Medicare Telehealth Crackdown: New Bill Requires In-Person Visits for Pricey Equipment & Tests

The "Preventing Medicare Telefraud Act" aims to curb fraud in telehealth, specifically targeting how high-cost medical equipment and lab tests are ordered. It's a mixed bag with good intentions, but potential downsides for folks who rely on remote care. The main goal, as stated in SEC. 1., is to cut down on shady billing practices within the Medicare system.

Telehealth Checks & Balances

This bill changes the rules for getting certain expensive medical gear (like wheelchairs or specialized braces) and lab tests through telehealth. Starting six months after the bill's enactment, Medicare won't pay for these if you haven't seen your doctor in person within the previous six months (SEC. 2.). Think of it like this: you can't just video-call your doctor and get a top-of-the-line wheelchair approved; you'll need a face-to-face checkup first. The same goes for certain "high-cost" lab tests, though the bill leaves it to the Centers for Medicare & Medicaid Services (CMS) to decide exactly what counts as "high-cost."

For example, imagine a construction worker who relies on a specialized back brace. Under this bill, if they tweak their back and need a new brace, they can't just get a prescription via a telehealth appointment; they'll have to take time off work for an in-person visit. The bill also requires Medicare to audit doctors who order a lot of this equipment or tests via telehealth (90% or more of their orders). These audits will begin six months after enactment (SEC. 2.).

The NPI Number Rule

Another key change is that doctors must include their National Provider Identification (NPI) number on all telehealth claims to get paid (SEC. 3.). This might seem like a no-brainer, but it's another layer of verification designed to make it harder for fraudsters to game the system. This rule also kicks in 180 days after the bill becomes law.

Real-World Ripple Effects

While the bill aims to save taxpayer money and prevent fraud, it could make things tougher for people in rural areas, those with mobility issues, or anyone who has trouble getting to a doctor's office. It's a trade-off: tighter controls versus easier access. Plus, leaving the definition of "high-cost" up to CMS could lead to some inconsistencies down the line. A small business owner, for example, might find that a crucial piece of equipment they need is suddenly classified as "high-cost," requiring an extra doctor's visit and potentially disrupting their work schedule. The bill's intentions are good, but the practical impact could be a bit bumpy for some.