As we approach 2025, it’s important to prepare for changes to Medicare’s telehealth policies. One notable update involves the reinstatement of geographic and location restrictions for telehealth services, which will take effect on January 1, 2025. These changes may impact how telehealth is delivered and reimbursed for Medicare patients, so being informed and proactive is key.
What’s Changing?
Starting in 2025, Medicare will return to its pre-pandemic rules for telehealth coverage. This means telehealth services will only be reimbursed for patients who are:
In a Health Professional Shortage Area (HPSA): Regions with limited access to healthcare professionals.
In a Rural Census Tract: Areas designated as rural based on U.S. Census data.
In Counties Outside Metropolitan Statistical Areas (MSAs): Locations outside of metropolitan boundaries.
Patients in urban or suburban areas will no longer be covered for telehealth services unless they are located in one of these qualifying areas at the time of service.
What Does This Mean for Your Practice?
While the return of geographic restrictions may affect some telehealth encounters, it’s manageable with the right approach:
Patient Location Matters: Medicare will only reimburse telehealth visits for patients in eligible areas. For urban or suburban patients, in-person visits may be needed instead.
Plan Ahead: Understanding which patients qualify for telehealth services will help streamline scheduling and ensure smooth billing.
How to Prepare
Verify Patient Location
Train your staff to confirm and document the patient’s location at the time of the telehealth service.
Update your patient intake process to include location eligibility checks for Medicare patients.
Communicate Clearly
Let your patients know about the upcoming changes and how their telehealth options might be affected.
Provide guidance to patients in non-eligible areas about transitioning to in-person visits when needed.
Streamline Your Billing Process
Work with your billing team to flag claims based on patient location.
Keep detailed records of patient location during telehealth sessions to ensure compliance with Medicare requirements.
Stay Updated
Monitor CMS announcements, as the Telehealth Modernization Act of 2024 could change these restrictions.
Check the updated CMS List of Telehealth Services to confirm which services remain eligible for reimbursement.
Looking Ahead
While these changes may require some adjustments, they reflect Medicare’s ongoing efforts to refine telehealth policy post-pandemic. By preparing your practice now, you can continue providing high-quality care to your Medicare patients while adapting to the new rules.
If you have questions or need assistance with billing and compliance, feel free to reach out. We’re here to help make this transition as smooth as possible for you and your patients.