Reimbursement for Telehealth: What’s on the Horizon?

Since its introduction, one of the biggest question marks regarding telehealth has been reimbursement. While most providers could recognize the potential of virtual care, without the ability to be paid adequately for those services, many hesitated on implementation. With the changes enacted considering the Covid-19 pandemic, these concerns were largely eliminated, allowing for rapid, large-scale adoption. Now that the pandemic is winding down, though, many are left wondering what is to come for telehealth reimbursement. Let’s take a look.

Telehealth Reimbursement Up to Now

Prior to the start of the pandemic, telehealth coverage was limited, particularly under Medicare. There were approximately 100 telehealth services covered at that time, but there were also limitations on who could benefit and how the services could be delivered. Outside of Medicare, before Covid-19, 36 states required that state-regulated payers cover telehealth, but only 25 of those states required a limit on cost-sharing for patients. Additionally, only 15 states required payers to reimburse providers for telehealth services at an amount on par with in-person care, and only three states required coverage for audio-only telehealth.

The Current State of Telehealth Reimbursement

During the early days of the pandemic, Medicare waived many regulations that limited telehealth reimbursement, allowing eligible providers to bill for telehealth no matter where the patient or provider was located at time of service. Most private insurers expanded to allow for widespread telehealth coverage as well.

Now that the pandemic is starting to wane, there have been some changes, but Medicare has extended telehealth reimbursement without restriction for certain services through 2023, with mental health being one of the main areas that allows for greater flexibility. Overall, most of the allowances to make telehealth reimbursement more seamless are still in place, just with a few additional caveats such as Anthem and United Healthcare requiring new POS codes beginning in 2022 and co-pay requirements resuming for most payers.

The Future of Telehealth Reimbursement

It’s expected that when all the dust has cleared, telehealth reimbursement rates will land somewhere between 75 and 90% of in-person reimbursement, with some payers setting criteria to determine the specific rates, with higher payments the more criteria is met. The sole exceptions are behavioral health and primary care which hare expected to be paid very close to in-person rates.

At this point, though, this is just speculation as telehealth reimbursement past the current year has not been set, but it is expected to land somewhere between the restrictions of pre-pandemic times and the widespread eligibility of the pandemic. Each private insurer can make their own rules, but typically they’ll follow suit pretty closely with the regulations put in place by CMS. There has also been discussion that regulatory officials are paying attention to the favorable reception telehealth has received over the course of the pandemic, and as such are likely to seek a way to maintain a solid level of access to telehealth services moving forward.

Telehealth has played a major role in maintaining patient care over the past two years, and many patients and providers alike have been impressed with the benefits this service can offer. Of course, reimbursement is a valid concern, but it does seem that when all is said and done, providers will see sufficient reimbursement for telehealth services. With that being said, if you have not already implemented a strong telehealth program in your organization, now is the time.

This is why MicroMD offers Medpod, a cloud-based telemedicine platform that enables your practice to provide care for your patients anytime, anywhere. For more information, visit micromd.com or call 1-800-624-8832.