As bad as the COVID 19 pandemic has been, it has led to some positive changes, including expanded insurance coverage for patient care by telemedicine.

"In addition to giving patients a safe way to check in with their doctor when they need care, it has given providers an opportunity to continue working and contributing to their cash flow," Cal LaGroue, CHBME of medical billing services company The Valletta Group, said. "Early in the shutdown, Medicare and other insurers recognized the need for continuing access to care for chronic conditions and acute problems that need immediate attention. Restrictions for reimbursing care by telemedicine have been loosened, at least for now, by virtually all payers."

Expanded coverage for telemedicine was originally set up as a temporary measure for managing the crisis. In the past, it had been primarily reserved for use in underserved areas or to bring the expertise of specialists into rural communities. Now that patients and providers have seen how well it works in handling routine care, many are hoping to see the wider use of telemedicine continue after the pandemic has passed.

Smart phones and computers with cameras and videoconferencing are widely available, making secure, face-to-face visits possible, which allows physicians to both talk with and see their patients much as they would in their office. Some patients with chronic conditions are already equipped with home monitors that can send data to the physician's office. The doctor may have to rely on the patient's home thermometer or blood pressure cuff, but there are many situations that can be diagnosed from available information. Prescriptions can be called in or adjusted without having to wait for a shutdown to be over. With a number of pharmacies offering both drive-through pickup and home delivery, patients can get started on medication without having to venture into an environment that might put them at higher risk of Covid-19 exposure.

If the patient has symptoms that suggest an immediate in-person exam is needed, physicians can advise them on the next step and set up follow-up care.

"For people who don't have computers or who may not have the technological background to feel comfortable dealing with computers or video, Medicare and some other payers have expanded telemedicine reimbursement to cover verbal communication through telephone visits," LaGroue said. "Phone calls can be billed and reimbursed as telephone visits for some diagnostic codes by meeting the criteria the insurer requires. It is important to verify coverage as you would with any office visit and review the telemedicine reimbursement requirements of that specific insurer."

LaGroue says that most of the practices The Valletta Group works with have had positive experiences with telemedicine. In some cases it has been a significant factor in easing cash flow burdens and helping the practice weather the challenges that came with the pandemic.

The impact telemedicine has had during the crisis has varied by specialty. You can't set a broken bone remotely, take blood or culture a lab sample. But there is a lot physicians can do for people with routine ailments, chronic conditions, followup visits, and monitoring patients who need to be watched carefully, such as diabetics who haven't achieved good control and patients on new medications with the potential for side effects.

"Psychiatry and psychology have adapted well to telemedicine," LaGroue said. "They can talk with patients and quickly transition to sessions online. Likewise, parents with a sick child don't have to worry about what to do if the pediatrician's office isn't open to see patients. They can set up a telemedicine visit."

For some practices, telemedicine may be a new idea, but it is worth considering. You may want to look into the capabilities of computers, smart phones and software already in your office or readily available, and you and your staff will want to review the telemedicine guidelines of your payers.

It's also helpful to have a mechanism in place for handling patient copays, perhaps by credit or debit cards through a patient portal or an email PayPal account.

"We have been advising our clients on the importance of staffing decisions when they are prioritizing who is essential to keep their practice going," LaGroue said. "They need at least one person continuing to gather and submit billing data. Don't let billing wait until everything is back to normal. Keep it current."

The wide use of telemedicine is still in its early days, and guidelines for how it will be covered after the pandemic are yet to be written. But as it is used more and its capabilities developed, telemedicine could be good for both patient health and the financial health of provider practices.

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Cal LaGroue, CHBME

Key Words

Telemedicine, telehealth, reimbursement, medical billing, The Valletta Group