Medicare Making Big Changes for Telehealth Reimbursement?

Government reimbursement is a major sticking point for physicians seeking to incorporate telehealth into their practice. The requirements for government telehealth reimbursement are burdensome and make implementing such services difficult to justify economically, despite the potential benefits to patients and providers.

However, earlier this month the Centers for Medicare and Medicaid Services (CMS) proposed significant changes in government reimbursement for telehealth services in the 2019 Physician Fee Schedule and Quality Payment Program.

Specifically, CMS is proposing new codes for remote patient monitoring services. The new codes will reduce some of the burden on practice groups. They will require less treatment time for a service to be reimbursed (20 minutes a month instead of 30 minutes). They provide separate reimbursement for set-up and patient education of the system. Finally, and perhaps most importantly, they allow other staff professionals (e.g., RNs) to be reimbursed for such services. These new codes might be the difference in the decision whether to provide remote patient monitoring.

CMS is also seeking to increase access to qualified health professionals by advancing virtual care services. CMS is proposing new codes for virtual check-ins, evaluations of forwarded images and videos, and peer-to-peer online consultations. Importantly, those codes would not require the use of live, interactive audio-video technology and would not require the patient be located in a rural area or a specific qualifying originating site. The originating site requirements and the live face-to-face requirements have been major hurdles in adopting or expanding telehealth services. The fact that CMS is proposing to remove those requirements in this area indicates the requirements may be losing favor. That would be good news for those who have been stopped by those hurdles when deciding whether to expand their telehealth services.

These changes are only proposals at this time. CMS is currently accepting comments on these changes up to September 10, 2018. However, it is likely that they will be adopted in some form for the 2019 fee schedule. That would be good news for providers seeking to expand their practice and good news for patients who have trouble traveling to a qualified provider for the treatment they need.