Telehealth reimbursement may be changing. How should providers prepare?

The future potential of telehealth hinges on how it’s reimbursed. Virtual care may be popular among patients, but if providers can’t get paid for their services, it’s unlikely they’ll be able to continue to provide them.

The government has signaled its support for reimbursing some telehealth services, at least in the short term. The Centers for Medicare and Medicaid Services announced earlier this month, for example, that it would add 11 virtual services to its reimbursement list during the COVID-19 public health emergency – following in the footsteps of its earlier flexibilities for virtual care.

This could act as a signal for other payers to do the same, said Andrew Selesnick, a shareholder in Buchalter’s Los Angeles office, in a Healthcare IT News interview. “The government can play a very positive role in telehealth by establishing clear standards and clear reimbursement guidelines,” said Selesnick. If the government, for example, requires documentation for certain services and certain rules around telehealth, “then the payers will be hard pressed to ignore them for a lengthy period of time.”

“If Medicare says you have to cover something – that’s going to be harder” for private payers not to cover it, Selesnick said.

Indeed, private payers have slowly begun to reinstate out-of-pocket costs for telemedicine. UnitedHealth Group and Anthem are saying that some members will be responsible for copays, coinsurance and deductibles for non-COVID-19 virtual visits.

The COVID-19 pandemic has “been a time of tremendous change” with regard to virtual care, said Selesnick.

Given the dozens of changes to policy at the federal level, including allowing providers to practice across state lines and to regard a patient’s home as an originating site, “we’ve probably had more regulatory reform in the last six months than we’ve had in the last six years when it comes to telehealth,” he said. “Many of my clients who weren’t even telehealth providers before have jumped into the fray.”

The providers most focused on the future of reimbursement and telehealth tend to be primary care clinicians, Selesnick said, as well as a “goodly number” of emergency physicians.

“They can do a lot of things, and they’re used to dealing with limited information and making decisions with people they don’t know,” said Selesnick, making them particularly nimble when it comes to virtual care.

“Hospitals and health systems were very active as well, because they had such a huge drop in volume at the early stage of the pandemic,” Selesnick continued, with many of them pivoting to ramp up existing telehealth technology and accommodate patients. “A lot of places saw drops of 30 to 50% in volume, and they have fixed costs – and people still need care.”

When it comes to the future of reimbursement, Selesnick predicted a continuously changing outlook over the next one to two years. “We’re going to see a lot of activity over the next 12 to 24 months, where the landscape shakes out and people have a good understanding of where they stand,” he said. “It’s going to be a struggle.”

So, given that uncertainty, how can providers best prepare?

One way, he said, is having a “stable, user-friendly platform.”

“And I don’t just mean user-friendly for the consumer; I mean for providers as well,” said Selesnick. He described clinicians who can’t easily get into their electronic health records from telehealth platforms and then just not billing for services, rather than jumping through technological hoops.

For providers, he continued, “it’s about clear guidelines” about what telehealth reimbursement requires in terms of documentation and visit length. “You put a lot of hurdles in, you’re going to have diminished use.”

Ultimately, “telehealth is here to stay,” he said. “I think there will be a scale-back in telehealth in terms of what they’re going to pay for, but it’s definitely going to stay.”