The long-awaited ET3 program is finally here! After delays caused by the pandemic, the Emergency Triage, Treat, and Transport (ET3) program went into effect on January 1, 2021. To support this initiative, swyMed and Logitech are working together to provide the mHealth technology (mobile real-time audio-visual communications) that makes the ET3 program possible. Read more
Last March, during the early days of the COVID-19 pandemic, Medicare temporarily eased the telemedicine requirements for reimbursement in order to increase access to care and reserve in-office visits for the sickest patients; in this way, Americans have been able to reduce exposure to COVID-19, for both themselves and healthcare workers, while continuing to receive needed care. However, the unprecedented rapid growth of telemedicine has been accompanied by a rise in telemedicine fraud cases and abuses. Whatever the error may be, the Department of Justice (DOJ) has begun holding offenders accountable for their actions. Ultimately, the telemedicine industry and healthcare providers will find themselves under closer scrutiny in the future. Read more
As we’ve noted previously, the COVID-19 pandemic has thrust telemedicine into the spotlight with pro tem lifted telemedicine regulation, allowing both patients and providers to embrace low-contact methods for accessing healthcare. Now, several months into the COVID-19 pandemic, industry stakeholders are examining the currently active telemedicine regulations to determine which changes would encourage medical facilities and providers, ranging from small-practice primary care providers to tertiary care hospitals, to permanently add telemedicine to their routine options for health care delivery. Read more
We may still be in the throes of the COVID-19 pandemic, but that isn’t stopping policy makers from planning ahead to determine whether temporary telemedicine CPT codes should be a permanent part of the “new normal” that is expected to reign after the emergency situation dissipates. As mentioned previously, quick changes to legislation, especially those that reimburse telemedicine visits at the same value as in-office visits, made telemedicine a much more convenient and financially viable alternative to the traditional model of in-office visits—for both patients and providers. As we look ahead to 2021, however, debate surrounds the Centers for Medicare and Medicaid Services (CMS)’ decision to drop a large majority of the recently-enacted billing codes, which may return the state of telemedicine almost to where it was before the pandemic began. Read more
With the ongoing shift in healthcare towards a value-based care model, the concept of remote patient monitoring (RPM) for chronically ill patients certainly grabbed attention throughout 2019. By introducing new reimbursement codes for RPM in late 2019, the Centers for Medicare & Medicaid Services (CMS) is clearly inviting the increased use of RPM, presumably made possible with telemedicine, in 2020. Some experts view 2019 as the trial run for RPM reimbursement; now that the CMS has officially endorsed RPM, albeit in limited capacities, 2020 is expected to see a significant rise in the adoption of RPM programs. However, current limitations in technology and software could curb growth, warn industry watchdogs. Read more
Over the last five years, several telestroke programs have flourished around the country, but only one has successfully garnered Medicaid coverage: New Mexico’s Access to Critical Cerebral Emergency Support Services (ACCESS) model. Now, in a bid for telestroke reimbursement, an advisory committee is suggesting that the Department of Health and Human Services (HHS) use the ACCESS program as a model for building a nationwide telestroke network backed by Medicare. Read more
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
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
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
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
