At first glance, it seems that the opening up of telehealth or telemedicine services to the public during the COVID-19 crisis was a major success amid all the negative news. Telehealth had been languishing as a service reserved primarily for treating patients in rural areas far from readily available medical care.
All that changed in mid-March when the Centers for Medicare & Medicaid Services (CMS) extended access to Medicare telehealth services so that beneficiaries could receive a wider variety of services from their doctors without having to visit healthcare facilities. Doctors, nurse practitioners, clinical psychologists, and licensed clinical social workers, were able to offer telehealth to their patients. Suddenly utilization spiked. At one health care facility virtual visits jumped from 1600 to 90,000 in one month.
But though the outlook for telehealth is brightening, it is not without its downside. The number one issue is fraud. “There are unscrupulous providers out there, and they have much greater reach with telehealth,” said Mike Cohen, an operations officer with the Health and Human Services Inspector General’s Office, which investigates health care fraud. Cohen noted the many fraud cases linked directly to COVID-19, including use of patient accounts to bill for “coronavirus emergency kits” that contain only gloves and hand sanitizer or bogus testing kits. Once marketers obtain a patient’s billing numbers, they often tack on thousands of dollars in genetic tests that are of no value to the medical case.
Another challenge is the increased chance of inferior care. Misdiagnosis happens often in in-person health care, but the risks increase with telehealth. Add to this the fact that there is no clear standard of care established by state legislatures. Regulations and licensing requirements can vary state-by-state. Keep in mind that your insurer may currently limit your telehealth benefits.
Generally covered are all health services, including non-clinical and mental health services, conducted using video-conference, over the phone, with an app or employing other secure applications. Telehealth can also involve being examined by a nurse or medical assistant at a medical facility while the consulting doctor provides a remote evaluation electronically. Additionally, it encompasses remote patient monitoring, whereby your health is measured and monitored remotely in real-time or via recordings and documents.
Here are examples of telehealth services:
The use of telehealth is growing. Most hospitals now connect remotely with patients using video, audio, email, chat and other technologies. Most health insurance plans offer some coverage of telehealth.
Telehealth state laws can be complicated and inconsistent around the country. All 50 states have some form of health insurance reimbursement for live video. However, many states do not have reimbursement for remote patient monitoring. Most states require physicians to be licensed to practice telehealth in the originating site's state, while others require the provider to have a valid license in the state where the patient is located.
Medicare patients have the option of using telehealth for office or hospital visits and other services that generally occur in-person. These include virtual check-ins with your practitioner using phone services or other devices and e-visits via an online patient portal. Medicare provides a list of covered telehealth services. You may be eligible for more telehealth services if you have a Medicare Advantage plan. The Centers for Medicare and Medicaid Services allows Medicare Advantage insurers to offer expanded telehealth benefits. You need to check with the individual plan to see what telehealth is covered.
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