The announcement by the Centers for Medicare & Medicaid (CMS) that they will reimburse telehealth physicians for certain virtual interactions has been well received by telemedicine advocates. Supporters of telehealth services see the move as overcoming a major hurdle in difficulties over payment. Within a far broader proposed rule change released by the CMS are plans to pay physicians for virtual check-ins and the reviewal of patient photos and videos. In addition, the proposals include new billing codes for “prolonged preventative services” and new remote monitoring reimbursement codes. If finalized in its current form, the proposals have been described as a “game changer” within the telehealth industry by creating a broad -based reimbursement for telehealth services beyond their current rural and health care facility locations. CMS is still refining their proposal. For example, they are consulting the industry over what types of “communication technology” are employed by physicians, so that they might refine the definition of virtual check-ins. An extra benefit of the changes may also be new treatment pathways for substance abuse, including virtual medication-assisted therapy. In outlining a new proposal that would pay providers that review asynchronous video or images captured by a patient, CMS asked for comments about whether there are certain cases—such as dermatological or ophthalmological services—where a prior relationship isn’t necessary. One of the most significant challenges at the moment though is how to maneuver around payment restrictions in Social Security Act, which limits telehealth payments to rural facilities. CMS knows that telehealth solutions will help drastically reduce their medical expenditure; an in-person visit costs $92 while a virtual one costs only $14 and the current forecast is for one million visits in the first year of the proposal. These plans are primarily intended to support existing physician-patient relationships but there is support for direct-to-consumer telehealth providers as well. This article was written by Dr. Robert M. J. A. L. Smith MD PhD FRCPT FAAP FAAN FACS CNAS.
The announcement by the Centers for Medicare & Medicaid (CMS) that they will reimburse telehealth physicians for certain virtual interactions has been well received by telemedicine advocates. Supporters of telehealth services see the move as overcoming a major hurdle in difficulties over payment. Within a far broader proposed rule change released by the CMS are plans to pay physicians for virtual check-ins and the reviewal of patient photos and videos. In addition, the proposals include new billing codes for “prolonged preventative services” and new remote monitoring reimbursement codes. If finalized in its current form, the proposals have been described as a “game changer” within the telehealth industry by creating a broad -based reimbursement for telehealth services beyond their current rural and health care facility locations. CMS is still refining their proposal. For example, they are consulting the industry over what types of “communication technology” are employed by physicians, so that they might refine the definition of virtual check-ins. An extra benefit of the changes may also be new treatment pathways for substance abuse, including virtual medication-assisted therapy. One of the most significant challenges at the moment though is how to maneuver around payment restrictions in Social Security Act, which limits telehealth payments to rural facilities. CMS knows that telehealth solutions will help drastically reduce their medical expenditure; an in-person visit costs $92 while a virtual one costs only $14 and the current forecast is for one million visits in the first year of the proposal. These plans are primarily intended to support existing physician-patient relationships but there is support for direct-to-consumer telehealth providers as well. This article was written by Dr. Robert M. J. A. L. Smith MD PhD FRCPT FAAP FAAN FACS CNAS.