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Reimbursement puzzle: Providers question policymakers on audio-only visits

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Physicians are not too pleased with the recent changes in telehealth policies as some of the real issues go unanswered

After CMS announced various telehealth benefits, there was a sigh of relief among the healthcare organizations. A lot of possibilities, like a ray of hope, emerged for these physicians helping them solve the dual purpose – continue to treat patients and reclaim the lost revenue. New rules were introduced to equip the healthcare system with the maximum flexibility in response to the COVID-19.

However, reimbursement policies have been changing by the moment as physicians, providers, and practices seek more answers on telehealth technologies. And this has led to a constant oscillation of disagreement between CMS and healthcare organizations. These physicians are not too pleased with the CMS’s decision of not allowing them to use audio-only visits — such as phone calls — for determining risk adjustment for patients in Medicare Advantage (MA) programs.

Bone of Contention

To determine the level of reimbursements, the provider should have a record of the preexisting condition of each patient. Medicare entails that the visit be done face-to-face or via telehealth “when the services are provided using an interactive audio and video telecommunications system that permits real-time interactive communication.”

Physicians strongly believe that video visits via smartphones would be a challenge for the senior or the underserved population. From the adoption of technology to the affordability of smartphones, Medicare beneficiaries would be unable to communicate via video call with their physicians. One of the physicians reiterated that the CMS needs to discuss this issue closely with the physicians’ community to understand their process of doing it ‘audio’ only.

Although the agency has recently added audio-only codes to the list of Medicare-reimbursed telehealth visits. However, the providers think it’s confusing as “for some purposes for reimbursement, it is considered telehealth, but for other purposes, like risk adjustment, you can’t have audio-only codes and hence it becomes difficult to keep a track of it”.

Why Vivify Health is the Knight in the Shining Armor

As a leader in connected care solution, we have invested a huge amount of time and effort into doing the research work to ensure that healthcare organizations can work seamlessly. We have designed and developed a fully managed kit that works right out-of-the-box and is ideal for patients with zero to little technology experience.

Our back-end caregiver portal is equally intuitive and allows clinicians to efficiently and proactively manage the complex workflow of remote care for virtually any clinical condition. Beyond simplicity and flexibility, the comprehensive, content-driven platform and turnkey workflow services enable providers to intuitively scale and maximize value across populations.

The Vivify solution is incredibly simple for patients of any age and ability, including patients well into their 80’s and 90’s and over 100’s. The engagement tactics and the educational tools utilized are varied and customized to each population segment or individual thereby delivering higher quality and more cost-effective care.

Device Assistance Program

We offer programs for device assistance for patients without access to Smart devices.

By recently collaborating with Samsung, we provide support to hospitals to screen their patients at home while providing relief to the ERs. We have designed an easy, out-of-the-box kit with a cost-effective smartphone, screening app and carrier connection that can be provided to help:

  • Prevent transmission in the hospital from the COVID-19 to non-COVID-19 patient
  • Relieve patients’ anxiety
  • Reduce caregiver workload and stress

We take pride in establishing an effective relationship with our customers and their patients which is based on trust, empathy and care.

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Vivify Health is transforming healthcare with the market’s most comprehensive patient-centered connected care platform, spanning from remote monitoring of high-risk patients and patient activation to population and employee health. Vivify’s platform is the digital pathway to collaborative care on demand — with a focus on ease of use for employees, members, patients and providers.

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