What Happens to Telehealth in 2023?

Telehealth isn’t what it used to be.  Historically, it was reimbursed at lower rates than in-office visits.  There were geographic restrictions, technological requirements, and even location restrictions about where a patient could access virtual healthcare and where a clinician could treat them.  Both healthcare providers and patients were less than enthusiastic about telehealth. It just wasn’t worth it.

Then the COVID-19 pandemic came and ironically outpatient healthcare providers were deemed to be non-essential workers and forced to cancel appointments.  In a relatively short time, telehealth has evolved from a niche service to a viable offering for providers and a big part of the future of healthcare.  According to Dr. William Lopez, the national director for virtual care at Cigna, virtual visits made up just over 1% of all professional office visits for Cigna.  Today they make up nearly 25%.

Why the Shift?

Simple - restrictions were lifted, providers and patients had no other options, and reimbursement is at par with in-house visits. 

The best part of the shift is that both providers and patients discovered that telehealth was a viable offering, especially for outpatient behavioral health.  Given the ease, convenience, and accessibility of virtual care it appears that the demand for telehealth will remain high.

However, the flexibility that patients and providers have experienced was initiated and protected by the COVID-19 public health emergency (PHE).  The PHE has been in place since January 27, 2020.  The latest HHS extension for the PHE will end on January 11, 2023.

Change is Coming

The potential for over-utilization and the resulting financial costs is a concern that has been voiced by Medicare and other insurers.  The telehealth flexibilities and reimbursement parity with in-office visits could result in costing private insurance companies more money.

Healthcare providers are left wondering if insurers will reduce coverage and reimbursement for telehealth.  The answer is yes, in some ways but not all.  As the PHE ends it is important to stay up to date regarding the latest changes to telehealth coverages and reimbursement.  Don’t be caught off-guard.

Perhaps your specialty will go unscathed, but you need to stay in the know so that you don’t end up providing free care.  Changes to who will get paid for telehealth and under what circumstances will be part of a transition, so it is important that you be informed immediately if telehealth services are denied.  Likewise, a reimbursement analysis will be key to determining whether telehealth is still viable for your practice.

If you’d like to talk further about this or our billing and collection services please contact us at your convenience.