• In The Trenches

    Telehealth Deserves Payment; the AAFP Is Helping Secure It

    "I need a hero. I'm holding out for a hero 'til the end of the night."
    -- Bonnie Tyler

    Old black telephone. Close-up of a rotary dial

    The past two weeks have been a whirlwind for all of us. As the COVID-19 pandemic spreads across the country and more people become infected with the SARS-CoV-2 virus, our nation and certainly our health care system are facing one of the greatest challenges in recent times. Tens of thousands of family physicians find themselves on the front lines of a pandemic that appears to have no immediate treatment or cure and, so far, has shown no sign of slowing. The spread of the virus has not been limited by geography and, despite early reports to the contrary, it has impacted individuals of all ages.

    AAFP President Gary LeRoy, M.D., often speaks of family physicians as the heroes of our health care system. This has never been more true than it is today. During the past few weeks, family physicians across the country have stepped forward to provide care to their patients and communities as they always do -- despite the uncertainty, challenges and risk.

    As I write this post, more than 160,000 people in the United States have been diagnosed with COVID-19, and more than 2,800 have died. Cases have been reported in all 50 states and the District of Columbia, and the pace of infection has been increasing. By the time you read this, these numbers most likely will be even higher.

    I want you to know that the AAFP is your partner in this battle. We are 100% focused on you. The Academy is doing everything it can to assist you as we fight this pandemic in our communities and we're scoring important wins on your behalf.

    Our latest advocacy success expands your ability to care for patients via telehealth. There are still obstacles to full virtual visits, but a March 30 announcement from CMS signaled an important win for the AAFP and others who have pushed for expanded use of telemedicine. Previously, physicians could bill for telemedicine visits for codes 99212-99215, but these all require audio and video capabilities. The change in policy will allow physicians to bill for care provided only by telephone with codes 99441-99443.

    The AAFP aggressively pushed CMS to permit physicians to bill for those three codes, and here is why: According to a June 2019 Pew Research Center report, more than 90% of seniors have cellphones, but less than 40% of those phones are smartphones with video capabilities. That means that although an overwhelming majority of seniors have a mobile telephone, more than 60 percent of Medicare beneficiaries would have been unable to participate in telemedicine under the previous policy. The lack of payment for telephone-based visits was hindering family physicians' ability to provide care to this population, and it created real access problems for patients. The AAFP wrote a letter to CMS on March 26 asking the agency to "take the appropriate actions to classify codes 99441, 99442 and 99443 as covered services in the Medicare program" and to "issue payment for these services when billed by physicians."

    We will continue to push commercial insurance companies to pay for telephone visits in addition to audio/video telemedicine visits. Our advocacy has already achieved some success, as large number of insurers are paying for telemedicine visits and more are coming online each day. You can view a complete list of coverage policies from private insurers on our COVID-19: Practice Management page.  

    Now that CMS has responded to this piece of our advocacy efforts, I want to assist you with the here-and-now challenges of billing for virtual visits, telehealth and telemedicine visits. There is a lot of confusion on this subject.

    As previously noted, family physicians have rapidly transformed practices to incorporate virtual visits and telehealth technologies. The AAFP has made available a comprehensive set of resources via our Using Telehealth to Care for Patients During the COVID-19 Pandemic page. This resource has extensive information on topics that include

    • advice on how to quickly implement telemedicine in your practice,
    • instructions for reimbursement,
    • examples of telehealth platform vendors,
    • key questions to ask when exploring telehealth platforms,
    • Medicare e-visits and
    • documentation requirements.

    I encourage you to use the resources we have assembled, but more importantly, I encourage you to share information from the front lines with us so we can better meet your needs, advocate for you and your patients, and create an environment where you can focus solely on the challenges in your communities.

    The AAFP also continues to update its main COVID-19 resource page with the latest information on the disease, our CME offerings, the AAFP's ongoing advocacy efforts, and practice management tools and resources to assist you and your practice.

    I encourage you to follow our COVID-19 member communications, which include updates from Dr. LeRoy, links to our weekly Virtual Town Hall meetings (held Wednesdays at 7 p.m. CT) and lists of questions and answers from previous Town Halls.

    I also would highlight our daily updates, which provide new information from the past 24 hours. Finally, we have created an online community, the COVID-19 Rapid Response Member Exchange, where family physicians can engage in peer-to-peer learning and share information and recommendations directly. The community also is a primary way to share information with the AAFP. If you are not already engaging with the community, I encourage you to sign up.

    And know that we continue to advocate for you on three primary objectives to help you address this pandemic:

    • aligning and enhancing payment for virtual care,
    • accelerating cash flow, and
    • increasing availability of supplies and personal protective equipment.

    The March 30 announcement from CMS was just the latest in a flurry of legislative and regulatory activity in Washington, D.C. Last week, Congress approved a $2 trillion COVID-19 stimulus package, the Coronavirus Aid, Relief and Economic Security Act -- commonly referred to as the CARES Act or "COVID-3." The CARES Act includes a variety of provisions that will assist family physicians, but the availability of these resources is weeks, if not months, away. I will be sharing details on these programs in future posts.

    Shawn Martin is senior vice president of advocacy, practice advancement and policy.


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    The opinions and views expressed here are those of the authors and do not necessarily represent or reflect the opinions and views of the American Academy of Family Physicians. This blog is not intended to provide medical, financial, or legal advice. All comments are moderated and will be removed if they violate our Terms of Use.