National Headlines

CMS Expands Reimbursement for Virtual Care and Telehealth

Most Physicians Not Aware of CMS’s Expanded Virtual Care Provisions, Survey Finds

January 7, 2019 |  By Heather Landi, Associate Editor
For the first time, starting in 2019, the Center for Medicare & Medicaid Services (CMS) will reimburse healthcare providers for certain virtual care visits with patients, regardless of the patient’s location—a move that has drawn praise from many healthcare leaders as helping to advance telehealth.

CMS Code Gives Docs a Chance to Use Store-and-Forward Telehealth

CMS will reimburse providers using store-and-forward telehealth (also known as asynchronous telehealth) to analyze and diagnose images sent to them from established patients. (Read Full Story …)

Jan 3

Modernizing Medicare: CMS Expands Reimbursement for Virtual Care and Telehealth (This is exactly why Medicare participatory concierge/private direct models must avoid selling “access” or “communications” without carefully tethering to the non-covered exam)

2019 Medicare Physician Fee Schedule: 3 Key Takeaways

Specific to RPM reimbursement expansion, the proposed 2019 Medicare physician fee schedule changes “are intended to better reflect how RPM services can be delivered to patients,” as healthcare regulatory attorney and long-time telemedicine advocate Nathaniel Lacktman told Xtelligent Media’s Eric Wicklund. Lacktman goes on to outline in detail three major ways it would do so:

  1. Reducing the amount of treatment time required for reimbursement eligibility. As Lacktman points out, the recently unbundled CPT code 99091 “requires at least 30 minutes per 30-day period,” whereas the new code — CPT 994X9 — requires just 20 minutes within the span of a calendar month.
  1. Allowing for separate payment for time spent on initial set-up and patient training and education — something CPT 99091 doesn’t offer. Lacktman calls this “a very helpful move to further incentivize providers to start using these technologies with their patients.”
  1. Extending RPM reimbursement eligibility to a physician’s or practice’s clinical staff. Currently, CPT 99091 is limited to the treating physician and certain specifically qualified professionals, “and does not expressly allow the RPM service to be delivered by clinical staff (e.g., RNs, medical assistants, etc.),” Lacktman told Wicklund.

“This means the physician or qualified health care professional must perform the full 30 minutes per 30-day period, which is a lot of time for these highly trained professionals,” Lacktman continues. “For some providers, this is too resource-intensive to justify the $58.68 per month reimbursement rate. The new code allows RPM services to be performed by clinical staff.”

Advice to Providers Seeking RPM Reimbursement Expansion

On top of these changes, the proposal signals a shift to the more widespread use of asynchronous technology in remote care delivery, as opposed to the strictly real-time communications represented by virtual visits — something that Lacktman believes to be “the future” of telehealth.

Analysis: 3 Predictions for Virtual Care in 2019

By Mandy Roth     January 03, 2019

Focus Will Expand Beyond Direct-To-Consumer Models | HealthLeaders | January 2019

How will virtual care be used in 2019? With more health systems moving toward value-based care, there seem to be few methods of healthcare delivery that won’t be touched by this trend, which can help improve care while reducing costs. Management of chronic illness is one of the key areas for growth, an idea echoed by multiple readers. Expansion of behavioral health and specialty medicine also will continue. Some readers predict telehealth will become part of the solution to address needs ranging from annual wellness exams to the opioid crisis.



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