As telehealth becomes more popular, current pay structures have had to adapt to ensure that patients can afford telehealth services. Medicare has expanded coverage to allow virtual visits, particularly for patients for whom traveling to a doctor is difficult. This expanded coverage brings the convenience and safety of telehealth to more people who rely on Medicare to pay for their doctor visits.
Let's look at how Medicare and telehealth intersect and the most critical aspects that you need to know about in your practice.
1. What Does Medicare Cover for Telehealth?
Medicare part B covers non-hospital medical procedures and costs, including doctor visits — where your telehealth visits will fall. Patients who qualify for part B can connect virtually with various medical providers, including general practitioners, nurse practitioners, specialists, etc.
Medicare Part B also pays for psychotherapy, counseling, and various other mental health visits. Patients must talk to their provider first to determine exactly what's covered.
Medicare Part C Advantage
Patients who expand their coverage with Part C have access to even more covered medical procedures. Again, they should consult with their insurance company to determine what services are covered in terms of telehealth visits.
2. Telehealth Still Requires Coinsurance Costs
Patients who interface virtually are still responsible for coinsurance costs, and the Medicare Part B deductible needs to be reached as well. Your telehealth platform must be set up to bill Medicare, so the process is simple and seamless for you and your patients.
Facility Restrictions
Medicare patients must have an established relationship with the physician and need to go to a facility to meet with you first for an initial evaluation (EV). The facility might be a skilled nursing facility, rural health center, a hospital, or another facility that has the equipment to take diagnostics. In many cases, however, these facilities will be more accessible or closer to the patient than the doctor, so there will still be a benefit of convenience.
3. Expanded Medicare Programs
For some conditions, the restrictions on telehealth through Medicare have been eliminated as of 2018. These conditions are allowed under Medicare, specifically with some restrictions.
End-Stage Renal Disease (ESRD)
Patients requiring dialysis, whether at a facility or home, can use telehealth to speak with their doctors for checkups related to ESRD. The only caveat is that patients will still need to see a doctor in person every three months. People with ESRD are often less mobile, and these changes to Medicare allow them to avoid trips to see their doctor regularly when all they might need is to speak remotely.
Accountable Care Organizations (ACOs)
ACOs ensure that people with chronic conditions don't miss out on necessary medical procedures, medicine, or visits. The patients are often unable to care for themselves fully or have a chronic illness, so telehealth has been expanded to them under Medicare. Unlike other service expansions, location restrictions are not a factor with ACO-related telehealth visits, which is a boon for homebound patients.
Stroke Care
Because every second matters when you have a stroke, telehealth isn't restricted under Medicare when it comes to stroke care. Telehealth can help diagnose and direct your care when you're concerned about stroke symptoms. It's an invaluable tool in the fight against long-term stroke damage and death.
4. COVID-19 Has Changed Some Aspects of Medicare and Telehealth
Because of the risk that COVID-19 infection poses to many people on Medicare, some restrictions were lifted during the pandemic. For instance, patients can get telehealth services in their homes, even when they'd typically have to go to a facility. Patients can also see a telehealth provider, regardless of whether they're the patient’s primary care physician.
Tremendous Benefits for Medicare Recipients
For both Medicare and non-Medicare patients, telehealth presents an opportunity for easy access to medical care. Remote visits are safer in the time of COVID-19, convenient, and are an excellent fit for chronic care patients like those who undergo dialysis. In general, Medicare has made a great connection with telehealth, and though there are restrictions, they are not prohibitive enough to hamper the adoption of virtual visits for Medicare patients.
If you're interested in including telehealth in your practice and have Medicare patients you're concerned about, let ViTel help ease your mind. From patient intake and care to billing Medicare, we have you covered with a virtual medical platform for all types of practitioners. Contact us today and see the difference ViTel can make.
