Proposed Rule: Expanded Telemedicine Benefits for Medicare Advantage Beneficiaries

February 14th, 2019 - Aimee Wilcox
Categories:   Compliance   CPT® Coding   Reimbursement  
0 Votes - Sign in to vote or comment.

Telemedicine continues its rise, with new technologies allowing for better communication and access to more aspects of healthcare than ever before. Each year Medicare has made strides, albeit small strides, in their telemedicine coverage while commercial payers continue to make great strides, constantly improving and expanding telemedicine service offerings to their beneficiaries to promote accessibility and increase their beneficiary health profiles. Among these commercial payers are those that offer Medicare Advantage (MA) policies. MA policies allow original Medicare beneficiaries to enroll in a Medicare plan governed by a commercial payer who also offers extended benefits for a supplemental premium paid for by the beneficiary. Where original Medicare doesn’t include dental or vision benefits, the MA plan will for a slight increase in the beneficiary’s premium. The MA plans are also offering extended telemedicine services (Part B services not telemedicine-covered with original Medicare and for services not covered at all by original Medicare) and paying for those services using the supplemental premiums and rebate dollars in an effort to improve patient accessibility to services that original Medicare has been dragging their feet on providing or is prevented by law from providing.

The Federal Register published a proposed rule in which it explains how CMS plans to expand telemedicine services to its beneficiaries while maintaining control over limitations of use, quality, and documentation practices. It will permit MA plans to offer telehealth benefits as part of the basic benefits package beyond what is currently available in the original Medicare telehealth with coverage of those services being included in the capitation payments to the MA plan. It appears they will open up Part B services for coverage and make them available through electronic exchange as “additional telehealth benefits” and expect the MA plan to regulate and manage those benefits appropriately, reporting use, overuse, and any policies they create to manage those expenditures to CMS. Additionally, it will officially approve MA plan use of rebate dollars and additional supplemental premiums to provide coverage for noncovered Medicare services like offering a videoconference dental visit to assess the dental needs of a Medicare patient prior to treatment, removal, or replacement of teeth or other supporting structures, not normally allowed by Medicare.

With all the telemedicine changes being implemented each year, it is important to keep up on what is happening, especially with Medicare. To read the full report on these changes in the Federal Register, go see II. Provisions of the Proposed Regulations; Part 1. Requirements for Medicare Advantage plans offering additional telehealth benefits. The Medicare Learning Network published a fact sheet on Telehealth services that includes the various services currently approved for reporting with original Medicare. 


Questions, comments?

If you have questions or comments about this article please contact us.  Comments that provide additional related information may be added here by our Editors.

Latest articles:  (any category)

Coding for a Performance of an X-ray Service vs. Counting the Work as a Part of MDM
March 21st, 2022 - Stephanie Allard , CPC, CEMA, RHIT
When x-rays are audited on the same date as an E/M encounter we have one of three decisions to make about the work that went into the radiological exam when the practice owns x-ray equipment and does their own interpretations internally. First, we must determine whether the x-ray was...
Continuous Glucose Monitoring (CGM) Systems: Leveraging Everyday Tech to Enhance Diabetes Management
March 16th, 2022 - Susan Gatehouse, RHIT, CCS,CPC, AHIMA-Approved ICD-10-CM/PCS Trainer
However, is the coding for the treatment and management of diabetes being adequately captured? Diabetes mellitus (DM) affects over 400 million people worldwide. It is a chronic disease of inadequate control of blood levels of glucose that affects the body’s ability to turn food into energy. Essentially, the...
ESRD Hemodialysis Hits Home with the New ETC Model
March 16th, 2022 - Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
In 2021, two major ESRD programs became effective, essentially preparing to transform not only risk adjusted services, but also at-home dialysis, health equity among beneficiaries needing transplant services, and improved access to donor kidneys.
Refresh Your IV Hydration Coding Knowledge
March 16th, 2022 - Aimee L. Wilcox, CPMA, CCS-P, CST, MA, MT
Reporting IV infusion services can be complicated, especially when multiple infusions are reported in a single encounter. Take a few minutes to freshen up your knowledge on IV hydration coding with a review of the guidelines and a few coding scenarios.
Medicare Auditors Caught Double-Dipping
March 14th, 2022 - Edward Roche, PhD, JD
Overlapping extrapolations require providers to pay twice. Some Medicare auditors have been caught “double-dipping,” the practice of sampling and extrapolating against the same set of claims. This is like getting two traffic tickets for a single instance of running a red light. This seedy practice doubles the amount...
Cybersecurity & Ransomware Warnings
March 10th, 2022 - Wyn Staheli, Director of Content
Although HIPAA Security protocols have been in effect for some time, as technology advances, if we are not diligent, gaps can be left available for intruders. On top of that, on February 23, 2022, the American Hospital Association issued a cybersecurity advisory. They stated, “there is concern that Russia may retaliate against the U.S. and allied nations with disruptive cyberattacks.”
The Case of the Missing Signature
March 10th, 2022 - David M. Glaser, Esq.
It’s important to remember that Medicare manuals are not binding, and they can’t “require” anything, including signatures. Regulatory framework is constantly changing. Never assume you know all of the rules, even if you carefully study them all the time. New things are constantly appearing....

Home About Contact Terms Privacy

innoviHealth® - 62 E 300 North, Spanish Fork, UT 84660 - Phone 801-770-4203 (9-5 Mountain)

Copyright © 2000-2022 innoviHealth Systems®, Inc. - CPT® copyright American Medical Association