In the age of technology breakthroughs, telemedicine has emerged as a popular choice for people to obtain healthcare services from the convenience of their homes.
Telemedicine, which includes video conferencing, is the use of technology to deliver healthcare services remotely.
Patients who cannot travel to a healthcare facility or have limited mobility can benefit the most from it.
What is Medicare?
Medicare is a federal health insurance program that protects people over 65 and those with specific impairments and illnesses.
Medicare has four parts:
- Part A covers inpatient hospital care, skilled nursing facility, hospice, home health care.
- Part B covers medical services, including check-ups, lab work, and preventive care.
- Part C, referred to as Medicare Advantage, is a supplement to Original Medicare that offers extra benefits like prescription medication coverage and coverage for vision and dental care.
- Part D provides coverage for prescription drugs.
What is Telemedicine?
Telemedicine, also known as telehealth, is using technology to provide healthcare services remotely. It includes various services like virtual consultations, remote monitoring, and teletherapy.
Telemedicine allows patients to receive medical care without leaving their homes, making it an ideal option for those with mobility issues, transportation challenges, or living in remote areas.
Does Medicare Cover Telemedicine?
Medicare covers telehealth services under Part B, so beneficiaries in traditional Medicare who use these benefits are subject to Part B. However, the coverage is constrained and governed by specific guidelines.
The telehealth guidelines, initially adopted in 2001 but updated and expanded over time, are the principal regulations governing Medicare’s coverage for telemedicine services.
The regulations specify the categories of telemedicine services that Medicare will pay for, the qualified medical professionals, and the payment amounts.
Telemedicine Services Covered by Medicare
Numerous telemedicine services are covered by Medicare, including:
- Virtual Check-Ins: These are quick conversations between patients and medical professionals typically held over the phone or through video conferencing. These check-ins aim to assess a patient’s health and determine whether an in-person visit is required. Medicare will pay for virtual check-ins for established patients who have seen the same practitioner in-person within the preceding calendar year.
- E-Visits: This are online interactions between patients and healthcare professionals, frequently carried out via email or secure messaging services. E-visits are utilized to assess symptoms and offer medical guidance to patients. For established patients who have seen the same clinician in-person during the last 12 months, Medicare pays e-visits.
- Remote Monitoring: Remote monitoring is when a patient’s health state, such as blood pressure, glucose levels, or heart rate, is tracked using technology. Healthcare providers can use the information to modify treatment plans by receiving and transmitting it to them. Patients with chronic illnesses, including heart failure, diabetes, or chronic obstructive pulmonary disease, can receive remote monitoring through Medicare (COPD).
- Telehealth Visits: Usually carried out via video conferencing, telehealth visits are online consultations between patients and medical professionals. Telehealth visits can be utilized for various medical issues comparable to in-person appointments. During telehealth sessions, Medicare covers some medical disorders, such as mental health, substance addiction, and preventive services.
Eligible Healthcare Providers
Not all healthcare providers are eligible to provide telemedicine services to Medicare beneficiaries. Medicare only covers telemedicine services provided by healthcare professionals enrolled in Medicare and meets specific requirements.
The qualified healthcare providers include:
- Physicians: Physicians are the most common healthcare providers who offer telemedicine services. They can include general practitioners, specialists such as psychiatrists, psychologists, and surgeons.
- Nurse Practitioners and Physician Assistants: Nurse practitioners and physician assistants are also qualified to offer telemedicine services, but only under the direction of a doctor.
- Nurse-midwives: Nurse-midwives can offer telemedicine services for maternity care and related services, such as prenatal and postnatal care.
- Clinical nurse specialists: Clinical nurse specialists can offer telemedicine services for preventative and mental health care. They can use telemedicine to provide counseling services, monitor chronic conditions, and advise on healthy lifestyle habits.
- Nurse Anesthetist: CRNAs are qualified to offer telemedicine anesthesia treatments. They can provide pre-anesthetic evaluations, post-anesthetic assessments, and anesthesia management for patients undergoing surgical procedures.
Telemedicine Services Payment Rates
Medicare’s payment rates for telemedicine services vary depending on the type of service and the patient’s location.
Medicare’s telemedicine services payment rates are subject to:
- Geography Restrictions: Medicare pays telemedicine services at different rates depending on the patient’s location. Medicare pays higher rates for telemedicine services offered to patients in remote areas, where access to healthcare providers may be constrained.
- Site-Originating Restrictions: The originating site, or where the patient receives the telemedicine service, influences how much Medicare will pay for telemedicine services. Compared to telemedicine services provided in the patient’s home, Medicare pays higher rates for telemedicine services provided in healthcare facilities, such as hospitals or clinics.
Medicare covers telemedicine services. However, there are some restrictions. The telehealth guidelines, which specify the categories of services covered, the qualified healthcare providers, and the payment rates, largely control Medicare’s coverage for telemedicine services.
Even though there was little coverage for telemedicine services before the Covid-19 pandemic, the CMS has increased Medicare’s coverage during the pandemic to support telemedicine use. In particular, telemedicine is an efficient way to deliver medical care remotely for individuals with restricted access to healthcare facilities.