Commercial health insurers are steadily adopting new medicare coverage plans and expanding existing ones to address this growing healthcare trend. Since coverage has been expanded to make financial sense, physicians looking to expand their practices can now use Telehealth. In actuality, they currently cover Medicare to some extent by most mid-range insurance policies.
However, before entering this new form of care, it’s vital to understand how the payment process works. As with other new forms of medical therapy, CMS has established the basic guidelines for Medicare coverage. The commercial carriers have followed suit, with similar coverage rules.
What Medicare Covers?
Adults 65 years of age and over, as well as those with disabilities and certain chronic diseases, have Medicare’s five significant possibilities for healthcare coverage:
- However, Medicare Part A provides basic hospitalization coverage.
- Medicare part B includes outpatient therapy like doctor’s appointments and diagnostic tests.
- So, Medicare Part C (Medicare Advantage) is a private alternative that combines Part A and Part B coverage and delivers additional benefits.
- Medicare Part D is prescription drug coverage.
Medicare supplement covers copays, deductibles, and other out-of-pocket expenses (Medigap) insurance.
Medicares Coverage
Below, we go through Medicare’s Telemedicine regulations and processes, including what makes a patient eligible, a provider qualified, and what forms of treatment may cover. We also explain how to bill for Telehealth services and provide the complete range of authorized CPT codes
1) Covered Patients and facilities
For telemedicine, the CMS reserves coverage to patients whose Medicare may be the most convenient type of care. Patients can utilize telemedicine when they don’t have accessible access to a specific form of therapy.
However, the CMS refers to an area lacking convenient coverage as a Health Professional Shortage Area (or HPSA) (or HPSA) (or HPSA). This task falls to the Health Resources and Services Administration (HRSA). Someone award annually official HPSA status. We reevaluate locations each year at the end of the calendar year. It initially evaluated them.
2) Approved Providers
That a patient lives in an HPSA does not guarantee that they may eligible for medical treatment delivered via telemedicine. Coverage is limited to certain diseases and modalities of therapy.
3) Procedural Guidelines
Telemedicine has its own set of rules.
Patents and providers must communicate over interactive audio and video telecommunications technology that offers real-time discussion.
Only Federal telemedicine demonstration projects in Alaska and Hawaii allow non-real-time communication (i.e., transferring medical information to a physician or practitioner for later assessment).
4) Treatment That Is Covered by Insurance (CPT Codes)
Medicare covers around 50 Telehealth operations, totaling around 70 CPT codes. Providers apply modifiers to the standard, equivalent CPT codes to charge the codes. For most processes, the modifier is GT. For non-real-time communication (in Hawaii or Alaska), the modifier is GQ.
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