Telehealth Claims Spike More Than 8,000% Amid COVID-19 Pandemic, Government Waivers

The number of claims for medical services provided remotely via telehealth was more than 8,000% higher in April than at the same time last year, a new analysis from the health data non-profit FAIR Health has determined.

Importantly, the data consists only of claims submitted to private insurers, and thus does not include the vast majority of nursing home residents covered under Medicare and Medicaid.

But the group’s statistics do illustrate the public’s willingness to embrace telehealth services during the initial peak of the COVID-19 pandemic — as well as the impact of efforts by both insurance companies and the federal government to substantially relax restrictions around virtual health interventions on an emergency basis.

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Telehealth claim lines — or individual billed services submitted to insurers for payment — accounted for 13% of all medical claims in April, according to FAIR Health. That’s compared to just 0.15% the year before, or an increase of 8,336%.

For comparison, the April spike compares to a 4,347% year-over-year increase in telehealth claims during March, the first month of coronavirus crisis in the United States.

In the Northeast, where New York City served as the epicenter of the first major COVID-19 wave, telehealth accounted for 19.69% of all claim lines, or a gain of 26,209% from the year before, FAIR Health reported.

“The swift growth of telehealth in March and April of this year fulfills expert predictions related to COVID-19,” the New York City-based organization observed. “Telehealth permits health care services to be delivered without in-person contact, reducing the risk of disease transmission, and frees up in-person health care resources for COVID-19 patients.”

Psychiatric appointments were among the most commonly billed interventions in April, FAIR Health found, along with routine consultations between doctors and their established patients; medical discussions conducted over the phone also ranked in the top five telehealth services.

The Centers for Medicare & Medicaid Services (CMS) has instituted a variety of telehealth waivers designed to curb the spread of the coronavirus. Nursing homes in particular have seen years of restrictions erased seemingly overnight, with the temporary lifting of rules that normally limit the number of telehealth interventions residents can receive — as well as a suspending the requirement that only rural facilities can bill for remote care.

Physical, occupational, and speech therapy services for nursing home residents can also be conducted via telehealth during the COVID-19 crisis, though that flexibility was relatively late in arriving from CMS.

In addition, the Department of Health and Human Services (HHS) waived HIPAA penalties for providers “that serve patients in good faith through everyday communications technologies, such as FaceTime or Skype.”

But those waivers only apply for the duration of the federal government’s formal emergency declaration, with many open questions around the future of telehealth whenever the pandemic eventually eases.

CMS administrator Seema Verma has expressed support for making expanded telehealth coverage permanent, remarking during a virtual event held by STAT News in early June that she “can’t imagine going back.”

“People recognize the value of this, so it seems like it would not be a good thing to force our beneficiaries to go back to in-person visits,” Verma said.

Players in the skilled nursing telehealth space agree.

“It’s kind of like toothpaste that’s now out of the tube,” Dr. Waseem Ghannam, the founder of the telemedicine company Telehealth Solution, told Skilled Nursing News late last month. “It’s going to be really tough to put it back in.”

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