationship, eligible providers, etc.

Finally, the presentation will examine the current state of reimbursement by commercial carriers, and the status of parity laws in the U.S.

With the advent of COVID-19, the Secretary’s Jan 31 announcement of a Public Health Emergency, and the President’s March 13 announcement of a National Emergency, extensive if temporary changes have been made in the reimbursement rules. Although the most sweeping changes have occurred in Medicare, we are also seeing substantial modifications in rules applicable to Medicaid programs and in the approaches taken by commercial health insurers. The rate of change in these rules is unprecedented. Given the importance these changes portend, however, the presentation has been revised to capture all the most significant reimbursement developments through COB 23 March 2020.

Webinar Objectives

After attending this information-packed webinar, you will be able to understand restrictions on telehealth reimbursement under Medicare, Medicaid, and commercial insurance and how to take advantage of recent changes that, while not eliminating existing barriers, nevertheless expand access to financial support for these services.

Attendees will also be able to understand the requirements now applicable to reimbursement during the COVID-19 pandemic.

Webinar Agenda

• Medicare’s traditional restrictions
• The rationale for those restrictions
• The emergence of chronic care management and the rules concerning reimbursement for it
• The provisions of the Balanced Budget Act of 2019 relevant to telehealth reimbursement
• CMS’s new approach to reimbursement for distance care
• The effect that has had on communication technology-based services
• Evolution in the rules governing acceptable originating sites
• OIG’s 2018 audit
• Recent indictments
• Recent developments in Medicaid reimbursement rules
• Recent developments in commercial carriers’ receptivity to covering telehealth
• Parity laws in the several states
• Medicare’s Intra-Pandemic Rules
• Medicaid’s Intra-Pandemic Rules
• Pandemic- Related Changes in Private Health Insurance

Who Should Attend

• Revenue integrity professionals
• Revenue cycle professionals
• In-house counsel and CFOs at telemedicine organizations
• In-house counsel and CFOs at medical facilities offering telehealth services
• Billers and Coders