Telemedicine Critical Care Billing For Hospitalized Medicare Fee-For-Service Beneficiaries, 2018-2024

Area of Science:

• Health Services Research
• Critical Care Medicine
• Telehealth Policy

Background:

• The COVID-19 pandemic expanded telehealth coverage, enabling billing for previously non-reimbursable services like telemedicine critical care (TCC).
• Understanding TCC billing practices is crucial for assessing its role in critical care delivery.

Purpose of the Study:

• To characterize TCC billing patterns among Medicare beneficiaries before, during, and after the COVID-19 pandemic.
• To identify patient, provider, and hospital factors associated with TCC utilization.

Main Methods:

• Serial cross-sectional study of adult Medicare Fee-For-Service beneficiaries with critical care hospitalizations (January 2018-September 2024).
• TCC billing identified using provider codes; multivariate regression analyzed associated characteristics.
• Key outcomes included patient-, provider-, and hospital-level factors.

Main Results:

• TCC billing increased from 0.002% pre-pandemic to 0.01% during/after the pandemic.
• Patients with TCC bills were disproportionately affected by COVID-19.
• Internal medicine/critical care providers led TCC billing; utilization was higher in minor teaching and safety-net hospitals, but lower in rural and critical access facilities.

Conclusions:

• TCC billing saw an increase among critically ill Medicare beneficiaries during the pandemic but remained a small fraction of total critical care bills.
• Variability in TCC utilization was observed across subspecialties and hospital types, with lower use in rural and critical access settings.
• Further research is needed to understand the clinical and economic impacts of this telehealth shift in critical care.