CMS Proposes Reimbursing Doctors for Telehealth

The Centers for Medicare and Medicaid Services (CMS) has proposed the first major overhaul of Medicare billing practices since 1995. Under the new rules, Medicare would pay for virtual visits, telephone and online consultations, and video or image reviews.

Under current billing standards, CMS bundles “routine non-face-to-face communication” into payments for in-person visits, but the proposed rule would permit reimbursement for video or audio check-ins – even if they don’t lead to an office visit.

“This is a big issue for the elderly and disabled population for which transportation can be a barrier to care,” said CMS Administrator Seema Verma, MPH. “We’re not intending to replace office visits but rather to augment them and create new access points for patients.”

Telehealth advocates expressed enthusiasm about the proposed changes. Krista Drobac, head of telemedicine trade group the Alliance for Connected Care, called the proposal the “biggest advancement in fee for service that we have seen.”

The proposed rule also incentivizes doctors to participate in a new Medicare Advantage demonstration by providing MACRA waivers for physicians with low Medicare Part B participation. Other provisions would eliminate Merit-based Incentive Payment System (MIPS) reporting requirements for doctors using advanced alternative payment models within Medicare Advantage networks.

Source: Modern Healthcare, July 12, 2018; Politico, July 13, 2018.