Medicare and Telehealth

Medicare and Telehealth

Telehealth, or the ability to receive medical treatment without an in-person visit with your doctor, is a growing trend throughout the United States. Although it offers many positive benefits, including convenient scheduling and eliminating the hassle of transportation, not every health insurer has embraced the concept.

Fortunately, Medicare has widened its telehealth offerings, but there are still a number of regulations that you should be aware of if you want to explore the possibility of remote medical care. Medicare Part B covers some telehealth services, and, for most of them, you will pay the same amount for services that you would have otherwise received in person.

Medicare offers telehealth services as replacements for in-person consultations, office visits, and psychotherapy and uses two-way communications systems to conduct the appointments interactively, such as real-time video and audio.

Medicare puts restrictions on the ways that you can access telehealth services, however, so it’s not as though you can “meet” with your doctor from the comfort of your own home. You can only participate in a virtual appointment if you are at one of the following locations: hospitals, other doctors’ offices, skilled nursing facilities, rural health clinics, federally-qualified health centers, community mental health centers, critical access hospitals, and hospital-based dialysis facilities.

In 2019, Medicare made changes to their previous telehealth model. As a result of these changes, you can now use telehealth under the following circumstances: 1) if you are being treated for a substance use disorder or a mental health disorder in conjunction with a substance use disorder, you can use telehealth services from home; 2) you can get services for faster evaluation, diagnosis, or treatment for symptoms of a stroke no matter where you are; and 3) you can now utilize e-visits and virtual check-ins.

In the case of virtual check-ins, Medicare will only allow you to use them if you already have an established relationship with a physician or an approved medical practitioner, and the “visit” is not related to a medical visit within the last seven days and will not result in another medical visit in the following twenty-four hours.

You should also be aware that not every medical professional can provide telehealth services under Medicare. The following are the only individuals who are approved to offer them: physicians; physician assistants; clinical psychologists; nurse practitioners; clinical nurse specialists; nurse midwives; registered dieticians and nutrition professionals; and clinical social workers.

Lastly, you may hear or see unfamiliar terminology when it comes to telemedicine. “Originating site” means wherever you, the patient, are located to receive services, and, as explained above, originating sites are limited. On the other hand, “distant site” refers to the location of the provider eligible to offer telemedicine services; there are no restrictions on distant sites.