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ambulance with telemedicine reimbursement

Ambulances in Line for Telemedicine Reimbursement

Starting early next year, the U.S. Department of Health & Human Services (HHS) will begin a trial program with new financial incentives, including telemedicine reimbursement, to encourage emergency medical services (EMS) to use telemedicine and transport Medicare and Medicaid patients to clinics other than the emergency room. Currently, only visits to hospitals, skilled nursing facilities, and dialysis centers are reimbursed, even when a lower-acuity destination may be more appropriate. The goal is two-fold: to promote a value-based payment system and to reduce unnecessary ER visits and hospitalizations. Read more

handing over stacks of cash

Did Medicare Overpay for Telemedicine Reimbursement?

Amidst concerns that current levels of telemedicine reimbursement are insufficient to support the demand for telemedicine visits, a 2018 report by the Department of Health and Human Services Office of Inspector General (OIG) reveals that a significant portion of the Medicare telemedicine payments that have occurred were actually improper; they never should have been approved in the first place. The overpayments amounted to roughly $3.7 million—a sizable chunk of the total $13.8 million in payments that Medicare made in 2014 and 2015. The reasons for the disallowed claims were numerous and varied. Read more

medical claim form with stethoscope and pen

New Telemedicine CPT Codes Created

After a long wait, the Current Procedural Terminology (CPT) codes have finally been updated to include telemedicine. A “95” modifier can be added to CPT codes for real-time remote encounters with a video and audio component; the list includes outpatient evaluation and management (E/M) codes, consultation codes, and behavioral health codes, among others. Additionally, a new place of service (POS) code, telemedicine CPT code 02, is required for clinicians who bill for telemedicine services. Read more

MACRA consists of the APM and MIPS programs

Medicare Reimbursements Shift towards Quality of Care

In an open letter last Friday, October 14, the Centers for Medicare and Medicaid Services (CMS), announced the finalized policies for implementing the new Medicare Quality Payment Program (QPP). Although the rule takes effect on January 1, 2017, several components will be phased in over the next few years to give physicians time to adjust accordingly. Many of the policies have been updated from the previous proposal in response to feedback from clinicians across the country. Read more

Let’s Operate on Interoperability

Wednesday, MedCity News and Life as a Healthcare CIO ran what I believe to be a very important piece on interoperability by Dr. John D. Halamka. I don’t agree with him that attempts to legislate interoperability into being should be jettisoned completely, but most of his points ring true.

Early on he asks the question that SHOULD be core to the HIT and Telemedicine industries, but especially for EHR vendors: “So what is our next step to help providers…to the point that Congress no longer wants to legislate the solution to the problem?” Read more

Hoping CMS’ Proposed ACO Rules Get Better

CMS helping a bit

Recently, CMS (the Centers for Medicare and Medicaid Services) released a proposal of new rulemaking asking for comments on easing “telehealth” requirements for ACOs (Accountable Care Organizations). You can find a wonderful press release here from the ATA (American Telemedicine Association), who was instrumental in getting CMS to reconsider their earlier rules.

Having reviewed the proposal, I had to remind myself that CMS (and, ultimately, the Department of Health and Human Services) is to actually very committed to enabling greater adoption of telehealth, and that their final rules have historically been heavily modified from their proposals. Having said that–and I’m no doctor or lawyer–but I felt this proposal to use waivers rather than simply waiving antiquated requirements just adds red tape where there shouldn’t be any. Does anyone else get that sense?

First, a quick statement of why s Read more

Maybe You Can get Reimbursed for That…

Treasure In Paper

Last week I posted a press release from the ATA about expanded Medicare coverage for Telemedicine.  Well, I decided to actually read the 1200 page rulemaking from the Centers for Medicare and Medicaid Services (CMS).  You can guess why it’s taken a week to write a follow up article…

Actually, no.  I didn’t read the entire rulemaking, only the pages relevant to all things “tele” in medicine and healthcare.  In doing so, I was reminded of something interesting:

There are a number of procedures already covered by Medicare without specific telemedicine codes.  In fact, of the seven bullet points listing the 22 codes rejected or deleted from inclusion, five noted the affected codes were largely unnecessary due to either an existing telehealth code or because Medicare does not distinguish whether the procedure is tele or not.

Here are a few examples:

Regarding electrocardiograms and echocardiograms: “By definition, Read more