You may have avoided telehealth pre-COVID as it didn’t reimburse enough, or at all. Then COVID made it essential to use telehealth to provide continuity of care. Now, you’re not clear what temporary reimbursement and regulatory changes will become permanent. What to do?
Keep Calm and Telehealth On.
There’s no temporary telehealth – what you’re building will be permanent and part of a hybrid practice. You can “solve for reimbursement” by asking yourself these questions.
- Based on your entity type, what types of telehealth can you be reimbursed for?
- For example, Federally Qualified Health Centers and Rural Health Center are currently limited to reimbursement for telehealth codes that do not include remote patient monitoring
- How much will each of your insurers pay?
- It will differ by insurance type and the contracts you have with the private payers. See what Medicare Fee For Service covers.
- Read guidance for physicians regarding CMS coverage during COVID-19
- What are the telehealth CPT codes for the services you will provide?
- What is predicted for post-Public Health Emergency reimbursement for your type of entity? How likely is it that changes will be made permanent?
- There are several bills brought forward in Congress to make the pandemic changes to reimbursement and regulations permanent. On June 17, 2020, The US Senate Committee on Health, Education, Labor and Pensions held a hearing titled Telehealth: Lessons from the COVID-19 Pandemic to discuss this.
- What other sources of virtual care revenue are available to you that might jumpstart or support your telehealth program?
- One example is a Medicare reimbursable Chronic Care Management (CCM) service, which consists of non-face to face care coordination for qualified individuals with two or more chronic conditions.
- Do you have the ability to sustain some revenue loss in order to gain experience with telehealth?
- While we and many others are hopeful and anticipate that telehealth and remote monitoring reimbursement will become fuller in time, many clinics and practices are deciding not to wait. First movers have an advantage, and there is great value in starting to create a hybrid practice now.
Which Public Health Emergency Actions Will Become Permanent?
The Center for Connected Policy prepared a very useful chart on the Federal COVID-19 Actions and what would be required to make them permanent.
If you need help designing a reimbursement strategy, a financial pro forma or ramp up a schedule, keep calm! Telehealth Associates can help. Contact us at 888-458-1275.