Telehealth Reimbursement Laws and Trends in the Surgical Space

Continued telehealth reimbursement is at the top of mind for surgery centers and healthcare providers recently.

Thanks to new reimbursement policies and payment parity, providers have been able to implement telehealth and other digital health services during this public health emergency.

Telehealth technology or telemedicine has been around for more than 50 years. However, it was largely underutilized.

According to a McKinsey report, consumer adoption of telehealth in the US was only 11% in 2019.

Reimbursement uncertainty was considered one of the biggest barriers to widespread telehealth adoption according to 77% of physician respondents in a 2019 survey.

Medicare had strict rules when it came to reimbursement for telehealth. Patients had to live in a designated rural area and travel to a special facility for their telehealth appointments.

This created financial and mobility difficulties especially for surgical patients as many were forced to travel not only for their actual surgery but also for their preoperative and postoperative recovery visits.

Everything changed due to the pandemic. Covid-19 accelerated telehealth adoption.

Consumer adoption in the US skyrocketed to 46 percent in 2020 to replace cancelled healthcare visits. Providers are now seeing 50 to 175 times more patients via telehealth since the pandemic started.

The CARES Act expanded telehealth coverage for Medicare, which became a turning point for virtual care. Providers could now collect Medicare reimbursement for telehealth visits provided in the home.

Nearly 1.7 million beneficiaries had received telehealth services in the last week of April 2020 compared with just approximately 13,000 in an average week pre-pandemic.

As patients demand the convenience and safety of virtual visits, this trend will likely continue.

Frost & Sullivan predicts the telehealth market will see a sevenfold growth rate by 2025.

At the beginning of the pandemic, telemedicine was the only thing that brought income to some surgical practices. But now, it is used as a practice-builder.

By utilizing telemedicine before surgery, surgeons can evaluate patients and gather their history. After surgery, surgeons also use telehealth to provide postoperative care.

Telemedicine can prepare patients by answering questions, such as how to set up their house for after surgery and ensuring that they are physically and mentally prepared.

In ASCs, a lot of time is spent going over pre- and post-op instructions which can be done via telehealth.

Many ASCs have found that in telehealth visits, patients are better able to make more informed decisions because they’re not rushed or struggling to understand someone who’s wearing a mask.

For example, one eye surgeon would typically see between 30 to 40 patients in clinic for post-op evaluations the day after surgery. With telemedicine, most of those patients can all be seen in just about 30 minutes.

The Centers for Medicare and Medicaid Services (CMS) released its 2021 Final Rule (Physician Fee Schedule) with bold telehealth policy changes designed to expand the use of telehealth technologies among Medicare beneficiaries.

Many of the expanded telehealth services it is covering due to COVID-19 will now be permanently covered after the pandemic. CMS is adding more than 60 services to the Medicare telehealth list that will continue to be covered beyond the end of the public health emergency.

It will also continue to gather more data and evaluate whether more services should be added in the future. For a list of covered telehealth services during this public health emergency, please refer to this resource: https://www.facs.org/-/media/files/covid19/current_phe_telehealth_codes.ashx

Some of the most impactful telehealth policy changes in 2021 include:

• Direct Supervision via Telehealth: Until December 31, 2021, or the end of the public health emergency (whichever is later), “direct supervision” under 42 C.F.R. § 410.21 can now be provided using real-time, interactive audio-video technology.
• Extended Audio-Only Assessment: CMS created HCPCS code G2252 for extended services delivered via synchronous communications technology, including audio-only (e.g., virtual check-ins). G2252 is cross walked to CPT code 99442 for reimbursement purposes, making its reimbursement higher than the current more limited duration virtual check-in code.

As the federal government led the charge in implementing Medicare flexibilities for telehealth, several states have also followed course enacting their own laws.

Several states passed recent laws that would require commercial insurance plans to cover more telehealth services on a permanent basis.

According to a recent report from law firm Foley and Lardner, the number of states with laws addressing reimbursement of telehealth services increased from 16 states in 2019 to 22 states in 2020, with 14 of those states now requiring insurers to pay the same amount for telehealth visits as in-person visits.

The passing of these laws serves to more permanently bolster coverage and ensure patient access to telehealth services during the pandemic and in the long-term.

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