by Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
Apr 12th, 2022
Because of the COVID-19 public health emergency (PHE) beginning in 2020, healthcare organizations experienced an enormous push towards creating and expanding opportunities for more and varied types of telehealth services. Expansion of broadband internet, new state regulations such as parity laws to ensure healthcare providers are able to receive adequate payment for services performed via telehealth, and new guidance created to govern access to and the use of telehealth services has been exponential. Reports indicate that the Department of Health and Human Services (HHS), Office of the Assistant Secretary for Planning and Evaluation (ASPE), who performed the analysis of the Medicare fee for service (FFS) data for 2019-2020 noted, “Medicare visits through telehealth in 2020 increased 63-fold, from approximately 840,000 in 2019 to 52.7 million” an increase that continued to grow upwards of 11,000%. Anytime there is such increased use in an area of medicine there is likely to be an increase in fraudulent behavior as well.
Increased use of telehealth services also resulted in petitions for states who had not yet passed laws defining telehealth services (e.g., access, scope of practice, parity) to pass these laws facilitating access and provider reimbursement. Parity means equality, so when states pass parity laws relating to telehealth, it means that payers must reimburse for telehealth services in the same manner they do an equivalent in-person encounter, as the criteria for the service being reported is met and supported in the medical record.
At the start of the PHE, CMS made changes to the guidelines regarding who, what, where, when, and why Medicare beneficiaries could receive telehealth services. Some changes were specific to HIPAA-approved software and devices, consents, place of service, and pretty much all things related to billing telehealth services. CPT, HCPCS, and ICD-10-CM all published new codes, modifiers, and coding guidelines, not just once, but several times throughout 2020-2021 because of the PHE. Some changes, while temporary, have been so successful that CMS is considering making them permanent. Other changes that were specific to the PHE are slated to end on the last day of the year in which the PHE is declared over.
Medicare maintains and publishes an updated list of approved telehealth services, which can be accessed by clicking HERE. As this list constantly changes, it is important to review this list at least monthly to ensure ongoing compliance and prevent the risk of unnecessary claim denials. It is also important to keep on top of the changes published by the many commercial payers (e.g., United Healthcare, BCBS) as one payer’s rules may differ from another as well as the dates such changes occur.
Each year, the Office of Inspector General (OIG) outlines the various projects (e.g., audits, investigations) it will be performing and for 2021-2022, telehealth is at the top of the list as follows:
Auditing Telehealth Services
Auditing Part B services performed during the public health emergency (PHE)
Auditing home health telehealth services
Because of the PHE and the significant changes and ongoing changes to access and reporting, criminals have successfully embarked on tricking Medicare beneficiaries into illegal and/or compromising situations, putting their personal health information at risk or taking advantage of them through telemarketing schemes.
While it is important to maintain current standards of care through the use of telehealth services no matter which payer our patient’s have coverage through, it is also just as important that we maintain detailed records of the changes that have occurred in the process and the dates on which those changes went into effect for retrospective audit reviews and to help protect providers during an audit by any payer.
At the close of the PHE related to COVID-19 we anticipate continued and even expanded use of telehealth services; but these will come with significant changes in coverage, billing, and guideline changes. Some codes will fall off the coverage list while new modifiers, such as the addition of modifier 93 (effective January 1, 2022) will continue to be added for better definition and reporting of the telehealth services provided.
For additional information on reporting telehealth services, consider signing up for the upcoming Find-A-Code informational webinar, “Reporting Telemedicine Services” scheduled for April 14, 2022 at 11:15 am Mountain Standard Time (MST).