TELE-MEDICINE Fraud, Abuse and New Barriers!

Telemedicine: Fraud and Abuse During the COVID Pandemic

By Susan Walberg

The COVID-19 pandemic has brought with it huge challenges for people all over the world; not only the obvious health-related concerns but also shutdowns, unemployment, financial difficulties, and a variety of lifestyle changes as a result.

When the COVID pandemic struck, CMS quickly recognized that access to care would be an issue, with healthcare resources strained and many providers or suppliers shutting down their offices or drastically limiting availability. Patients who needed routine care or follow-up visits were at risk for not receiving services during a time when healthcare providers were scrambling to enhance infection control measures and implement other new safety standards to protect patients and healthcare workers.

The Centers for Medicare and Medicaid Services (CMS) has responded by easing restrictions and regulatory burdens in order to allow patients to receive the healthcare services they need without undue access challenges. One key area that has changed is the restrictions related to telehealth services, which were previously only paid by Medicare under certain circumstances, such as patients living in remote areas.

Among the changes and waivers CMS has offered, telemedicine reimbursement is among the more significant. Telemedicine services, which includes office visits and ‘check ins’ are now allowed and reimbursed by Medicare. In addition to reimbursement changes, CMS has also relaxed the HIPAA privacy and information security enforcement standards, paving the way for providers to adopt a new model of providing services electronically.


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One Response

  1. Docs Press CMS for Permanent Telehealth Flexibility, Relief from Pay Cuts

    Several doctor groups are pressing the Biden administration to not just extend Medicare telehealth reimbursement flexibilities through 2023 but for them to be made permanent. The Centers for Medicare & Medicaid Services proposed in the 2022 Physician Fee Schedule to extend telehealth flexibilities through 2023 instead of through the end of the COVID-19 public health emergency, which is expected to run through this year. Doctor groups in comments on the rule, the deadline for which expired Monday, called for a permanent solution.

    Doctor groups were also worried about a looming 3.75% cut in the 2022 Medicare conversion factor, which calculates reimbursement for procedures under fee-for-service. The cuts are mandated under a budget neutrality provision in Congress and comes after a pay bump from Congress that expires in 2022. MGMA said that the cuts are going to be especially difficult on physician practices as other cuts could come into effect, such as a 4% payment cut to Medicare reimbursements under the PAYGO law that mandates cuts if federal spending reaches a certain level. Physicians also must likely brace for the return of a 2% cut to payments that was installed under the sequester. The cut has been put on pause for more than a year due to the pandemic, but lawmakers seek to use it as a pay-for in a bipartisan infrastructure bill expected to be considered in the House later this month.

    Source: Robert King, Fierce Healthcare [9/14/21]


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