Skip to main content

Telehealth Reimbursement

Medicare Sees Increased Use Under Extended Telehealth Coverage

By News

By Victoria Bailey


With other payers looking at Medicare’s actions on telehealth coverage, a Kaiser Family Foundation brief offers insights on Medicare beneficiaries that support the permanent expansion of connected health services.

– Medicare beneficiaries are using telehealth more often due to extended coverage and access measures introduced during the COVID-19 pandemic, according to a Kaiser Family Foundation brief. And making these measures permanent could further benefit members and influence other payers to follow the same strategy.

Prior to the pandemic, Medicare only covered telehealth services for members living in rural areas, with restrictions on where members could receive services and which providers could deliver them. The Centers for Medicare and Medicaid Services expanded coverage in early 2020 to address the pandemic, and renewed the extension in April 2021, to allow members to access healthcare services while avoiding in-person contact.

For its study, KFF collected telehealth use data from Medicare beneficiaries between summer and fall of 2020. Kaiser researchers noted the increase in use among members, as well as the populations who used telehealth more frequently during the COVID-19 emergency.

Of the Medicare members with an established source of care, almost two-thirds (64 percent) reported that their provider offered telehealth appointments. Before the pandemic, only 18 percent of members could say that. Some beneficiaries reported that they did not know if their provider offered telehealth services, including almost one-third (30 percent) of members living in rural areas.

More than a quarter (27 percent) of Medicare and Medicare Advantage beneficiaries had a telehealth visit with a healthcare professional, according to the survey, which equals 15 million people who used telehealth during the pandemic. Of the members whose established providers offered telehealth, almost half (45 percent) had a telehealth visit.

Telehealth use was higher among beneficiaries under 65 who qualify for Medicare due to a long-term disability, dual eligible beneficiaries, Black and Hispanic beneficiaries, and beneficiaries with six or more chronic conditions, with more than 50 percent of each group reporting using telehealth.

The study also offered evidence supporting continued coverage for audio-only telehealth services, which have been popular during the pandemic.

More than half (56 percent) of Medicare beneficiaries who used telehealth reported using a telephone for their visit. Of those, 65 percent were 75 or older, 61 percent were Hispanic, 65 percent lived in rural areas and 67 percent were dual eligible enrollees.

Audio-only telephone visits are permitted during the public health emergency but will be dropped from coverage once the PHE ends. KFF research indicates that permanent coverage of audio-only telehealth could benefit older beneficiaries, people of color and, beneficiaries living in rural areas, especially since less than half of Black and Hispanic beneficiaries (42 and 34 percent) own a computer.

Under Medicare’s emergency extensions of telehealth coverage, healthcare professionals can provide and get reimbursement for telehealth services; prior to the pandemic, that coverage was limited to telehealth services for patients who’ve been meeting with the provider for at least three years.

CMS has also extended telehealth services to rural health clinics and federally qualified health centers, locations not covered under pre-COVID-19 rules.

CMS has increased telehealth reimbursement rates during the pandemic as well, in some cases offering payment parity – a factor that, if extended, could pull more providers onto the platform. Reimbursement has long been a challenge to telehealth adoption, with providers saying they aren’t being paid enough to try new platforms and payers arguing that they should be able to negotiate their own rates with care providers.

Medicare Advantage plans are more telehealth-friendly, with 98 percent covering connected health services to members even before the pandemic.

Still, the path to increased or even permanent coverage is uneven.

In May 2021, the Government Accountability Office told Congress to hold off on expanding Medicare telehealth coverage past the public health emergency, citing concerns about spending, program integrity, patient health and safety, and equity. The GAO is asking for more evidence showing that telehealth services are cost-effective and produce positive health outcomes for Medicare beneficiaries.

The results from the KFF brief show the impact that expanded telehealth coverage has had on members and how these outcomes could help influence Medicare and other payers’ decisions about telehealth coverage going forward.

FCC’s COVID-19 Telehealth Program Reboots in 2 Weeks

By News

The Federal Communications Commission will accept applications for the second round of the COVID-19 Telehealth Program from April 29 to May 6.

By Eric Wicklund

April 16, 2021 – Healthcare providers interested in taking part in the Federal Communications Commission’s COVID-19 Telehealth Program will have seven days to submit applications, beginning on April 29.

The FCC made the announcement on Thursday, setting the stage for a second round of funding for projects aimed at boosting access to connected health services during the coronavirus pandemic through better broadband resources.

“For over a year, health care providers have fought on the front lines of this pandemic and have had to rapidly innovate to support the health and well-being of all Americans,” Acting FCC Chairwoman Jessica Rosenworcel said in a press release. “Telehealth has been at the forefront of this effort and I’m pleased to announce that additional support is just around the corner.”
Dig Deeper

“The FCC is dedicated to moving quickly to review and approve applications for this funding to support health care providers and patients across the country,” she added.

Congress appropriated $200 million in the CARES Act to launch the program in 2020 through the FCC’s Wireline Competition Bureau. FCC issued awards to 539 applicants before running out of money in July, but was criticized in some corners for a lack of transparency in the program.

Another $249.95 million was set aside in the Consolidated Appropriations Act of 2021 to create a second round. At the same time, FCC officials revised the application and award process.

  • It will establish a system for rating applicants, with more attention paid to hardest-hit and low-income areas as well as projects that failed to gain approval in the first round, those in healthcare provider shortage areas and Tribal communities.
  • It will ensure “equitable nationwide distribution of funding so that each state, territory, and the District of Columbia will receive funding since the program’s inception.” Last year’s program funded projects in 47 states, Washington DC and Guam but sent no money to Hawaii, Alaska or Montana.
  • It will set a deadline for applications, rather than reviewing programs as they are submitted, so that all projects can be reviewed at the same time.
  • It will award funding in two phases, so that approved projects can be funded quickly and the rest have an opportunity to provide more information to qualify for the second phase.

The filing window will run from Thursday, April 29 to Thursday, May 6.

The money is designated for “telecommunications services, information services, and connected devices necessary to enable telehealth during the COVID19 pandemic.”

The COVID-19 Telehealth Program isn’t a grant program, but a reimbursement program. To receive disbursements, healthcare providers are required to submit an invoicing form and supporting documentation to receive reimbursement for eligible telemedicine and mHealth expenses and services.

Primary Care Needs Telehealth Reimbursement, Targeted Relief

By News

From continued telehealth reimbursement to more targeted federal relief, primary care practices need payment reform to survive the second year of the COVID-19 pandemic.

 By Jacqueline LaPointe


– Better-targeted federal relief, continued telehealth reimbursement, and help acquiring personal protective equipment are some ways primary care providers can maintain financial stability as the country enters the second year of the COVID-19 pandemic, industry experts are saying.

An already underfunded area of medicine, primary care has faced significant financial challenges throughout the first year of the pandemic, explained experts from the Robert Wood Johnson Foundation and Urban Institute in a new brief.

Funds from the federal government and telehealth reimbursement parity were key to surviving empty waiting rooms, higher PPE costs, and other changes in operations during the pandemic. However, experts found that policymakers still have much to learn from these sources of support.

“COVID-19 has created enormous challenges for primary care providers that could result in long term changes in the delivery of care,” Katherine Hempstead, senior policy adviser at the Robert Wood Johnson Foundation, said in an emailed statement. “We need to find out what practices need to succeed in this environment, and devise policies to help support this foundational part of our health care system.”

The Provider Relief Fund, for example, did little to help independent primary care practices, the brief explained.

Established by the Coronavirus Aid, Relief and Economic Security (CARES) Act in March 2020, the Provider Relief Fund (PRF) has given hundreds of billions of dollars in grants to healthcare providers. But the government’s distribution methods have favored large hospitals and health systems, leaving most practices with relatively small payments from the initial, automatic distribution.

Instead, primary care practices relied more on Paycheck Protection Program funding and advanced Medicare reimbursements, the brief found. But again, hospitals received more upfront Medicare reimbursements, which were essentially zero-interest loans if repaid in time, compared to physicians.

“Future outlays from the PRF should ideally be better targeted than past payments, in order to support those providers most in need,” the brief stated.

Additionally, federal support is likely needed to ensure primary care practices can access sufficient PPE and meet the demand for increased telehealth and audio-only services.

The brief found that practices shifted rapidly to telehealth and other modes of care delivery when delivering in-person care was not feasible or safe, and that transition was relatively seamless according to the practice leaders interviewed for the brief.

But practices could not have been successful with telehealth implementation if not for federal support for reimbursement from the CARES Act.

“Respondents generally felt that their shift to telehealth as a significant portion of their interaction with patients was only viable because of altered payment rules and increased reimbursement for telehealth services,” the brief stated.

However, the reimbursement policies are only temporary and private payers who jumped on the bandwagon can pull the plug on telehealth reimbursement parity at any time in most states. Additionally, only one state has required payers to waive cost-sharing requirements for telehealth visits during the emergency period although many payers have elected to adopt the policy internally.

The latter policy has particularly supported practices, according to a Massachusetts respondent, who described deductibles as “killing” practices financially even before the pandemic.

Primary care practices are already planning the future of telehealth now that they have implemented the technology to facilitate visits and have a better understanding of how telehealth can fit into appropriate care delivery.

Patients have also taken to virtual care and many have started to demand telehealth appointments, even too much in some cases according to some practice leaders.

However, respondents reported that some private payers are already scaling back telehealth reimbursement rates and reinstating cost-sharing requirements. This is leading to concerns among practice leaders that telehealth will not be financially stable.

Practice leaders also voiced concerns about payers encouraging patient use of telehealth-only providers even though these providers may not be invested in the long-term health of a patient and can result in overutilization.

Continued support for telehealth reimbursement would help struggling practices maintain patient volumes in the event of more COVID-19 waves as well as with sustaining care transformations beyond the pandemic.

Additionally, policymakers should address increasing levels of clinician and staff burnout to strengthen primary care, experts stated.

These policy considerations could help to support vaccination efforts.

A new survey from the Primary Care Collaborative, Larry A. Green Center, and 3rd Conversation found that primary care continues to be untapped as the government struggles to administer COVID-19 vaccines. In fact, eight in ten primary care practice leaders surveyed said their organization is ready and willing to assist with vaccine distribution despite ongoing staffing shortages.

However, 44 percent of respondents also reported that local health systems are getting the vaccine, while smaller and independent practices are not.

“Primary care can play a major role in targeting and encouraging their patients to get vaccinated, particularly people with chronic conditions, the elderly, and people who are hesitant to get vaccinated,” Ann Greiner, President and CEO of the Primary Care Collaborative, said in an announcement. “Patients trust primary care, and trust is a major factor in our ability to help patients overcome vaccine concerns.”