Analyzing Policy

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THE TOPIC 

How does U.S. government reimbursement policies for healthcare providers impact the use of telemedicine in your state? 

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THE TASK 

MAKE A REVIEW OR RESPONSE TO THE ESSAY BELOW

  • Length: A minimum of 250 words, not including references
  • Citations: At least one high-level scholarly reference in APA per post from within the last 5 years

 

Reimbursement Policies for Telemedicine in California

Telemedicine is the common word that covers different ways to facilitate the consultation, diagnosis, treatment, education, care management, and self-management of a patient’s health or well-being using technological tools like phone calls, video chat, email, and text, all while delivering the same standard of care than that of an in-person visit (DHCS, 2022).

As per the DHCS (2022), the coverage and reimbursement regulations for telemedicine in California are supported by the California Telehealth Advancement Act of 2011, in conjunction with other federal laws. Its stipulations are outlined in the Medi-Cal Providers Manual. The California Telehealth Advancement Act was established by Bill AB 415 and signed by the Secretary of State on October 7, 2011. More recently, Bill AB 133, which supersedes the June 23, 2020 guidance, approved by the Governor on July 27, 2021, determined flexibility or waivers to the delivery and reimbursement of services provided via telehealth modalities for the time of the Covid-19 pandemia period and until December 31, 2022 (DHCS, 2022).

Currently, Medi-Cal enrolled providers can bill DHCS or their managed care plan using the correct Telemedicine procedure codes defined by the American Medical Association (AMA), which can be found in the billing manual. In addition, the Current Procedural Terminology (CPT) or Healthcare Common Procedure Coding Systems (HCPCS) are obtained in the same manual, and they are used to bill for services using Place of Service (POS) “02” with the appropriate telehealth modifier. The modifiers are 1. Synchronous: interactive audio and telecommunications systems, modifier 95. Used for two-way interactive audio-visual communication. 2. Asynchronous: store and forward telecommunications systems, modifier GQ. They are used for teleophthalmology, teledermatology, teledentistry, and teleradiology.

The only exception is mental or behavioral health which uses the modifier GT for both telehealth and telephone modality (DHCS, 2022).

In conclusion, Medi-Cal Telemedicine legislation includes flexibility to offer limited services by audio-visual, two-way, real-time communication, and store and forward. In addition, there are no limitations on origination sites. For now, the Centers for Medicare and Medicaid Services (CMS) extended flexibility on the reimbursement to physicians for some telehealth services until the end of 2023 while they can evaluate and report to stakeholders before an extension or permanent approval (CMS, 2021). Many organizations are currently working on making the reimbursement flexibilities permanent through policy (DCHS, 2022). Nevertheless, some consumers and providers still feel somehow nervous about telemedicine. The consumers, because of the uncertainty of getting appropriate service, the providers due primarily to its requirements for reimbursement and the fate of continuity, but the advantages of its use are clear for both consumers and providers. 

References

Centers for Medicare and Medicaid Services (CMS). (2021). CMS Physician Payment Rule Promotes Greater Access to Telehealth Services, Diabetes Prevention Program. Retrieved from https://www.cms.gov/newsroom/press-releases/cms-physician-payment-rule-promotes-greater-access-telehealth-services-diabetes-prevention-programs

Department of Health Care Services (DHCS). (2022). Medi-Cal & Telehealth. Retrieve from https://www.dhcs.ca.gov/provgovpart/Pages/Telehealth.aspx

Department of Health Care Services (DHCS). (2022), Medi-Cal Payment for Telehealth and Virtual/Telephonic Communications Relative to the 2019-Novel Coronavirus (Covid-19). Retrieved from  https://www.dhcs.ca.gov/Documents/COVID-19/Telehealth-Other-Virtual-Telephonic-Communications.pdf