Telehealth use has soared, reaching nearly 53 million visits in 2020. With it, compliance officers have guided their healthcare organizations in complying with changing documentation, coding, and confidentiality requirements.
As virtual care requirements for telehealth evolve, we explore how compliance officers can support patient care and help their organizations stay up to date. This is particularly important as the waivers that enabled this rise in telehealth may end as soon as the end of 2022.
Consolidated Appropriations Act
“While the delivery of most healthcare services has – for the most part – returned to pre-pandemic processes, telehealth remains a prominent method of delivery of healthcare services for certain types of visits and providers, such as behavioral health,” said Isabella Porter, director of Compliance at District Medical Group, Inc. “Not surprisingly, both government and health plan audits have identified what Compliance professionals warmly refer to as ‘opportunities’ with respect to how telehealth services are documented, coded, and reimbursed by healthcare providers.”
A measure in the Consolidated Appropriations Act signed into law in March, extended Medicare telehealth reimbursement for 151 days following the end of COVID-19. This is an opportunity for organizations that have embraced virtual care to continue offering telehealth visits to their patients.
The extension provides continued flexibility, convenience, and access to care for medical care and services. It’s also a continuation of mental health services and an expansion of psychologist audio-only services.
Currently, 13 states waive in-state licensure requirements for telehealth, and 19 states have long-term or permanent interstate telemedicine. To stay current on interstate telemedicine licensing requirements, compliance officers should set monthly or quarterly monitoring reminders to ensure they are up to date. YouCompli subscribers receive notifications about regulation changes at the state, federal and local level instead of monitoring manually.
Patients who live in rural areas or medically underserved areas benefit the most from physicians being able practice in more than one state. Multi-state licensing, especially when delivered via telehealth, allows these patients to have access to medical and behavioral health care. Moreover, multi-state licensure and care via telehealth allow providers to give needed care to patients regardless of where they are located.
The future of telehealth
American Medical Association research found that physicians overwhelmingly embraced telehealth during the pandemic, and more than 70% of physicians are motivated to increase telehealth use.
If the Centers for Medicare and Medicaid Services (CMS) continues to expand coverage for telehealth services and provides reimbursement for virtual care, telehealth will continue. However, if CMS no longer reimburses for telehealth services, organizations will likely discontinue or greatly decrease virtual care.
To prepare for potential changes, compliance officers should stay abreast of new bills and legislation to further expand coverage for Medicare telehealth services. Legislation to watch includes the Telehealth Extension Act of 2021 (H.R. 6202) and the Telehealth Extension and Evaluation Act (S. 3593). Also, compliance officers should help prepare organization leadership for potential discontinuation of some Medicare telehealth coverage and reimbursement.
In addition, compliance officers should work with billing and coding staff to ensure they adhere to regulatory changes that terminate certain telehealth services. Compliance officers also can partner with clinical leaders to educate patients. Patients will appreciate advance notice of any discontinuation of telehealth services.
“It behooves healthcare organizations to include Compliance with the monitoring and auditing of telehealth services. The Compliance team can also help ensure that the workflows that support delivery of these services are compliant with additional applicable regulatory requirements. This includes HIPAA Privacy and Security,” Porter said.
You can support your organizations’ efforts to implement telehealth long term by staying abreast of the telehealth regulatory requirements and anticipating potential barriers to care. Also, compliance officers can assist their organizations in obtaining patient feedback regarding telehealth services and monitoring patient compliance with telehealth visits. Demonstrated patient satisfaction with telehealth services and low patient appointment cancellations rates may encourage organizations’ leaders to continue telehealth long term.
Denise Atwood, RN, JD, CPHRM
District Medical Group (DMG), Inc., Chief Risk Officer and Denise Atwood, PLLC
Disclaimer: The opinions expressed in this article or blog are the author’s and do not represent the opinions of DMG.
Denise Atwood, RN, JD, CPHRM has over 30 years of healthcare experience in compliance, risk management, quality, and clinical areas. She is also a published author and educator on risk, compliance, medical-legal and ethics issues. She is currently the Chief Risk Officer and Associate General Counsel at a nonprofit, multispecialty provider group in Phoenix, Arizona and Vice President of the company’s self-insurance captive.