Medicare telehealth reimbursement returns to pre-COVID framework
Without a deal in place to extend the deadline for Medicare telehealth flexibility, those laws have officially expired as of Oct. 1—the same day the federal government began its shutdown, following a dispute between congressional leaders over extending subsidies to health plans purchased through the Affordable Care Act marketplace.
The missed deadline means Medicare patients will have difficulty getting access to primary and specialty care through telehealth visits, as there’s no guarantee providers will be reimbursed.
COVID-era legislation allowed physicians to bill Medicare for virtual visits at rates similar to in-person care, offering elderly patients the option of skipping an office visit for certain appointments that don’t require a physical examination.
This was made possible in part due to the removal of geographical barriers placed on Medicare. Patients were, until Wednesday, allowed to seek and receive billable care from physicians and medical professionals outside their local areas—including across state lines.
In some cases, this made it easier for patients in rural areas to seek care, as many live far from the nearest physicians’ office or hospital.
The new framework also allowed providers to bill for the time they spend with patients virtually, without fear of a claims denial from the Centers for Medicare & Medicaid Services (CMS), which before COVID placed heavy restrictions on telemedicine reimbursement.
Those old rules are now officially back in place. As confirmed by the U.S. Department of Health and Human Services’ telehealth website, all Medicare billing flexibilities officially expired after Sept. 30.
Telehealth trade group calls for immediate action
In response, the American Telemedicine Association (ATA)—the industry lobby made up of provider groups, hospitals and technology companies—wrote an open letter to Congress, urging them to immediately take action to pass the extension, something considered a mere formality at this point.
“These flexibilities have been in place since 2020, and this is the first time they have lapsed, creating widespread concern and disruption among providers and patients about the future of access to care,” the organization wrote.
It noted that, for now, many providers and health systems are continuing to offer televisits to Medicare patients, under the assumption they will be reimbursed by CMS once the extension is passed. However, that calculated risk to continue care ultimately depends on “Congressional action to restore telehealth,” the ATA said.
Its full letter is available here.
Chad is an award-winning writer and editor with over 15 years of experience working in media. He has a decade-long professional background in healthcare, working as a writer and in public relations.