The White House recently announced a two-year extension for telehealth waivers, but higher telehealth coverage for physicians and hospitals is only approved through the end of 2023. The discrepancy has many hospitals and medical providers on edge.
Why Telemedicine Is Struggling for Telehealth Coverage
Many hospitals and health systems relied upon and therefore invested heavily in telehealth during the height of COVID-19. Executives invested in technology and infrastructure for telehealth to meet the unprecedented demand for telehealth services. Telehealth visits billed to Medicare are currently paid at the same fee-for-service rate as an in-person visit. Medicare added over 100 billing codes for the duration of the public health emergency.
Telemedicine Reimbursement Specifics
When the Centers for Medicare and Medicaid Services (CMS) develops the fee schedule, each code has three components:
- Work Relative Value Unit (RVU)
- Practice expense RVU, and
- Malpractice expense RVU.
When a service is performed in a facility (e.g., hospital, advanced surgical care or ambulatory surgery center, nursing home, outpatient department), the practice expense RVU is lower than in a “non-facility” such as a medical professional’s office. The lower RVU is paid because the practice does not have the expense for the overhead, staff, equipment, and supplies used to perform that service.
During the public health emergency (PHE), however, CMS reimbursed providers at the “facility” rate and created “payment parity” between an in-person and a telehealth visit. They paid higher rates for patients at home or at other non-medical sites. At issue is that telehealth rates may revert to pre-COVID, non-facility levels, and payment parity will disappear. As a result, patients will likely be required to come to the physician’s office for their routine services rather than using telehealth and remote patient monitoring technology both parties now have at their fingertips and have been using for years.
Before the pandemic, telehealth was only reimbursed…
