Challenges of New Medicare Telehealth Rules Amid COVID-19 Outbreak

New legislation signed last week to waive Medicare telehealth restrictions may present practical and operational challenges for seniors and medical practitioners alike, according to a recent blog post from the Alliance for Connected Care. 

Last Friday, Congress signed the Coronavirus Preparedness and Response Supplemental Appropriations Act which gave the HHS Secretary Alex Azar the power to dismiss any telehealth restrictions for Medicare beneficiaries. Policymakers intended for the law to create a new pathway for some seniors to receive care during COVID-19. 

Seniors are the most vulnerable population in regards to COVID-19, which means they need the most protection from the virus. The bill is a step in the right direction to address this issue, healthcare industry leaders have agreed.

Currently, practitioners only get paid if a senior is physically present in a facility located in a rural area, the blogpost highlighted. The patient’s home does not count as a facility which means that seniors are forced to travel to medical institutions for telehealth visits. In the current outbreak situation, this poses as a threat to patient health.  

But details contained in the new Medicare telehealth rules may spell trouble for providers and their patients, the Alliance for Connected Care stated.

The blog post touches on three specific challenges that may limit the number of seniors who can take advantage of the new legislation. These include challenges associated with the definition of a “qualified provider,” the fact that newly-eligible Medicare patients are not eligible, and free telehealth visits for Medicare patients may violate anti-kickback rules. 

To qualify as a medical provider who can receive payment for telehealth visits under the legislation, the provider must have a previous relationship with the patient, and they must have provided a service within the three years prior. This barrier makes it difficult to offer covered telehealth visits in Medicare.

Hospitals often contract with vendors to provide telehealth services under their care umbrella. It is hard to determine a relationship because vendors are not usually linked to the hospital EMR or claims database, the blogpost stated. If a hospital doesn’t work through a vendor, the clinician must start an office visit with a look-back at claims data to determine eligibility. If the clinician doesn’t do this, they risk incurring a false claim.

Additionally, a provider from another part of the hospital or physician group must identify under the same Tax ID Number (TIN) as the provider who is linked to the patient. If there has not been a covered claim under a different TIN, Medicare will not cover the telehealth visit. 

The legislation was implemented in a way that makes the provider’s prior relationship with the patient a Medicare relationship. If a 65-year-old patient had commercial insurance and visited their primary care doctor, the visit wouldn’t count toward the previous relationship requirement because it wasn’t covered by Medicare.

To tap into patient-centered care, hospitals around the country may provide coronavirus-related care at no cost to the individual. But hospitals are not able to give the Medicare patient the visit for free, as CMS would consider this an incentive under Medicare rules. Unless CMS waived the rules, free care could be considered a violation of anti-kickback rules.

But the blog post emphasized that the administration should waive the rules during the COVID-19 epidemic, although they commend them on their ongoing effort to reduce any anti-kickback barriers to value-based care.

The healthcare industry continues to lean on telehealth to tackle COVID-19. Spectrum Health recently announced that it is now offering free virtual screenings for individuals in Michigan who may be experiencing COVID-19 symptoms.  

Patients can call and schedule a free virtual screening through the health system’s telemedicine service. Spectrum Health providers will ask individuals a set list of questions to decipher if they are a candidate for additional provider care. 

“We want to provide a community health service for people who may have symptoms and are concerned about the virus, while allowing them to stay at home and prevent the spread of the illness,” Darryl Elmouchi, MD, MBA, chief medical officer and president at Spectrum Health, said in the announcement.

Other providers, as well as payers and telehealth vendors, are increasingly used the power of technology to battle COVID-19, which has affected 647 individuals and led to 25 deaths in the US, according to the latest numbers from the CDC.