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CMS Offers Expanded Telehealth Coverage for Providers

By Jennifer Bresnick

New telehealth services will be included in the Medicare reimbursement plan starting on January 1, 2015.

Providers will be able to receive Medicare reimbursement for a new group of services under the telehealth benefit at the beginning of 2015, CMS announced at the end of October, including mental health care, annual check-ups, and a related code for chronic disease management.  The new CPT codes may help to address the significant disconnect between providers who are embracing telehealth services and those who are actually getting paid for their work.

As part of the 2015 Physician Fee Schedule (PFS), providers may now bill Medicare for annual wellness visits, psychoanalysis, psychotherapy, and prolonged evaluation and management services.  The code for chronic care management, 99490, is not specifically a telehealth code, explained the American Telemedicine Association (ATA), and can be used regardless of the patient’s location to address the time and effort providers put in to collecting and reviewing data for complex patients.

“We reported that this code could be bundled with CPT code 99091 for collecting and reviewing patient data (which is valued at $56.92 on the books),” the ATA said in a press release. “However, it turns out that CMS will still not allow any additional payments for this service. The agency will allow providers to count the time they spend reviewing data towards the monthly minimum time for billing the chronic care management code. CMS expects that this accommodation will enhance the utilization of the 99490 service. So, while CMS has once again not allowed payment for data collection, the battle has taken a small but significant turn.”

A number of studies and pilot programs have highlighted the usefulness of telehealth for patient management, especially in the area of mental health care.  The VA has had a long track record of success with providing remote services to veterans suffering from PTSD, chronic pain, and behavioral health conditions, as well as supporting their caregivers through mHealth apps.  Despite the success of telehealth for these patients and for connecting rural populations to specialty and emergency care, many providers don’t receive reimbursements for their efforts.

More than forty percent of providers state that they don’t receive reimbursement for telehealth services, even though twice as many executives think telehealth is an important strategic goal for their organizations that can boost patient engagement and improve the quality of care.  Telehealth advocacy groups have been steadily urging Congress to make remote services a higher priority for Medicare and Medicaid to encourage the expansion of the valuable set of tools.

“Congress has the responsibility to take necessary steps to help Americans realize the benefits of these solutions,” wrote the ATA and a number of other organizations earlier this fall.  “Despite an outdated and restrictive legal and regulatory environment, these transformative technologies have been demonstrated to result in increased quality of care, reduced hospitalization, avoidance of complications and improved satisfaction, particularly for the chronically ill, and reduced costs, among others.”





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