Episode 126:
Telehealth Compliance in Late 2025

CJ Wolf: 0:34 

Welcome everybody to another episode of Compliance Conversations. I'm CJ Wolf with Healthicity. And today's guest is one that we've had on the show before, but we're excited to have her back. It's Keisha Wilson. Welcome, Keisha. Glad you're back. 

Keisha Wilson: 0:48 

Hi, CJ. Thank you so much for having me back again. 

CJ Wolf: 0:52 

Absolutely. We we met at uh met again at a conference recently, and um we said, hey, let's let's let's talk about some of the things that you spoke about at that conference. But before we get into that, let's just kind of remind our guests of who you are, what you do, and anything you want to share in that regard. 

Keisha Wilson: 1:10 

Awesome. So my name is Keisha Wilson. I am the founder of KW Advanced Consulting. I've been in healthcare now almost 30 years. Funny, I know. Everyone always try to figure out my age after I see that. Um but I've held various roles when it comes to healthcare, and I decided to bet on myself as a friend encouraged me. So almost like four years now, I started the company. So a lot of what I did in compliance uh when it comes to audits, education, um, revenue cycle management, I do now as a vendor. Uh, have clients of various areas. So some may have just opened a practice, some um has one for a while, and I go and assess, I write policies and procedures, uh, teach medical coding, so I teach under KW Advanced Consulting, and I also teach for VILT and then New York City College of Technology, my old albumada. I teach patient care navigation there. And then I also sit on various board of directors, and one in particular is for the International Society of uh Telemedicine and e-health, and um of course mental health board and HIM board and a nursing board. I know, I don't know when I sleep, but that is a bit about yes, and so main focus a lot on telehealth, risk adjustment, and EM. So we are here to talk about one of my favorite topics. 

CJ Wolf: 2:37 

Yeah, we're gonna talk about telehealth, but let me just say uh Keisha's a wonderful person, uh an outstanding professional in this field. So we'll include in the show notes links to her company and to her in case you need her services. We highly recommend you reach out to her. 

Keisha Wilson: 2:53 

Thank you. 

CJ Wolf: 2:54 

Um Keisha, before we jump in, I just want to level set with the audience here. We are recording this podcast on October 30th of 2025. Um, and so the topic we're going to talk about is pertinent today. It'll still be pertinent a week from now, which is when we think this will go live, probably early November. But if anything changes um in the next few days, just recognize that the things we're talking about are true and pertinent as of October 30th. And tomorrow may bring some new things. We actually hope it brings some changes to what we're saying today, because we're going to talk a little bit about telehealth and the federal government shutdown. Um, and so let's jump into that, uh, Keisha, a little bit. And because in your presentation at the uh at the conference, um, this was a big part of it, right? Because we're like all have our hands up in the air, like, what's going on with telehealth? And um, and so tell us a little bit is about this recent federal shutdown, federal government shutdown, and how is that affecting telehealth access and reimbursement under uh CMS for for like Medicare beneficiaries, for example? 

Keisha Wilson: 4:05 

Okay, and I'm just smiling because I'm like, who would have thought when I think I proposed to speak about this topic at the conference, um, that we would have had a shutdown, you know, right? So we knew, you know, since last year when they had the extension, you know, things were supposed to end December 31st of last year, 2024. And then we had some extensions uh through the American Relief Act until uh uh March 31st, 2025. I always have to close my eyes to think about dates. And then we had some more extensions um once March 31st. They actually told us two weeks before that things would be extended until at least September 30th. Uh so I think many of us thought that okay, they would extend it again. Um, but then lo and behold, we had to shut down October 1st. So I knew things were going to be like kind of up in the air. So I know I reached out, you know, to the board and I was like, hey, I know my topic is due, but can I have an extension? Because we have some changes that's supposed to happen September 30th. And I want to make sure it's as coming as possible because I think I was presenting October 6th. So no pressure at all. Uh, and then we had the shutdown. I remember I didn't sleep um at all that night. I was just watching and waiting and trying to update the slides, and even to the minute of presenting, like down to the hour before, I I know I sat in your session the hour before and I kept checking, like, okay, no changes because I wanted to make sure I brought real-time information to those that was attending. Um, but nothing changed. So right now we have a shutdown that has affected millions of Medicare patients all around the United States. And I think I gave that example during the conference. Two hours before my session, I had a phone call with my mom, and she was stating that a doctor's office called to give her um to make a follow-up appointment for her, and it was telehealth. And then they called back 10 minutes later and they said unfortunately, due to the government shutdown, um, Medicare patients, they have to bring them back in person to be seen. And so this was something that was like real time that was happening, and a lot of organizations didn't know what to do. So that's to show you the landscape that we're in, how the Medicare patients are being affected. You know, I spoke about my mom before, how she's post-stage four cancer and different things. So when it comes to her white blood count and certain things, you just want to keep them safe and telehealth has helped with that. But the shutdown now, they have to go back in person. Um, MLN, they had put out an alert saying that the MAX should hold certain claims for 10 days. But now, October 21st, they sent out another alert saying that they can process claims, but some will be paid, some may not be paid, they're not sure. Uh, so you just have to submit and see. And so right now we're in the landscape of we're going back to a lot of how telehealth was before the public health emergency. When it was really restricted, you had to be in a geographic particular rural health area for to be paid, or in a Medicare designated area that is approved for telehealth services. You know, before there was limited amounts of telehealth services that can be done via telehealth as well. Now we know they expanded that list. Um, so we're in a space when it comes to Medicare, like we're not sure with the patients. They're signing ABNs, and I know we're going to talk about that in a bit about what they can do. So the advanced beneficiary notice, um, that's something that is a possibility. Some organizations have halted seeing Medicare patients. Some are actually kind of eating the cost and still seeing patients for continuity of care. So when it comes to Medicare, we're still at a very up and down, or I like to say salsa dance. But when it comes to Medicaid and it comes to the private payers, they already had a lot of permanent uh laws and guidance and policies in place when it comes to telehealth. So it's more the Medicare patients, but it's a significant amount of patients. Um, so now, unless you're like mental health services may not be paid because mental health services, I think it was in the 2022 physician fee schedule, they changed the definition of mental health visits to make it permanent, even when it came to some of the geographic areas. And even then, there's some exceptions. Like the mental health thing is so huge where you have to read, and there's some exceptions that I'm sure we're gonna talk about some more. So we're in the landscape of the shutdown restrictions, things not getting paid, Medicare patients having to go back in the office. And it's not the easiest when you think about the Medicare populations, because it's normally over 65, the elderly disabled if they're under 65. So, you know, really um a population that really needs telehealth along with others as well. 

CJ Wolf: 9:29 

Yeah, well, and you know, for for a lot of us, let's just go back before the pandemic, even you already alluded to this, that telehealth was pretty strict and pretty limited. And we just got to remember that the because there was a public health emergency and that status could be declared, that's what gave us flexibility. The law was not changed. And so for years we were living under flexibilities because of the public health emergency. Congress never permanent, with some of the exceptions you've mentioned, there weren't like major permanent legislative changes, and and Medicare just can't cover whatever they want. They have to get their direction from legislation. And so, but we all got used to telehealth during those three or four years and we loved it, right? And so we're all like, hey, telehealth is great. It's all for all the reasons you just described, it's better for patients, it's easier. And then all of those, you know, extensions that you mentioned, the last one was to expire, you know, like you said, at the end of September. If the even if the government shutdown had not happened, we would have still been dealing with Congress needs to do something for us to continue, right? And so uh we just all need to remember that um all of these flexibilities existed because of because of a public health emergency. And now we're dealing with everyone liked it, everyone saw how effective it was, but the law doesn't really allow for it. And if we don't have a formal declaration of a public health emergency, we don't have those flexibilities. And so um, yeah, so for everything you just said, and and before we get into some of the other specifics, let's just pretend that there hadn't been a government shutdown. Correct me if I'm wrong, but I believe you said there was legislation moving along in Congress that had bipartisan support that if the shutdown had not happened, that probably would have passed, and it probably would have done what? Is that what would it have done? Did I first of all understand correctly that there was legislation? And if it had been passed, what would have happened? 

Keisha Wilson: 11:44 

Yes. So I'm gonna give a few answers because you said a lot of good points there too. So over the weekend, I think it was October 25th, Sonal uh Patel and I did this telehealth playbook workshop. Uh it was six hours, and we had the president of the International Society of Telehealth and e-medicine. She came and she presented, and it was from a physician perspective because she talks a lot uh when it comes to Congress and all over the world and internationally about telehealth and policies. And so it was amazing to hear the difficulties or the frustrations from a physician perspective when they want to take care of patients and there's this restrictions. Um, but she's been an internal medicine provider for 30 years. So she's seen the landscape of telehealth. And during this session, I think I did this once in HealthCon, I talked about um the timeline of uh telehealth. And so a lot of us now got familiar with telehealth, as you mentioned, because of the public health emergency. This is what we had to do to see our patients and just for continuity of care. But telehealth has been around since the early 1900s. Um if you go back, even the 1800s, when we talk about the phone, but early 1900s, where they use like television and radio, then NASA used it. So everyone always asks, is telehealth going away? I always say it's not going away because it's actually been around longer than most of us have been alive, right? But we have to get Congress and other payers on board to make certain legislations permanent when it comes to telehealth. And we have to learn how to do it compliantly. Because during the public health emergency, you know, we just like a lot, we were up trying to see our patients, it wasn't always on the compliant platform. And so that's after, you know, after the public health emergency, as of August 9th, 2023, we must all be on a HIPAA compliant platform, but not everyone is, right? And so before telehealth, as you mentioned, or before the public health emergency, it was really restricted. You had to be in a rural health area. If you were an FQAC, it was like outside of a non-metropolitan statistical area. It was paid on a limited basis, um, and there was a limited amount of providers that could bill for Medicare services. So Medicare also has a permanent list of telehealth providers, like the MDs, DOs, nurse practitioners, PAs, nurse midwives, psychologists, uh licensed marriage social workers, they're on there, and I think dietitians are on there now too. But the PTs, OTs, speech language pathologists, as of September 30th, right now, they cannot provide services anymore. So we were in a real restricted area. Uh, some places, if they did bill for telehealth before the public health emergency, they had grants. So I remember I worked in one particular hospital in New York City, they had a grant, and that's how they got paid for telehealth services. So now there are, and that's why I say it's not going away, uh, the American Telemedicine Association, the ATA, they continue to foster and lobby. Uh, they had a letter written on President Trump's desk, even the day he was inaugurated, you know, talking about making a lot of the flexibilities permanent, right? Because when you think about mental health, you have HRSA, the social work compact, who was licensing social workers in all different states because of the significant increase in mental and behavior health, right? So you have a lot of people who have virtual practices. So it's like, okay, well, what are they supposed to do now when it comes to the landscape of, well, you need to have a location or we need to have an in-person visit. So there was some, we have a few bills that was on Convice desk waiting to get approved. Um, and then the shutdown happened. So we had one uh was the Connect Health Act, uh, which is looking to make some of the flexibilities when it comes to geographic restrictions. They're looking to make it permanent. Um, and when you think about it, it makes sense, right? So someone does not have to be outside of a metropolitan statistical area to get telehealth services, then it was going to also expand the eligible providers that can provide telehealth services. Another one that was on their desk, I think, is the telehealth modernization act. That one was definitely on there, and they're looking to continue some of the flexibilities that happened post-public health emergency. They're looking to extend some of these flexibilities at least until 2027. So it just happened that the shutdown happened while we were in this dance. I think they know that as of September 30th, that they were supposed to have the shutdown, they needed to have some things in place, and then we just got stuck in between. And then we still have the Consolidation Appropriation Act of 2021, now 2023, which we're making a lot of things permanent or trying to make a lot of things permanent that's still there when it comes to the flexibilities. So right now we have at least those three, and then there's the telehealth um coverage act, which was proposed, and that one was supposed to like make audio-only services permanent uh when it comes to telehealth. And as you mentioned before as well, there's some things that Medicare can make permanent on their own, that's you know, within their guide within what they're allowed to do, but there's other things that they have to get Congress approval. And unfortunately, the geographic restrictions and certain other things are just in the hands of Congress. And now we're we're kind of waiting to see what that looks like. 

CJ Wolf: 17:52 

Yeah. Let's talk about some of those things uh in a moment. We're gonna take a quick break and then let's come back and talk about that specifically. Welcome back from the break, everybody. Uh, we were talking about some of the legislative actions that have occurred and that were about to occur, and then the shutdown happened. So basically, so eventually the shutdown will end. I have no crystal ball, I don't know when that will be, but eventually it will. Um, and Congress can hopefully then act on some of those laws. And they have done this in the past. I don't know that they'll do it. Sometimes they make things retroactive. And so to your earlier point, that's why some Macs were saying hold the bills, right? Um, you talked about ABNs, but let's briefly just say in in a nutshell, um as of today, if you want to guarantee reimbursement, you have to revert back to the pre-COVID rules with a general kind of high-level exception about behavioral health, where those you can still, I believe the patient can still be seen in their home, whereas all the others kind of require this uh other site. Is that a good high-level general statement? Or and I know there's probably some exceptions, but is that generally true? 

Keisha Wilson: 19:55 

Yep, it's generally true. Um, and there's so many, you know, exceptions, but unfortunately, right now, and CMS just and we will link it for you all to see in case you didn't. CMS came out with the FAQ, it's about five pages long, and they answer a lot of these questions. And so they mentioned one, you know, if it's non-behavioral health right now, unfortunately, you have to go back into an office um to be seen, and it has to be an approved location. So a lot of people didn't even know that Medicare had a telehealth payment eligibility analyzer. Um, I showed it in uh my slides at the conference. And so if you go right now, it talks, it has a blurb, as with everything that you go, all government sites. When you go right now, there's a blurb that said right now there's a shutdown, so it may not be updated. Um, but organizations should use that analyzer going forward after that to make sure that you're within a certain area that you will get paid, right? Because right now we're going back to that pre-public health area. If you're not, you know, if you're not within a non-metropolitan statistical area, then the FQATs and RACs right now they're kind of covered because of that be mental health law that they passed before in 2022. Um, and they the FAQ also did mention an update when it comes to in-person visits. So they mentioned that if you did not, like as of you know, September 30th and on, you know, you definitely would need an in-person visit. If you did not have one prior, um basically they're honoring that. But as of now, going forward, you need to. If that provider is not available, then someone else within the same subspecialty can provide that in-person visit that has to be recorded in CMS database for those behavioral mental health services. So you think about those psychotherapy codes, those 9071s, 90792s, and the group therapy, individual therapy, that would need to be recorded. But again, you can see why the ATE is fighting to make a lot of things permanent because there's a lot of providers that are affected. And then you think about the elderly populations who, you know, when I teach the patient care navigation course, even though we live in such a big city, for example, New York, there's still a lot of patients that have social determinants of health where they can't. Transportation is a huge issue. Um, how do they get even in a business city, right? Because there's people don't want to go on these things. So you think about the patients that is affected when it comes to those areas. 

CJ Wolf: 22:45 

Yeah. 

Keisha Wilson: 22:46 

Um audio only as well, like you said. 

CJ Wolf: 22:49 

Yeah, yeah, exactly. So now when you were on the show before, and this was maybe like spring of 2024, we were trying to figure out roughly when it was. We'll we'll find the episode and link it to this one. We discussed at length ABNs. So we don't necessarily need to go into all the details about ABNs, but tell us about how some have been encouraged, or potentially that idea has been thrown out there and about because these services aren't necessarily covered right now, uh, having a patient sign an ABN. And have you actually seen people doing that or are most of them not? 

Keisha Wilson: 23:27 

Um, now seeing them start to do it, I think they had forgot about ABNs. Believe it or not, in 2025, there's still a lot of organizations that don't even know what an ABN is. And that always baffles me. But, you know, we're still there, right? So we have to train our front descent administrators that ABNs, this is a time, advanced beneficiary notice. So you give it to your patient in advance. And I had someone that attended the workshop over the weekend that asked a good question. She was like, you know, in my organization, we saw a whole bunch of Medicare patients and we didn't. Can we go back and now have them sign those ABNs? And I said, no. CMS talks about that. If you don't give it to them way in advance, you can now not have them sign it because you forgot to give it to them. So they have to have a choice to know that they may now be responsible for this bill. And that's what the ABN is. There's options, there's three options on there. You can check there's modifiers that would be applicable. You have to write the service that it is, how much it costs, and the patients have to know that it may not be covered and they're going to be responsible for their bill. Can they do that? If you did not provide that to your patient before, then now your organization will have to, you know, waive those visits. You can now not bill those patients for those visits, and it was your fault. So, you know, organization should go back, listen to those ABNs, make sure your organization has it. The most current one is set to expire January of 2026. Um, and so if you're using an old one that's still considered null and void, like you didn't even do it, and you need to make sure it's signed and filled out in its entirety. So I think people forgot about APNs, and that would be an option, even though ML MLN said it. So we're gonna link that for everyone as well so you can read it. 

unknown: 25:22 

Yeah. 

Keisha Wilson: 25:23 

And it comes in English and Spanish, exactly in small print for those that wear contacts and glasses. 

CJ Wolf: 25:29 

Exactly. So the majority of what we've been talking about so far has been Medicare. You did mention Medicaid a little bit, but can you just briefly tell us what are commercial payers doing? Are some commercial payers still allowing telehealth? I think some commercial payers are finding telehealth to be a benefit, um, right? And may have continued these benefits. Tell us a little bit about what you know there. 

Keisha Wilson: 25:51 

Oh, yeah. So I would say a lot of payers, private payers and state government, state Medicaids have permanent laws and um policies when it comes to telehealth. And even like New York State Medicaid, I use that as an example um all the time. Sorry, because that's a state. Um but they had about the payment parity and that they're continuing to pay under payment parity. So they're paying those telehealth visits as they would in-person visits until April of 2026. They also have about place of service because they want to see something other than 02 and 10. They want to see 11 for payment parity. So I always tell um everyone make sure you check your specific payers because each one wants something different. One shoe doesn't fit each right, but right, it's it holds true to the payers. Commercial payers have actually policies on their websites regarding telehealth. They are paying it, they're paying payment parity as well, but their specific modifiers, there's specific codes. So a lot of payers, private payers did not adopt um the new AMA codes, the 9-8 series codes. A lot of them were following what CMS did, and they were using the outpatient EM visits with the appropriate place and service and modifier. And a lot of state Medicaids are doing that too. I think we had just a few sightings of a lot of the blues, like Florida blue, Alabama blue, that were paying those 9-8 series codes. So that's to show you that you need to check your payer policies. But also, what payers are also doing is they have their own platforms and their own physicians to provide services. So they may not approve your provider to provide services. They may actually want that patient to be seen by one of their providers on their platform. So that's why I tell everyone you have to check eligibility, you have to check your payers, uh, your patient's insurance to see if it's approved, if your provider is approved. Um, you can't assume because a patient Aetna that is going to be curved and you have 10 patients that have Aetna. Each policy is different. 

CJ Wolf: 28:09 

That's right. And and you know, Aetna might sell a Medicare Advantage plan. And so it might say Aetna, but it's really Medicare Advantage. And so, you know, you you probably run into this a lot with your clients. I know I get it with my clients. They say, Can we build telehealth? Sounds like a simple question. And the answer is it, the short answer is it depends. And the long answer is part of what you started, which is what state are you in? What payer are you trying to bill? You know, and so because people hear on the news telehealth not being covered, and they think that's the world and Medicare, and some parts of it are, but a lot of it isn't. But that's Medicare. And to your point, your answer you just gave, check with your payers, check with your states. It's very, very unique. And I've even seen some payer policies say use this place of service as to what you were kind of saying that's different than what Medicare says. And so you know, you just really it it's frustrating, but you have to go through that exercise. 

Keisha Wilson: 29:09 

Yes. And I feel like some clients like they may get annoyed when you say, Well, each pay is different. And I hear the students when you teach the billing, they say that too. I'm like, no, it's really true. And then I have a sign on my desk. I always like to show it. It says, Oh, this calls for a spreadsheet. Um and it's literally because you also have to create a spreadsheet for everything, like with the payers, what modifier, place of service. Each one is different, and um, you're seeing that when it comes to telehealth. So, you know, getting I encourage organizations to teach your friend desk to check eligibility, check if it is a part of that patient's plan. Um, because it starts in the front, and I realize that they're not doing that. Sometimes they think, oh, the front desk doesn't need information about telehealth, but they actually do. They need to understand the whole scope so that they can, you know, check and make sure it's covered before the patient comes in. 

CJ Wolf: 30:05 

Yeah. Well, Keisha, we we are kind of coming towards the end. I know we haven't gotten to everything that we had planned to talk about, but maybe we have you, and I know, not maybe, we want to have you come back and um and you know, maybe talk about once the government reopens and maybe some of these laws pass and get signed, have you come back and kind of tell us the fine print there? But you know, as we're coming to a close, are there any last-minute things that you think are really important that I didn't ask about, um, or you know, kind of parting comments that that you'd like to share with everybody before we close? 

Keisha Wilson: 30:42 

Yes. So I think one, I remember last year in one of the presentations I gave, I talked about the different states, and a lot of them had passed recent bills making audio only and certain things permanent. So, again, that's to show you how when we're talking about telehealth, there's a lot of stuff on the federal level, but we have state levels as well. So you have to go back to what you said, CJ. What state do you live in? And then look at those state laws because they already have permanent stuff when it comes to telehealth and audio only services. So you have to read. Research that has to become your middle name. I always say that's my middle name. That has to become your middle name when it comes to this. Um, there's a lot when it comes to telehealth. I definitely think of part two because there's so much when it comes to mental health services and non-mental health services. But for now, you want to check your resources, look at Medicare. If you have a significant amount of Medicare patients, look at the Medicare FAQs, go back to your Medicare manuals. Uh, a lot of stuff already set in stone when it comes to FQHCs and RHCs. You know, there's a manual for everything. Um and then look at your state laws, look at your Medicaid states, and do not just take, okay, because Medicare did this, we're gonna stop seeing all patients. That's not it. That's where policies and procedures come in. You can still see Medicaid and commercial payers, right? And then you just have to look at your Medicare clientele right now and decide are you gonna sign ABNs or are you gonna halt it and bring them back in person for a time being? So research, stay abreast, read the links that we put and stay in tune for part two of when the government opens and what's next. Because there's a lot actually for uh 2026 that we didn't get to talk about too. 

CJ Wolf: 32:33 

Okay. Well, good. Well, let's have you let's have you come back when things, when some of the dust settles a little bit. And I know you're working on other things unrelated to telehealth that we'll probably want to have you back and talk about as well to kind of tease some of our listeners about some of the other things you're doing. So, Keisha, thank you so much for taking the time and your willingness to share your expertise. 

Keisha Wilson: 32:54 

Thank you for having me back. I enjoyed it. Have an amazing day, everyone. 

CJ Wolf: 32:59 

Yeah, it's it's a pleasure talking to you and to all of our listeners. Uh, we always like to close with this that, you know, if you know of a speaker or a guest that we should have on, please let us know. If there's a specific topic that you would like to hear discussed, please let us know. We want to make this useful to you. Um, and until our next episode, take care, everyone.