UPDATE: As of March 17, 2020, CMS has implemented temporary measures that allow greater use and reimbursement of telehealth for rehab therapists. Read more here.
Telehealth continues to garner headlines as providers, patients, and payers all seek more effective and cost-efficient ways to deliver care. In fact, this increasingly popular treatment option is giving providers of all stripes the flexibility to cast a wider net and provide services to patients seeking alternate ways to access health services (e.g., those who are homebound or who reside in more rural, underserved areas). But, as with anything new, there are bound to be some growing pains.
As we reported recently on the WebPT Blog, Medicare and many private payers don’t include PTs, OTs, and SLPs on their current lists of approved telehealth providers, thereby preventing therapists from potentially treating more patients—and thus, earning more revenue. Of course, that all may change—eventually. After all, efforts to create new telehealth CPT codes have been in the works for some time. But there’s still no clear answer as to when those codes will actually see the light of day, which means that, for the time being, therapists are still very much in the dark about whether they’ll ever be able to bill for telehealth services. Here’s the sitch:
Understanding Irksome Billing Guidelines
There’s still uncertainty around the rollout of new telehealth CPT codes.
Currently, PTs aren’t able to bill Medicare for telehealth services, as there are no telehealth-specific CPT codes for rehab therapists. And as I touched on above, there doesn’t seem to be much movement on this front. And after a 50-member workgroup—which was tasked with creating new telehealth CPT codes—and the CPT Editorial Panel convened separately last month in New Orleans, I thought we’d see some action by now. (As a side note, Medicaid has been reimbursing providers who perform telerehab services since 2002, although not in all 50 states.)
But, according to the most recent CPT® Editorial Summary of Panel Actions, all we got was one little blip of information about the future—or, more appropriately, the fate—of the Telehealth Services Workgroup: “Accepted sunset of the Telehealth Services Workgroup.” That’s it—no information about what discussions occurred and whether anything will come of two previously floated proposals, which included:
- Introducing a telehealth services modifier (i.e., a modifier providers could append to existing CPT codes in order to receive reimbursement for services rendered via telehealth); and
- Creating a telehealth services appendix (i.e., a resource that would list codes for services payers currently cover when delivered via telehealth).
The CPT Editorial Panel is scheduled to meet June 1-3, 2017, in Boston, so perhaps we’ll find out more information on this front in the next few months.
Your best bet is to contact your payers directly.
So, how do PTs bill third-party insurances for telehealth? And more importantly, can they? In some cases, private payers may cover telehealth services, but reimbursement ultimately depends on your payer contracts. So, your best bet is to contact those payers directly.
But, for argument’s sake, let’s say you’re able to bill for telehealth rehab services. How would you go about submitting these types of claims to your payers? According to this APTA resource, “If a private party is being billed, then the level 1 CPT/HCPCS codes that are used for traditional clinical visits should be used with an addendum attached to the charge that identifies the service as being provided via telehealth. Private payers may ask for an explanation of the charges, so it is important to be prepared to outline the reasoning behind the charges.”
Meeting Demands for Patient-Centered Care
Telehealth creates greater patient engagement.
As we know, achieving optimal patient outcomes depends largely on patient engagement. Now, you may be hard-pressed to convince some old-school PTs—and perhaps an older generation of patients—that virtual provider-patient interactions have any merits. But, in addition to saving valuable time and resources, telehealth allows PTs to “get creative with their practice.” As one former private practice manager put it, “Seeing patients on a fee-for-service model creates a sense of hustle, because the grading scale is on productivity, not on outcomes. The incentive is in the wrong place.” But, when patients aren’t forced to travel long distances—and instead have the convenience of receiving care from the comfort of their homes—it’s a win-win for providers and patients alike. For providers, we’re talking massive cost containment—not to mention major efficiency gains, which may lead to increased patient volume—while patients receive more immediate treatments and diagnoses. But the buck doesn’t stop there.
It can also help improve patient outcomes.
The previously quoted PT, who left his practice to work at a telerehab tech startup in San Diego, also believes patients can gain more autonomy and feel more empowered about their care through telehealth. “Our knowledge and skill sets are valuable, but due to time constraints, we give a rudimentary exercise rather than taking the time to educate patients about why they’re doing the prescribed movements and how it will ultimately lead to their successful rehabilitation. By providing a tool to help patients perform simple exercises at home…we are able to take the time to further that experience by empowering them with information to know how the exercise helps [in] their overall recovery. This type of robust practice will be what thrives in the value-based payment model.” Furthermore, PTs who are able to achieve better patient outcomes through telehealth services will be able to demonstrate their clinical value on a bigger scale, ultimately helping them to secure higher payments and be seen as bigger players in the overall healthcare industry.
Navigating Telehealth’s Role in CJR Episodes
This initiative will help further telehealth’s reach.
As we’ve previously reported on the WebPT Blog, CMS’s long-anticipated Comprehensive Care for Joint Replacement (CJR) initiative—which holds hospitals accountable for the quality and cost of knee and hip replacements, including post-surgery rehab—will seemingly play a hand in furthering telehealth’s reach. In particular, the bundled payment program relaxes some rules regarding the use of telehealth for CJR patients. And while telehealth can’t take all the credit, the CJR initiative already seems to be paying big dividends: According to this HealthcareDive.com article, “Research published earlier this year suggested the initiative helped to decrease spending on joint replacements by $5,000 per patient and to reduce prolonged hospital stays by 67%.”
It also waives site requirements.
CJR also “waives geographic and originating site requirements that factor into reimbursement,” meaning providers can perform post-operative care via telehealth from any location, including the patient’s home. According to this article, the rollout of CJR is also “the first step in establishing telehealth as the standard of care for all post-discharge programs, not just those focused on knee and hip replacements.” And, if Medicare and other private payers create new telehealth CPT codes for PT, rehab therapists may one day have even more options to leverage this mode of care delivery.
Telehealth will continue to open new doors to more efficient and effective care delivery. And even though the development of telehealth-specific CPT codes is taking longer than many providers would like, it’s safe to say this new care delivery model will gain a lot of popularity in the long term. What remaining questions do you have about telehealth? Share your thoughts in the comments section below.