Two doctors reviewing brain scans on hospital computers

Telemedicine Reimbursement, Savings, and Care—Oh, My!

The Centers for Medicare & Medicaid Services has accepted five new Current Procedural Terminology (CPT) codes to allow physicians to be reimbursed for telemedicine specialist consultations and to expand remote patient monitoring conducted via telemedicine. The telemedicine reimbursement codes were originally proposed by the American Medical Association; now approved, they took effect on Jan. 1, 2019.

Codes 99453, 99454, and 99457 are designed for provider-to-patient interactions; they enable health care providers to monitor physiologic parameters like blood pressure and to interact with the patient or caregiver monthly to manage and coordinate treatment. These changes permit providers to utilize new technologies to deliver health care, such as virtual check-ins. These codes will likely become particularly helpful for providers who want to make sure patients are following a care plan at home as well as those who need to check on patients with mental health issues. In certain situations, the virtual check-ins will not be eligible for discrete reimbursement due to being one part of a bundled service.

Codes 99451 and 99452 are intended for provider-to-provider communications, recognizing and reimbursing consultations to coordinate patient care between a consulting health professional and a treating physician via telemedicine—an “e-Consult.”

As the application of telemedicine rises, the use of these codes should bring significant savings to medical practices.

For instance, Community Health Center (CHC), Connecticut’s Medicaid program, saved almost $579,000 between 2014 and 2016 simply by adopting telemedicine—without these new codes and reimbursement. CHC utilized telemedicine to deliver care to patients who were referred to dermatologists, gastroenterologists, endocrinologists, and orthopedists. For patients whose physician held an e-Consult visit with a specialist, CHC’s costs per month were $84 lower than for patients who were referred for an office visit; annualized, this calculates to almost $579,000. CHC researchers attributed the savings to several factors:

  • Fewer diagnostic tests and procedures
  • Avoiding specialist visits
  • Faster initiation of treatment, which may have reduced downstream complications and hospitalizations
  • Reduced visits to urgent care centers or emergency departments while waiting for a specialist office visit

In terms of other shared savings, patients received treatment sooner due to a lower turnaround response time, and they experienced less travel, decreased childcare expenses, and fewer lost wages from time taken off work. For CHC, less staff resources were needed for scheduling, tracking, and following up on office visits.

CHC researchers noted that revenues could be even higher if e-Consults are integrated into an established procedure, rather than being conducted informally or as “curbside consultations” that are not paid for.

CHC is encouraging other clinics nationwide to implement similar programs. CHC has demonstrated that substantial savings can be found separate from CMS reimbursements; once the savings are combined with the reimbursements, these will be no chump change. Add in a low-cost, high-yield telemedicine platform like swyMed and you’ll have higher savings with high-quality results, no matter how large or small the organization might be.

Referrals to specialists are one of the most common and expensive decisions that primary care physicians make, indicated the CHC researchers, as they explained their strategy of seeking a reduction in the need for in-office specialty consultations. Since telemedicine can provide just that, as well as savings, comfort, and faster initiation of treatment, it’s not hard to see why the CMS added new codes for telemedicine reimbursement this year—it’s about time!

To learn more about the new CPT codes, click here.
To read more about virtual check-ins, click here.
To learn more about Connecticut’s Community Health Center, click here.
To learn more about swyMed, visit swyMed.com.

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