On July 12, 2018, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that includes proposals to update payment policies, payment rates, and quality provisions for services furnished under the Medicare Physician Fee Schedule (PFS) on or after January 1, 2019.
The focus of this article is the telehealth services included in this proposed rule. For CY 2019, CMS is proposing to add the following codes to the list of telehealth services:
- HCPCS codes G0513 and G0514 (Prolonged preventive service(s))
CMS is also proposing to implement the requirements of the Bipartisan Budget Act of 2018 for telehealth services related to beneficiaries with end-stage renal disease (ESRD) receiving home dialysis and beneficiaries with acute stroke effective January 1, 2019. They want to add renal dialysis facilities and the homes of ESRD beneficiaries receiving home dialysis as originating sites, and to not apply originating site geographic requirements for hospital-based or critical access hospital-based renal dialysis centers, renal dialysis facilities, and beneficiary homes, for purposes of furnishing the home dialysis monthly ESRD-related clinical assessments. Additionally, CMS will add mobile stroke units as originating sites and not to apply originating site type or geographic requirements for telehealth services furnished for purposes of diagnosis, evaluation, or treatment of symptoms of an acute stroke.
In an article posted by Healthcare IT News, CMS Administrator Seema Verma further elaborated on the proposed rules, stating: ” Under this proposal, Medicare will start paying for virtual check-ins, meaning patients can connect with their doctor by phone or video chat, Verma said. “Many times this type of check-in will resolve patient concerns in a convenient manner that gets them the care that they need and avoids unnecessary cost to the system. This is a big issue for our elderly and disabled populations where transportation can be a burden to care as well as to caregivers. We’re not intending to replace office visits but rather to augment them and provide new access points for patients.”
The article further summarized important parts of the proposed rule, stating that “[t]he proposal also greatly eases documentation requirements, with the intent of allowing EHR developers to build tools geared towards patient care rather than satisfying billing requirements. CMS estimates the changes could save clinicians an estimated 29,305 hours and approximately $2.6 million in reduced administrative costs over a year. It works by standardizing the requirements among different evaluation and management codes.”
CMS currently has an open period for commenting on these details and more on their company website until September 10, 2018. For assistance with the coding and reimbursement of telehealth technologies or services, please contact us by email or call us at 1-844-514-4477 . For similar CMS news, follow our Company LinkedIn page for bi-weekly reimbursement articles and appropriate payment updates.
Source(s):
https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2018-Fact-sheets-items/2018-07-12-2.html
And:
https://www.healthcareitnews.com/news/cms-proposes-new-rule-boost-telehealth-payments