The Office of Inspector General (OIG) recently announced that physicians and other practitioners will not be subject to administrative sanctions for reducing or waiving any cost-sharing obligations Federal health care program beneficiaries may owe for telehealth services.
The announcement followed efforts to encourage CMS to expeditiously expand telehealth coverage in response to the Covid-19 public health emergency. Telemedicine is playing a critical role in the fight against Covid-19. The loosened restrictions will alleviate some of the provider-voiced concerns over the provision of telecare during the emergency.
These changes come at a critical moment. The challenges regarding reimbursement in telemedicine are a well-documented complication that would have hindered the provision of care during Covid-19.
More doctors providing telemedicine during the pandemic mean more doctors are subject to the laws of telemedicine. These laws come from the state the provider is in, and the state in which they are providing teleservices, which means that billing, compliance and liability are complicated. The Centers for Connected Health Policy refer to the patchwork of laws and guidelines as “fifty states, fifty approaches,” tellingly.
Take billing rights for a physician as one of the countless examples. Assignment of rights is a straightforward process that hospitals and doctors both understand well when it comes to in-person doctors providing onsite care.
In telemedicine, though, it has historically been much more complicated. For example, when a doctor provides a service billed through Medicare, the place of service must always list the physician’s state, not the hospital. These simple, but common mistakes keep many doctors from being paid promptly or at all.
Then there are the Medicare Administrative Contractors or “MACs”, who serve as the commercial carriers that administer Medicare benefits. If a teleneurologist in California provides care for a patient located in Montana, the hospital is required to bill the MAC in California, not Montana.
However, there are specific laws about billing MACs in individual states. In the California example, the hospital must also ensure that the rendering physician is enrolled with Medicare through their home MAC. Furthermore, the hospital that received the billing rights reassignment from the physician must also be enrolled in both its home MAC and in the provider’s home MAC.
Therefore, to remain compliant and receive payment, the hospital will need to enroll in multiple MACs across the country before it ever bills for telemedicine services correctly.
This is just one of many examples that meant financial liability for doctors and hospitals in the fight against Covid-19 until OIG announced the loosened restrictions.
It is also an example of the exact hindrances for the broader adoption of telemedicine. Today, we need telemedicine. The fight against Covid-19 requires that we provide as little contact between health professionals and virus-carriers as possible, while still providing care. Telemedicine is the solution to that problem. It is how hospitals are unclogging waiting rooms, triaging patients, monitoring the less sick and supporting the fight against Coronavirus by treating those with other maladies from afar.
Yet, in many hospitals and health systems, there is far less telemedicine technology in place than is needed. Many hospitals have delayed telemedicine implementation because of the complexities around billing and reimbursement.
Doctors, of course, don’t have a dog in this fight, other than exposure to financial or legal liability stemming from their provision of care. So long as they are protected appropriately, billed accurately and paid in a timely manner, it is of no consequence whether the ultimate billing services are rendered by a telemedicine platform or by a hospital or health system.
Yet, the billing requirements of our country, that stood in place until the coronavirus necessitated their loosening, cost some doctors the opportunity to provide telemedicine care during this pandemic.
Today, as we fight against Covid-19 and waive many of our historical restrictions, the question might need to be: why didn’t we always make it this easy?
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