Provider Access and Reimbursement Updates
May 20, 2020

We continue to monitor changes in the healthcare marketplace in response to COVID-19 and various state and local stay-at-home orders.  Recently, the Centers for Medicare and Medicaid (CMS) and group health payors made sweeping changes to telehealth rules to allow providers to efficiently render care.  While CMS does not specifically govern state or federal workers’ compensation programs, or group health plans, its changes influence state-based workers’ compensation regulatory actions and medical provider practices.


In this advisory, we take a closer look at some of the prevailing changes to telemedicine access and reimbursement rules taking effect across the country.



Key regulatory changes, and a heightened commitment to patient safety, have prompted providers to turn to telemedicine.  Recently, CMS made several critical changes to telehealth.  Among the CMS changes most likely to affect our industry are the following:

  • Broadened access and coverage by adding 125 new codes which now include both physician and allied professional therapy services;
  • Eliminated site of contact origination requirements, added therapies and new types of approved providers;
  • Permitted ER and hospital visits via telemedicine;
  • Equalized provider reimbursement rates by eliminating place of service payment differentials;
  • Modified CPT/HCPCS coding of related services;
  • Relaxed HIPAA privacy requirements, and in some cases allowing audio only visits when billed appropriately;
  • Offered providers financial assistance to technically enable delivery of telehealth services; and
  • Increased the scope of what professionals (e.g., Nurse Practioners and Physician Assistants) can order tests and medications.


These federal changes enable providers to adapt to telemedicine, and in some cases, obviate the need for in-office visits.  Related, social distancing requirements, restrictions on elective procedures, and staff limitations have resulted in a dramatic drop in non-emergent services provided.  In the latest jobs report, the highest rate of unemployment increases was in ambulatory healthcare services.  We have seen provider organizations furlough or repurpose staff and facilities to reallocate resources to COVID related care.


Hospitals are taking advantage of CMS waivers related to “Hospitals Without Walls”, which allow these facilities to treat patients in parking lots or other buildings and to use telemedicine for professional provider patient interactions. These waivers authorize alternate facilities like ambulatory surgical centers to act like and bill like a hospital.  Today’s reimbursement guidelines, along with reasonable accommodations to safely permit access to care have changed the provider landscape, perhaps for good.



Historically, telemedicine’s acceptance and reimbursement has varied state-to-state. But, as CMS is leading a transformation in telehealth, we are seeing several states move quickly and dramatically to amend their telehealth practices in workers’ compensation along similar pathways.  We take a closer look at some of the parameters states have used to expand telehealth.  


  Broadened In-State Telehealth Offerings

In New York, the Workers’ Compensation Board broadened telehealth services offered by NY medical providers.  The Chair’s full statement on the emergency amendment is available here.  We have seen similar alerts to broaden telehealth in Ohio, Vermont, and West Virginia. In Oregon, the Workers’ Compensation Division issued emergency alert to encourage telehealth and increased related fee schedule South Carolina Encouraging telehealth. 


Expanded Geographic and Media Access
In Maine, the Workers’ Compensation Board issued an emergency declaration to encourage the expanded access to telehealth through the use of out of state providers.   In Mississippi, the Workers’ Compensation Commission expanded the types of providers that can be reimbursed for telehealth and is allowing limited use of audio communication.  In a similar move, Montana amended its rules to allow the use of audio only telehealth services.


Wider Range of Services Allowed

In California, the Division of Workers’ Compensation, issued a Newsline encouraging telehealth both within the context of an MPN, as well as for QMEs. The Texas Department of Insurance, Division of Workers’ Compensation adopted CMS approved codes for telemedicine and added coverage for telerehab.  The State of Washington now allows telerehab including for brain injury, added tele-translation, and is allowing some expanded telemedicine access for initial treatment


Pre-Authorization Waived

The Colorado Department of Labor and Employment issued a bulletin to encourage telehealth, move to CMS coding, and eliminate pre-authorization requirements.  Similarly, the New Mexico Workers’ Compensation Administration broadened telehealth access and waived preauthorization requirements.


  Revised Billing to Create Parity

Arizona Executive Order 2020-29 added new telehealth and testing codes to the fee schedule.  In Tennessee, the Governor’s office issued a clarifying order that panel physicians can deliver care via telemedicine visits and affirmed that related reimbursement will align with CMS guidelines. We have seen a similar clarifying order in Florida.  And in Kentucky, the Department of Workers’ Compensation issued an order to reinforce payment parity for telehealth.


In accordance with these changes, GB’s bill review partners are diligently amending all system programming rules to accept appropriate billing codes and fee schedule accuracy.  For additional information, please contact your GBCARE representative or your GB Account Management team.


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