Telemedicine Critical Care Billing For Hospitalized Medicare Fee-For-Service Beneficiaries, 2018–2024
Uchenna R. Ofoma, Jonah M. Graves, R. J. Waken, Anne M. Drewry, Sanjay Subramanian, Benjamin Scott, Chiedozie Udeh, Vitaly Herasevich, Karen E. Joynt MaddoxObjectives:
Expanded coverage for telehealth during the COVID-19 pandemic allowed providers to bill for telemedicine services that were previously not reimbursable, including telemedicine critical care (TCC) services for critically ill patients. We aimed to characterize TCC billing practices among Medicare beneficiaries before, during, and after the COVID-19 pandemic.
Design, Setting, and Patients:
This was a serial cross-sectional study of adult Medicare Fee-For-Service beneficiaries with at least one bill for critical care at acute care hospitals from January 2018 to September 2024. TCC billing was identified using provider billing codes; multivariate regression models were used to determine characteristics associated with receipt of TCC. Key outcomes were patient-, provider-, and hospital-level characteristics associated with TCC billing.
Interventions:
None.
Measurements and Main Results:
Billing for TCC increased from 0.002% of critical care bills pre-pandemic to 0.01% of critical care bills during and after the pandemic. Patients billed for TCC were disproportionately likely to have COVID-19 but were otherwise relatively similar to critically ill patients not billed for TCC. Internal medicine/critical care providers accounted for the highest proportion of pandemic TCC bills (46.0%). TCC billing occurred more often at minor teaching hospitals (adjusted odds ratio [aOR], 1.21; 95% CI, 1.03–1.43) and at safety-net hospitals (aOR, 1.33; 95% CI, 1.04–1.70). TCC billing was less likely at small-sized hospitals (aOR, 0.39; 95% CI 0.26–0.58) and medium-sized hospitals (aOR, 0.67; 95% CI, 0.47–0.95), government-owned hospitals (aOR, 0.70; 95% CI, 0.57–0.86), for-profit hospitals (aOR, 0.58; 95% CI, 0.48–0.71), rural hospitals (aOR, 0.70; 95% CI, 0.55–0.89), and critical access hospitals (aOR, 0.59; 95% CI, 0.47–0.73).
Conclusions:
Billing for TCC among hospitalized critically ill Medicare beneficiaries increased during the pandemic but remained low as a proportion of all critical care bills. There was variability in utilization across subspecialties and lesser utilization at rural and critical access hospitals. Further studies are needed to characterize the clinical and economic consequences of this shift.