Telehealth in limbo: Providers split on continuing Medicare services during shutdown

Editor's Note

Telehealth providers are divided over whether to continue serving Medicare patients after reimbursement expired alongside the federal government shutdown, Modern Healthcare October 9 reports. The impasse has forced organizations to weigh patient access against financial risk, with many issuing advance beneficiary notices warning patients they may be responsible for visit costs.

The Centers for Medicare and Medicaid Services (CMS) advised it would collect telehealth claims for 10 days following the shutdown, but offered no clarity on whether payments will follow, leaving providers uncertain. Alexis Apple of the American Telemedicine Association said the field has split evenly into thirds: some have halted telehealth visits, others are proceeding in hopes of retroactive reimbursement, and the rest remain undecided.

Joe Ganley of AthenaHealth said its providers deliver roughly 2.5 million virtual visits monthly and need assurance that services will be reimbursed once funding resumes. Some systems, such as Valley Children’s Healthcare in California, plan to continue telehealth for at least a year, accepting potential losses as a write-down. “If we’re able to bill for it, we will,” said CEO Todd Suntrapak, noting the financial cost is unavoidable.

At Novant Health in North Carolina, more than 2,000 patients used telehealth in one week, but the organization cannot bill for most inpatient or at-home services under current Medicare rules. Meghan Huffman, Novant’s vice president of digital health, said the system may shift visits to in-person care if the shutdown drags on and reimbursement is not restored. She urged longer-term congressional action beyond the short extension proposed in the House’s continuing resolution bill, which would only sustain coverage through November. Endeavor Health in Evanston, Illinois, is maintaining current telehealth appointments while monitoring the situation, according to the article.

While traditional Medicare telehealth coverage has lapsed, most Medicare beneficiaries are enrolled in Medicare Advantage plans, whose insurers may continue covering telehealth as part of their benefits. Companies such as UnitedHealthcare, Aetna, Blue Cross Blue Shield of Michigan, and Highmark Health report no changes to their telehealth coverage. Medicare Advantage plans can maintain these benefits under the Bipartisan Budget Act of 2018 and current CMS regulations, offering some continuity amid uncertainty.