Telehealth: What It Is, Its Benefits, and How It Can Help Medicare Programs
Telehealth: What It Is, Its Benefits, and How It Can Help Medicare Programs Blog Feature
Russ Godek

By: Russ Godek on October 14th, 2020

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Telehealth: What It Is, Its Benefits, and How It Can Help Medicare Programs

Telehealth is defined as the delivery and facilitation of health and health-related services including medical care, provider and patient education, health information services, and self-care via telecommunications and digital communication technologies.

This new form of health care delivery is growing rapidly, especially since the start of the pandemic.

Recently, the Centers for Medicare and Medicaid Services (CMS) has broadened access to Medicare telehealth services so that beneficiaries can receive a wider range of services from their doctors virtually, reducing the need to travel.

By expanding this benefit, healthcare providers have the opportunity to better serve their patient populations during a difficult time while being properly reimbursed.

At ThoroughCare, our goal is always to provide practices with the tools and resources to improve patient health outcomes and maximize revenue.

We’ve helped over 400 clients across the country in this regard with our intuitive, clinician-friendly software, award-winning client support, and wealth of knowledge and experience.

In this article, we’ll explain the ins and outs of telehealth, the new Medicare expansion of the benefit, and the benefits afforded to both patients and providers.

What Is Telehealth?

In the definition we mentioned above, we stated that telehealth includes the “delivery and facilitation of health and health-related services.”

This is an important distinction, as many confuse telehealth with Telemedicine.

Telemedicine is specific to the practice of medicine via technology, whereas telehealth is a holistic term that covers all components and activities of healthcare that can be conducted remotely via technology.

There are several technologies that are being utilized to deliver telehealth to patients, with mobile health and Remote Patient Monitoring (RPM) being the most popular.

Mobile Health

Mobile health (mHealth) involves using healthcare applications and programs on the patient’s smartphones, tablets, or laptops to deliver care.

Through these applications, patients can track health measurements, set medication and appointment reminders, and share data and information with clinicians.

Appointments themselves can even be conducted virtually through these apps, eliminating the need for in-office visits unless medically necessary.

Remote Patient Monitoring

RPM utilizes intuitive digital technology to collect medical data from patients. With RPM, healthcare providers can collect and track a variety of patient health data including weight, activity levels, blood pressure, heart rate, blood sugar, and more.

In 2018, CMS began offering reimbursement to healthcare providers that provide RPM services to patients.

Healthcare providers stand to gain an additional $119 per patient per month to their practice with RPM.

Who Can Provide and Be Reimbursed For Telehealth?

In the introduction, we mentioned Medicare had expanded the telehealth benefit.

This was a measure put in place on a temporary and emergency basis under the 1135 waiver authority and Coronavirus Preparedness and Response Supplemental Appropriations Act.

This expanded benefit is effective for services starting March 6, 2020 and for the duration of the COVID-19 Public Health Emergency. Medicare will make payment for Medicare telehealth services furnished to patients in broader circumstances.

This has impacted who can deliver and be reimbursed by Medicare for telehealth care. Under this new waiver, Medicare can pay for office, hospital, and other visits, including in the patient’s residences.

Various providers can now offer telehealth as well, including doctors, nurse practitioners, clinical psychologists, and licensed clinical social workers.

Prior to the waiver, Medicare would only pay for telehealth under the following circumstances:

  • The patient was in a designated rural area, and
  • When the patient goes to a clinic, hospital, or certain other type of medical facility for the service

Beginning in 2019, CMS began reimbursing providers for brief communications or Virtual Check-Ins, which are classified as short patient-initiated communications with a healthcare practitioner.

Medicare Part B separately pays clinicians for E-visits as well, which are non-face-to-face patient-initiated communications through an online patient portal.

Medicare beneficiaries can receive specific telehealth care including common office visits, mental health counseling, and preventative screenings.

Below we’ll detail these three types of virtual services that are now billable through CMS due to the expanded benefit.

3 Types of Telehealth Services Medicare Reimburses

The three types of telehealth services CMS now reimburses are Medicare telehealth visits, Virtual Check-Ins, and E-visits.

1. Medicare Telehealth Visits

These visits are when patients use telecommunication technology for office, hospital visits, and other services that generally occur in-person.

During these visits, providers use an interactive audio/visual telecommunications system that permits real-time communication between the clinician and the patient.

Medicare telehealth visits may be provided by physicians, nurse practitioners, physician assistants, nurse midwives, certified nurse anesthetists, clinical psychologists, clinical social workers, registered dietitians, and nutrition professionals.

2. Virtual Check-Ins

These visits can be conducted for new or existing patients. These visits are considered the same as in-person visits and are paid at the same rate as regular, in-person visits.

Virtual check-ins are brief communications (5-10 minutes) with practitioners that can be conducted via telephone, audio/video, secure text messaging, email, or use of a virtual patient portal.

This service will mostly be initiated by the patient, however in certain cases practitioners may initiate such services. The goal of this service is to give patient’s quick, brief access to providers to avoid unnecessary trips to the doctor’s office.

CMS requires the billing practice to have an established (or existing) relationship with the patient.

Patients must give verbal or written consent to the services, however, practitioners may educate beneficiaries on the availability of the service prior to patient agreement.

Additionally, the virtual check-in cannot be related to a medical visit within the previous 7 days and does not lead to a medical visit within the next 24 hours (or soonest appointment available).

3. E-Visits

These visits involve established Medicare patients having non-face-to-face communications with their doctors using online patient portals.

The patient must give verbal or written consent to the services, as well as generate the initial inquiry. Communications between patient and provider can occur over a 7-day period.

Like with virtual check-ins, CMS requires the billing practice to have an established (or existing) relationship with the patient.

5 Benefits of Telehealth

The growth of telehealth has brought with it a wide array of benefits.

1. Expands Access to Care to More Patients

Telehealth is shifting the healthcare model away from the traditional in-office visits to virtual visits that can be done anywhere, anytime.

This new model allows clinicians to expand their patient-based care offerings to harder to reach patients after traditional business hours, creating ample opportunity for new revenue streams and improved quality of care.

2. Improves Patient Engagement

One of the best ways to improve patient health outcomes is to improve patient engagement.

A 2019 study explored the importance of patient engagement on the health outcomes of diabetes patients. The results showed higher levels of patient activation and engagement with remote patient monitoring technology were associated with better glycemic control outcomes.

While this study was focused solely on diabetes patients, the success stories of various practices prove the importance of patient engagement.

With telehealth, providers can leverage a program like RPM to treat patients proactively. Through RPM, patients have a daily touchpoint with their provider, monitoring their conditions and getting ahead of serious health issues before they arise.

3. Increases Revenue for Providers

With Telehealth, providers can now extend appointment hours into the evenings past traditional office times, billing for phone calls and care provided to patients remotely.

This allows providers to treat more patients, increasing revenue, all while lowering costs.

Telehealth reduces overhead costs per visit due to the virtual nature of the appointments and is drastically less time-consuming for both the patient and provider.

Telehealth also eliminates the costs associated with no-show appointments, improving the efficiency of your practice.

4. Improves Quality of Care (i.e., Early Detection)

Telehealth improves the quality of healthcare in a variety of ways.

First is the improvement of early detection.

Because telehealth affords patients access to care in a 24/7 time frame, more preventative measures can be taken to mitigate or stop the progress of diseases and chronic conditions before they become more harmful and/or costly to the patient.

Secondly, telehealth improves healthcare delivery particularly in rural areas due to the nature of service delivery and acute conditions able to be treated.

Without telehealth, patients in rural areas sometimes have to travel long distances to be properly treated. Telehealth eliminates the need for travel, meeting the patient where they’re at virtually.

Telehealth can also reduce the amount of unnecessary in-office and ER visits. Because providers have the ability to meet with patients more frequently, patients feel less need to seek out trips to the physician’s office or ER.

5. Improves Patient and Provider Satisfaction

In a study done by the National Center for Biotechnology Information, between 94 and 99% of patients reported being “very satisfied” with all telehealth attributes. One-third preferred a telehealth visit to a traditional in-person visit.

Patients love the convenience of telehealth, as well as the comfort knowing their health can be cared for around the clock. Similarly, providers stand to gain additional revenue, cut costs, and improve efficiencies within their practice.

Telehealth is a win-win for both patient and provider.

Telehealth Works in Conjunction with CCM

Chronic conditions are extremely prevalent in the United States, accounting for approximately 75% of the nation's aggregate health care spending, according to the Centers for Disease Control and Prevention (CDC). That’s an estimated $5,300 per person in the U.S. each year.

What’s more, the Centers for Medicare and Medicaid Services (CMS) estimates that approximately one in four adults, including 70% of Medicare beneficiaries, have two or more chronic conditions, qualifying them to receive CCM.

With such an impact on healthcare, providers are looking for ways to lower the cost of chronic disease management, improve the quality of care, and achieve better health outcomes.

To be managed effectively, chronic conditions need to be actively monitored. Telemedicine allows providers to monitor patients around the clock, keeping chronic conditions in check and responding to patients in a timely manner.

With telehealth increasing access to care for patients in rural areas, many more patients with chronic conditions can now be effectively treated from afar.

Chronic conditions often lead to hospital readmissions due to their persistent, degenerative nature. By having providers meet patients where they’re at virtually and providing quality, timely care, hospital readmissions can be reduced significantly.

Improve the Quality of Care You Provide During the Pandemic with Telehealth

CMS has recognized the need to expand the telehealth benefit during these extraordinary times for the health and well being of patients across the country.

Now more providers can take advantage of the benefits that telehealth offers throughout the duration of the pandemic.

As with other Medicare programs, quality care management software can greatly help in running a successful program at your practice.

ThoroughCare’s platform now features a telehealth solution, allowing providers to efficiently manage their telehealth programs, maximizing their revenues and improving the health outcomes of their patients.

Due to the expansion of telehealth only happening earlier this year, many providers have not yet implemented telehealth at their practice. We hope this article has shined a light on the benefits for both patients and providers offered through telehealth.

If you’re interested in learning more about ThoroughCare’s telehealth solution, reach out to one of our representatives today!