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Transmitting Telehealth Reimbursement Advocacy to the Executive Level


The unexpected home health industry development that emerged from the coronavirus (COVID-19) pandemic was the widespread acceptance and use of telehealth visits. With mandatory shelter-in-place orders in most states, performing necessary healthcare visits seemed out of reach. Enter technology.

The use of telehealth visits became so integral to the way healthcare was conducted, more than 300 organizations sent a letter to Congress urging them to take the step in making this care method concrete: with telehealth reimbursements. As it stands, telehealth visits cannot be counted for low utilization payment adjustment (LUPA) thresholds or reimbursed in any fashion. And while the ability to use telehealth protects patients and staff and allows rural areas much-needed convenient access to healthcare, the inability of telehealth to count for reimbursement purposes still causes angst.

What 2021 Will Bring for Telehealth

The Centers for Medicare and Medicaid Services (CMS) annually releases a new rule for the upcoming fiscal year. The 2021 rule has one bullet point home health organizations won’t like to hear: telehealth visits in 2021 will not be reimbursed.

This blow could be softened with an additional facet to the 2021 rule – an increase in Medicare payments to organizations by 2.6%, equating to roughly $540 million. Considering the 2020 increase in Medicare payments was 1.3%, it is possible this extreme jump was meant to cover those inevitable telehealth visits that are ultimately being paid for by the organizations.

The Silver Lining of Virtual Visit Costs

CMS previously announced that this reimbursement change could only happen through executive action, with Congress signing this allowance into law before any money can come from telemedicine claims.

A silver lining for care-at-home organizations has been the actual cost reimbursement that comes with the use of telehealth. Money spent on technology can be claimed on cost reports, a concession that eases some financial strain. However, not being able to claim these visits under the newly enacted Patient-Driven Groupings Model (PDGM) has hindered organizations struggling to adapt in the current environment.

Establishing Telemedicine One Step at a Time

The home health industry could be one step closer to these reimbursements after CMS released news that the Trump Administration has issued an executive order, called Improving Rural and Telehealth Access, which would permanently expand the practice of certain services through telehealth. One hundred thirty-five healthcare services were added for telehealth use during the pandemic, and this proposed regulation would make some of those services permanent.

This executive-level acknowledgement of the importance and necessity of telehealth could help bolster support for future legislation allowing Medicare reimbursement for those virtual visits. Changes from Congress have been mentioned, with U.S. Senator Susan Collins of Maine announcing plans to create a telehealth reimbursement bill, but nothing has been presented yet.

With 91% of Americans under the belief that telehealth should be covered by insurance and 77% saying they plan to use this method in the future, home health organizations have a strong case to persuade congressional support. Put your voice in action by visiting the National Association for Home Care and Hospice’s Advocacy Center for ways to get involved and encourage Congress to act.

Axxess provides tools and guidance for you to succeed under PDGM. With an innovative home health software that ensures compliance and helps your organization take better care of patients, Axxess is used by enterprise organizations to maintain lasting success as the industry evolves.

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