Payment for Telehealth and Telephone Consultations During COVID-19

ACP Chapter Action Tool Kit

Prepared by ACP’s Division of Governmental Affairs and Public Policy

January 22, 2021

Summary

To help ensure access to care, during the COVID-19 health emergency, the Centers for Medicare and Medicaid Services (CMS) has lifted many of the Medicare barriers to telehealth by expanding coverage and paying for telehealth services including telephone (audio-only) calls at in person rates. Patients can be at home and non-HIPAA compliant technology is allowed. In addition, to encourage use by patients, Medicare is allowing practices to waive cost-sharing (copays) for all telehealth services, and many of the prior authorization activities are being paused.

Key changes include:

  • During the COVID-19 public health emergency, Medicare will pay physicians for telehealth services at the same rate as in-person visits for all diagnoses, not just services related to COVID-19.
  • Medicare will pay physicians for audio-only telephone calls and has greatly expanded the list of covered telehealth services to include emergency department visits, for example.
  • Patients can receive telehealth services in all areas of the country and in all settings, including at their home.
  • CMS will not enforce a requirement that patients have an established relationship with the physician providing telehealth.
  • Consent for telehealth services may be obtained by staff or the practitioner at any time, required only once on an annual basis.
  • Physicians can reduce or waive cost-sharing for telehealth visits.
  • Physicians licensed in one state can provide services to Medicare beneficiaries in another state. State licensure laws still apply.
  • Physicians can provide telehealth services from their home. Physicians do not have to add their home to their Medicare enrollment file. 
  • HHS’ Office for Civil Rights (OCR) offers flexibility for telehealth via popular video chat applications, such as FaceTime or Skype, during the pandemic.

ACP has urged CMS and congressional leaders to maintain many of these interim policies and waivers at least through the end of 2021, or until such a time when effective vaccines and treatments are widely available, with an option to extend it even further, or consider making permanent, based on the experience and learnings of patients and physicians who are utilizing these service.

Not all payers/plans are in line with Medicare’s new rules. Some payers, including Medicaid, fully insured plans, self-insured plans, association health plans (AHPs) and short-term limited-duration insurance (STLDI) plans, do not expand coverage and payment for all telehealth or telephone services.

ACP believes that:

Congress should require that all payers cover and pay for audio-only telephone consultations between physicians and their patients, at the same rate as an established patient in-office visit.  While virtual telehealth visits may be covered in many cases by insurers, the service requires equipment with both audio and video capability and does not include traditional audio-only phone calls with patients. Not reimbursing for telephone visits (99441-99443)—at a payment level on par with in-person visits—disproportionally affects physicians and practices taking care of elderly and underserved patients. Many of these patients are managing multiple chronic conditions, do not have smartphones, or may have a smartphone, but do not know how to use FaceTime or Skype. As physicians convert in-person visits to virtual ones, practices are experiencing huge reductions in revenue while still having to pay rent, meet payroll, and meet other expenses without patients coming into their practices.

Requiring all payers to cover and reimburse physicians for audio-only telephone visits at the same rate as an established patient in-person visit (99212-99214), will ensure that patients without advanced video-sharing capabilities are able to get care virtually, while helping to sustain physician practices.

Additionally, telehealth and telephone visits should include payment for the Medicare annual wellness visit ((G0438 and G0439 and the preventive medicine service visits (annual physicals new patients 99381 – 99387 and established patients 99391 – 99397). These visits are vital to the physician in determining the general status of a patient’s health. The visit also gives the patient the opportunity to talk to the physician about any ongoing pain or symptoms that the patient may be experiencing or any other health concerns that patient might have. This allows the physician to detect at an early stage any concerning symptoms that may be addressed before escalating into a more serious condition.

Requiring all payers to cover and reimburse physicians for audio-only telephone calls will ensure that patients without advanced video-sharing capabilities are able to get care virtually, while helping to sustain physician practices.

ACTION:

ACP Chapters should urge insurers, Medicaid directors, and state officials and legislators to:

  • Ensure broad coverage and payment for all telemedicine services by all plans  and payers, including Medicaid, fully insured plans, self-insured plans, association health plans (AHPs) and short-term limited-duration insurance (STLDI) plans.
  • Temporarily allow coverage and payment for all telemedicine modalities, including voice only telephone calls in the state Medicaid programs (as enacted by CMS).
  • Suspend requirements that an existing patient-physician relationship must be established prior to the provision of telemedicine services. 
  • Ensure that telemedicine visits including audio-only phone calls are treated the same as in-person visits and paid at the same rate as an in-person visit.   
  • Provide coverage and payment of COVID-19-related telemedicine services with no cost-sharing (co-pays, co-insurance, deductibles). 
  • Suspend any restrictions on telemedicine, including types of services,  originating sites and geographic limitations for telemedicine services. 
  • Suspend annual limits imposed on telemedicine services. 
  • If not already covered, temporarily expand physician’s medical liability coverage to include telemedicine. 
  • Ensure patients have access to telemedicine from the physician of their choice, if that physician makes it available. Allow physicians to provide telemedicine services directly to their patients, without requiring they contract with specific telemedicine service.
  • Temporarily waive licensure requirements for out-of-state physicians, including those providing telemedicine across state lines (especially in areas of the country that are experiencing a surge in coronavirus patients) to address workforce shortages.

Resources: