Proposed Rule: Expanded Telemedicine Benefits for Medicare Advantage Beneficiaries

by  Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
Feb 14th, 2019

Telemedicine continues its rise, with new technologies allowing for better communication and access to more aspects of healthcare than ever before. Each year Medicare has made strides, albeit small strides, in their telemedicine coverage while commercial payers continue to make great strides, constantly improving and expanding telemedicine service offerings to their beneficiaries to promote accessibility and increase their beneficiary health profiles. Among these commercial payers are those that offer Medicare Advantage (MA) policies. MA policies allow original Medicare beneficiaries to enroll in a Medicare plan governed by a commercial payer who also offers extended benefits for a supplemental premium paid for by the beneficiary. Where original Medicare doesn’t include dental or vision benefits, the MA plan will for a slight increase in the beneficiary’s premium. The MA plans are also offering extended telemedicine services (Part B services not telemedicine-covered with original Medicare and for services not covered at all by original Medicare) and paying for those services using the supplemental premiums and rebate dollars in an effort to improve patient accessibility to services that original Medicare has been dragging their feet on providing or is prevented by law from providing.

The Federal Register published a proposed rule in which it explains how CMS plans to expand telemedicine services to its beneficiaries while maintaining control over limitations of use, quality, and documentation practices. It will permit MA plans to offer telehealth benefits as part of the basic benefits package beyond what is currently available in the original Medicare telehealth with coverage of those services being included in the capitation payments to the MA plan. It appears they will open up Part B services for coverage and make them available through electronic exchange as “additional telehealth benefits” and expect the MA plan to regulate and manage those benefits appropriately, reporting use, overuse, and any policies they create to manage those expenditures to CMS. Additionally, it will officially approve MA plan use of rebate dollars and additional supplemental premiums to provide coverage for noncovered Medicare services like offering a videoconference dental visit to assess the dental needs of a Medicare patient prior to treatment, removal, or replacement of teeth or other supporting structures, not normally allowed by Medicare.

With all the telemedicine changes being implemented each year, it is important to keep up on what is happening, especially with Medicare. To read the full report on these changes in the Federal Register, go see II. Provisions of the Proposed Regulations; Part 1. Requirements for Medicare Advantage plans offering additional telehealth benefits. The Medicare Learning Network published a fact sheet on Telehealth services that includes the various services currently approved for reporting with original Medicare. 

About Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT

Aimee L. Wilcox is a medical coding, billing, and auditing consultant, author, and educator with more than 30 years of clinical and administrative experience in healthcare, coding, billing, and auditing. Medicine, including coding and billing, is a constantly changing field full of challenges and learning and she loves both. Aimee believes there are talented medical professionals who, with proper training and excellent information, can continue to practice the art of healing while feeling secure in their billing and reimbursement for such care.