Palmetto GBA: Medicare telehealth coverage expands

Published: September 1, 2020

Telehealth is a Medicare-approved healthcare service between a provider and a patient via a telecommunication system (such as by phone or video chat). It’s been a covered service for more than a decade, focusing on rural areas where appropriate care may be hard to come by. Patients would be “seen” via a communications medium at a Medicare-approved location (not their homes), and the provider and the facility they were “seen” at would receive payment for the service.

Let’s fast forward to today. The model has changed. As of March 6, 2020, providers can perform “office” visits and other expanded services via telecommunications to a beneficiary at their home. Regulations require that the provider (your doctor, a physician assistant, nurse practitioner, etc.) have an interactive audio and video communications system for use in this service. An “office visit” is another term for a “doctor’s visit;” however, visits completed through telehealth can also include emergency department visits, initial hospital and nursing facility visits and hospice visits. Telehealth services also include psychotherapy, services for substance use disorders, certain physical, occupational and speech-language pathology services and many others.

The expansion to allow for telehealth services in a patient’s home are part of Medicare’s response to the COVID-19 Public Health Emergency (PHE) starting on March 6, 2020. Many Medicare patients are more vulnerable to this disease, based on their medical conditions and age. As such, the expansion of telehealth services makes sense for both the provider and the patient. This has been especially important as many provider offices were closed or were not accepting in-person visits with beneficiaries. Providers are still required to perform the service in a Medicare-approved location, such as a physician’s office, skilled nursing facility or hospital.

Seema Verma, administrator of the Centers for Medicare & Medicaid Services (CMS) and a member of the White House Coronavirus Task Force, said that this expansion of services “represents a seismic shift, initiating a new era of healthcare delivery in America,” per CMS. (To learn more about Administrator Verma’s comments, please visit the CMS website at www.CMS.gov/Newsroom).

If you have a telehealth service, Part B coinsurance and deductible apply. You pay 20% of the Medicare allowed amount after your Part B deductible has been met. These costs are the same as if you had an in-person visit. If you have a preventive or screening service, for which the Part B coinsurance and deductible do not apply, you will pay nothing.

Be sure to watch your quarterly Medicare Summary Notice (MSN) to be sure the charges are correct as many providers are learning how to bill for these services in real-time. If you notice any discrepancies, or you are asked to pay more than you would for an in-person visit, be sure to call Palmetto GBA’s Beneficiary Contact Center at 800-833-4455, Monday through Friday, from 8:30 a.m. to 7 p.m. ET when customer service representatives are available or visit Palmetto GBA’s website at www.PalmettoGBA.com/RR/Me.