Michael McLafferty, CPA, MBA, FACHE, FHFMA, FACMPE, CEO and founder, MJM Advisory and Educational Services, LLC
| April 15, 2020
The Trump Administration recently announced expanded Medicare telehealth coverage that will enable beneficiaries to receive a wider range of healthcare services from their doctors without having to travel to a healthcare facility. This is especially helpful amid the coronavirus pandemic and provides an opportunity to show how valuable telemedicine services are in our society. We believe this expanded coverage will provide Medicare with the data it needs to justify the payments made to providers utilizing telemedicine to treat their patients.
On March 6, 2020, Medicare — administered by the Centers for Medicare & Medicaid Services (CMS) — temporarily paid clinicians to provide telehealth services for beneficiaries residing across the entire country. On March 13, 2020, President Trump announced an emergency declaration under the Stafford Act and the National Emergencies Act. Consistent with President Trump’s emergency declaration, CMS is expanding Medicare’s telehealth benefits under the 1135 waiver authority and the Coronavirus Preparedness and Response Supplemental Appropriations Act. Access the CMS Fact Sheet here: https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet.
Prior to this, Medicare was only allowed to pay clinicians for telehealth services such as routine visits in certain circumstances. For example, the beneficiary receiving the services must live in a rural area and travel to a local medical facility to get telehealth services from a doctor in a remote location. In addition, the beneficiary would generally not be allowed to receive telehealth services in their home.
Now, a range of healthcare providers, such as doctors, nurse practitioners, clinical psychologists, and licensed clinical social workers, will be able to offer telehealth to Medicare beneficiaries. Beneficiaries will be able to receive telehealth services in any healthcare facility including a physician’s office, hospital, nursing home or rural health clinic, as well as from their homes.
Medicare beneficiaries will be able to receive various services through telehealth including common office visits, mental health counseling, and preventive health screenings. This will help ensure Medicare beneficiaries, who are at a higher risk for COVID-19, are able to visit with their doctor from their home, without having to go to a doctor’s office or hospital which puts themselves or others at risk.
For CPAs who work in the medical field or whose clients work in the medical field, this also means easier payment processing. Clinicians can bill immediately for dates of service starting March 6, 2020. Telehealth services are paid under the Physician Fee Schedule at the same amount as in-person services. Medicare coinsurance and deductible still apply for these services. Additionally, the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services is providing flexibility for healthcare providers to reduce or waive cost-sharing for telehealth visits paid by federal healthcare programs.