Tag Archive for: Medicaid

Telehealth Services Coverage

Medicare and Medicaid Introduce New Expansion of Coverage for Telehealth Services

The use of telehealth for delivering healthcare services expanded in recent years, an innovation that owes much to the decision by the Centers for Medicare and Medicaid Services (CMS) to cover selected telehealth services. Even before the COVID-19 pandemic, the expansion of telehealth services coverage helped providers reach mobility-challenged patients, who found it difficult to leave their homes to receive the healthcare services they needed. It also helped expand access, making it possible for patients to receive services from providers sometimes well outside of their geographic area.

In California, for example, the County of Lasson uses GrandCare’s HIPAA-compliant telehealth capabilities to provide therapy visits. And in Ohio, LADD, a Cincinnati-based non-profit, created a smart home for disabled men, which uses GrandCare and other ground breaking innovations in accessibility, lighting and sensory control. This home is built from the ground up to enable the residents to live safer, more independent and happier lives. According to said Brian Hart, Chief Strategy Officer at LADD, “We have been working on this for a long time and our partnership with GrandCare enables us to provide a safe, scalable and affordable service model.” Reimbursement through Medicaid for these services is possible, because Medicaid has expanded its definition of assistive technology to include support for remote supports, such as reminders and prompts for daily activities, and even video calls to receive remote support from caregivers. 

With the advent of the pandemic, the importance of telehealth became even more apparent, when it allowed patients to receive services safely, even as they sheltered at home. This was especially critical for our nation’s seniors, who were at the highest risk for the most severe forms of the disease. Those in congregate living were often under quarantine, and unable to safely leave their communities for needed care. The pandemic resulted in a dramatic increase in the use of remote telehealth services.

“Before the COVID-19 public health emergency (PHE), only 15,000 fee-for-service beneficiaries each week received a Medicare telemedicine service. Since the beginning of the PHE, CMS has added 144 telehealth services,” according to CMS. In the 7-month time period between mid-March and mid-October of 2020, over 24.5 million people received a Medicare-covered telehealth service. 

Telehealth has long been a priority. We started paying for short virtual visits in rural areas long before the pandemic struck. But the pandemic accentuated just how transformative it could be.” – Seema Verma, CMS Administrator

In recent months, Network Health, a Wisconsin-based insurance company, started a new program for its Medicare Advantage members in Wisconsin, using GrandCare in member homes to provide virtual visits with care managers and providers, and reduce loneliness and isolation. They will continue to roll out telehealth and medication management solutions to offer a better member experience.

This year’s Physician Fee Schedule (PFS) final rule once again expands CMS coverage for telehealth services. Although one category of new covered services is designed to be temporary, remaining on the list through the end of the declared public health emergency, others are permanent additions to the list of covered services. It’s part of a strategy, according to CMS, to “create a healthcare system that results in better accessibility, quality, affordability, empowerment, and innovation.”

Telehealth has long been a priority,” said CMS Administrator Seema Verma. “We started paying for short virtual visits in rural areas long before the pandemic struck. But the pandemic accentuated just how transformative it could be.”

Among the many additional to this year’s schedule is a welcome broadening of the coverage for remote monitoring services. In addition, CMS has created new codes for coverage of online assessments, making it possible for qualified non-physician health care professionals to perform these services. “Medicare beneficiaries will now be able to receive dozens of new services via telehealth, and we’ll keep exploring ways to deliver Americans access to healthcare in the setting that they and their doctor decide makes sense for them,” said HHS Secretary Alex Azar.

Laura Mitchell to Speak on Hospital Readmission

At the First National Medicare-Medicaid Payment Incentives and Penalties Summit

“The Leading Forum on Recovery Audits, Readmissions, Value-Based Purchasing, HACs and Never Events, and Managing to Medicare Margins.”

Laura Mitchell, VP Business Development will be speaking alongside Dr. Erick Eiting on “Healing in Place™ — Using Technology to Reduce the Risk of Hospital Readmissions.” Conference Theme II: Thursday, May 31, 2012, from 4:45pm-5:15pm in the Prince William room. 

Laura has also recently published a whitepaper under the same title.

The following is an excerpt form “Healing in Place™”:

From Hospital to Home: The Grand Transition
One cannot seriously talk about healthcare reform, improving outcomes, or reducing cost without talking about the aging of America, given the large portion of healthcare costs that are incurred in the later stages of life.1 Healthcare already consumes a distressing 17% percentage of GDP, and with the “Boomers” entering their chronic condition years, the financial strain on our society is certain to become more acute, if not critical. As a society, we pay for many pounds of cure. GrandCare Systems is passionate about providing those ounces of prevention that allow patients to successfully transition from acute care to heal at home with a technology assist. Only by moving from the monitored life to the analyzed life to the influenced life, can we reverse the cost spiral of post-acute and chronic care.

A downloadable copy of this whitepaper is available HERE.

For more information on the summit visit http://www.medicaremedicaidpaymentsummit.com

Register at http://medicaremedicaidpaymentsummit.com/registration.php

First National Medicare-Medicaid Payment Incentives and Penalties Summit

Medicare compliance Medicare RAC recovery conferenceThe Leading Forum on Recovery Audits, Readmissions, Value-Based Purchasing, HACs and Never Events, and Managing to Medicare Margins

May 30 – June 1, 2012
Hyatt Regency Crystal City
Washington, DC

Online at

Conference Theme II: Healing in Place™ — Using Technology to Reduce the Risk of Hospital Readmissions  is scheduled for Thursday, May 31, 2012, from 4:45pm-5:15pm. Featuring Laura Mitchell of GrandCare and Dr. Erick Eiting.

– SAVE UP TO $400 –
Register by Friday, April 20, 2012 for
Early Bird discount and save up to $400.
Click here to register.

– CMS Updates on Medicare and Medicaid Initiatives
– Hospital Compliance Programs
– Recovery Audit Contracting in Medicare and Medicaid
– Reducing Hospital Acquired Conditions and “Never Events”
– Proven Strategies to Prevent Unnecessary Readmissions
– Key Legal and Regulatory Issues Ahead
– Employer Demands for Value
– Total Revenue Cycle Management
– Instituting a Culture of Patient Safety
– Making Value Based Purchasing a Bonus not a Penalty
– How Patient-Centered Care Improves Quality and Lowers Cost
– Managing to Medicare and Medicaid Margins
– The Board’s Role in Quality and Safety
– How Baldrige Winners Meet the Triple Aim

12/01/11 Webinar “Health Care: Payment & Delivery System Reforms”

Date: Thursday, December 1st, 2011
Time: 2pm ET (1pm CT / 12p MT / 11am PT)


The Patient Protection and Affordable Care Act will mark a paradigm shift in the way health care is delivered in this country and how providers will be compensated.

In this webinar, you will learn about:

  • Impacts to home health and long term care providers with respect to Medicare and Medicaid reimbursement.
  • Other new initiatives, demonstrations and pilot programs that are designed to shift payment for services from volume to value-based criteria.
  • The heavy emphasis on clinical integration across the continuum of patient care settings.

Our Speaker: Dan Santos, Williams Mullen

Dan Santos is a regulatory and corporate attorney at the law firm Williams Mullen, and is a member of the Firm’s Long Term Care Industry Service Group and its Health Care Practice Group.  Mr. Santos has extensive experience representing health care clients on a multi- state basis and at the federal level. He regularly counsels health care providers in transactional and regulatory matters, including hospitals, health systems, skilled nursing facilities, behavioral health companies, physician groups, rehabilitation clinics, and home health agencies, among others. He frequently interacts with federal and state health regulators on his clients’ behalf regarding compliance issues, such as investigations,enforcement actions and reimbursement issues.

Our Sponsor: Williams Mullen

Williams Mullen is a full service legal and governmental affairs firm of over 300 attorneys and professionals with offices in Washington D.C., Virginia and North Carolina.

Image Credits: http://www.instbusapp.org/education/webinars/creating_incremental_expense_budget_under_stark.html