Telerehab is a hot topic due to COVID-19. New policies, codes and billing requirements are released daily from Medicare, Medicaid, and health plans. Payers have each taken their own position on how and when they will cover telerehab services, creating inconsistency. This has most physical therapists’ heads spinning.
Seemingly overnight, dozens of “industry experts” have sprouted up offering advice on how and what to bill for these services. For reference, payment of physical therapy services was less than 0.01% prior to COVID-19. How can anyone be an expert in a crisis that has never been experienced before?
Many believe telerehab is here to stay and will be a tool in our toolboxes after the pandemic. However, it’s important to realize its limitations and acknowledge that it is only part of the solution.
Telehealth is not for every patient
The typical outpatient PT caseload cannot simply be transitioned to telerehab. First, the patient has to have access to the Internet and be “tech-savvy” enough to utilize the telerehab platform.
Telehealth works well for pediatrics, patients who are experiencing weakness or lack of flexibility, high-level athletes rehabbing from injury, or patients who need check-ins for wound care.
But patients who need hands-on care, have balance issues or are at risk of falls, have severe mobility limitations, or who are recovering from complex orthopedic surgeries may find telerehab has limited benefit.
The healthcare system is changing overnight
New information clarifying the coverage and billing requirements for telehealth is being released daily from health plans, Medicaid, and Medicare. Some policies have been given a defined end point, indicating that coverage for telehealth by some payers is only temporary, and the long term coverage for telerehab is uncertain. In addition, many of the health plans’ claim systems are not configured to pay claims for telerehab or e-visits. It may take some additional time to update in their systems to pay for these services correctly. Even Medicare, who may possibly approve some form of televisits, has not yet given them a green light. (update: 5/1/2020 - this has been temporarily approved)
Telerehab is not for every therapist, either
Telerehab requires additional therapist training. In addition to training staff on a telerehab platform, there are changes to:
- Security and privacy measures
- Documentation and coding for telerehab
- Processes for patient scheduling, billing and documentation
The economics of telerehab remain to be seen
The volume of visits that can be recaptured through telerehab and the profitability of telerehab is yet to be determined. Reimbursement for telerehab will likely be lower than on-demand or clinic visits that are in-person. Rick Katz, President of the CPTA, says “With COVID-19, many practices responded with telerehab. However, the limitations of telerehab are proving that it is not the complete solution and practices need to explore even more ideas and solutions to sustain through this crisis and in the future."
The new landscape of physical therapy options
| Telerehab |
On-Demand and Delivered to You |
Traditional In-Clinic |
- Limited to certain patient populations (technology savvy, not all cases)
- Reimbursements are uncertain
- Training needs for therapists
- Convenient and safe
|
- Applies to vast majority of patients
- Outpatient rates are compelling and predictable for therapists
- Convenient and safe
|
- Patient adherence and inconvenience
- Safety concerns
- Scheduling issues
- Transportation issues
|
At Luna, we are enabling our therapists to deliver in-person care on-demand, and also leverage televisits throughout a patient’s care plan. We encourage our therapists to work with their patients to determine the best course of action, choose the right delivery form factor for the need, and leverage all technology available to support the right treatment strategies.
