Health Care Reimbursement and Payor Dispute Update Special Edition - Year End Regulatory Review

The end of 2021 brings positive indications of the continued acceptance of telehealth as an important clinical care approach post public health emergency (“PHE”). The Centers for Medicare and Medicaid Services (“CMS”), like other payors, overhauled its approach to telehealth services in response to the COVID-19 PHE. In the CY 2022 Physician Fee Schedule Final Rule (“Final Rule”) just published this November, CMS recognized telehealth’s surge in popularity during the PHE and responded by announcing two further regulatory changes to promote wider use of telehealth: (1) an extended timeline for Medicare reimbursement for current telehealth services, and (2) relaxed criteria for diagnosing, evaluating, and treating mental health disorders via telehealth. Such changes signal CMS’ appreciation for telehealth and an openness to continue revisiting its reimbursement criteria. Limits a patient’s financial responsibility for OON emergency services, most non-emergency services furnished by OON providers at in-network (“INN”) hospitals, and OON air ambulance services to the amount for which the patient would be responsible had those services been furnished by INN providers continue to be reimbursed for such services until the end of the 2023 calendar year.ii This extended timeline will allow providers to continue to provide Telehealth Services, while developing clinical evidence to support their permanent addition to the CMS Telehealth List.

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DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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