The recent addition of new telemedicine Current Procedural Terminology (CPT) codes may have opened the door for more widespread usage of telemedicine, but it also carries implications for telemedicine reimbursements. This article outlines the some of the most likely developments for 2019 and beyond as predicted by industry analysts Akerman LLP.
Medicare Advantage Reimbursement for Telemedicine
Currently, telemedicine coverage by Medicare is optional, although some Medicare Advantage (MA) plans might offer such coverage to attract beneficiaries. Beginning in 2020, however, MA plans will include telemedicine coverage as part of the “basics benefits” package and will be required to notify enrollees about the telemedicine option, including a list of providers who offer telemedicine services. With such broad application, all MA enrollees will be eligible for telemedicine coverage regardless of whether they live in urban or rural areas, and regardless of whether they receive care in a home or office environment.
Such blanket acceptance of telemedicine by the Centers for Medicare and Medicaid Services (CMS) indicates a huge shift in thinking. No longer are telemedicine visits seen as being inferior to in-office visits or being vulnerable to fraud or abuse; instead, telemedicine services are just as good as in-person evaluations.
Combatting Fraud and Abuse in Telemedicine Payments
Despite the progress in telemedicine coverage, the opportunity for fraud and abuse remains. As telemedicine reimbursements increase, so too will the monitoring for improper claims. The False Claims Act has already seen activity involving telephone consults and prescription drug benefits, and more is sure to come.
Closing the Gap between Medicare and Fee-for-Service
So far, limitations regarding geography and patient setting have been lifted for particular telemedicine services, such as certain home dialysis end-stage renal disease-related services and substance use disorders, but members of the House Energy and Commerce Committee have indicated that legislators should remove such limitations for other medical services as well. This would bring the commercial telemedicine reimbursement schedule in line with the 2020 Medicare basic benefits plan described above.
Altogether, these changes signal growing acceptance of telemedicine services into mainstream healthcare as a popular new method of healthcare delivery. Now, the question remains: How can you position yourself to take advantage of this shift?
To read more about Akerman’s analysis, visit Lexology.com here.