Reimbursement Changes for Telehealth Remain a Debate

By Gerald Buggs, MSJ

Last week CMS proposed a new rule that would make many of the COVID-19 related Telehealth waivers introduced at the beginning of the pandemic permanent for Medicare beneficiaries. Included in the proposal are clarifying statements as well as proposals from CMS on Remote Patient Monitoring (RPM) services:

  • Clarifying
    • Following the PHE, an established patient-physician relationship will be required for RPM services to be furnished
    • Medical device supplied to a patient as part of CPT code 99454 must be a medical device as defined by Section 201 (h) of the Federal Food, Drug, and Cosmetic Act - the data from the device must be automatically collected and transmitted, rather than self-reported
    • After the PHE, CMS will maintain the requirement that 16 days of data each 30 days must be collected and transmitted to meet the requirements to bill CPT codes 99453/99454 *CMS is seeking comment on whether the current RPM codes capture the work furnished to acute patients, or whether there needs to be coding revisions
    • Only physicians and NPPs who are eligible to furnish E/M services may bill RPM services
    • Practitioners may furnish RPM services to patients with acute conditions as well as patients with chronic conditions
    • For CPT codes 99457 and 99458, an “interactive communication” is a conversation that occurs in real-time, it includes synchronous two-way interactions that can be enhanced with video

  • Proposing:
    • Permanent policy to allow consent to be obtained at the time the RPM services are delivered
    • Permanent policy to allow auxiliary personal to furnish CPT codes 99453 and 99454 under a physicians supervision
    • To clarify that RPM services are considered to be evaluation and management (E/M) services

View the full proposal, here.

The President’s Executive Order

This announcement from CMS came at the same time as President Trump’s Executive Order to improve rural and telehealth access. The goal of the Executive Order is to improve access and convenience of care for Medicare beneficiaries, with a specific focus on those in rural areas. Unfortunately, the changes within the Executive Order do not benefit Home Health Care Agencies, however, the Executive Order “encourages the Health and Human Services Secretary to take a look at ways to extend the measures taken during the public health emergency.”

The healthcare industry has seen a sufficient increase in telehealth services during the COVID-19 pandemic but HHAs have continued to experience lack of reimbursement, forcing them to provide telehealth services at a loss and triggering higher LUPA rates. CMS has stated that they would not be making any telehealth-related changes to how LUPAS are handled, or to LUPAs under PDGM. Important to note is that Congress is responsible for making the changes that will expand access to telehealth, making it a more feasible option for home health agencies. At the end of June, CMS proposed permanent telehealth changes for home health providers.

Home Health Agencies Want Telehealth Reimbursement

The one major change that home health agencies and RPM/Telehealth organizations would like to see that has not occurred is reimbursement for telehealth services. CMS has stated that it does not have the authority to introduce and Congress must give them approval to initiate any changes.

CMS Administrator Seema Verma states “our regulatory authority outside of the public health emergency is largely limited to the types of services that can be provided via telehealth, we cannot make telehealth available permanently outside of rural areas, nor can we permanently expand the list of provider authorized to provide it. Any extension of the removal of restrictions on site of care, eligible providers and non-rural areas must come from Congress.”

What You Can Do Urge Change

Everyone in the Home Health and Hospice community should contact their representative in Congress and urge that changes be made in the home health industry for “fair payment for the delivery of telehealth services under the home health benefit.”

For changes to occur, Congressional action must be taken.

Find your representative, here.

Request a Conversation with a Telehealth Expert

Please feel free to reach out to the HRS Reimbursement Department at reimbursement@healthrecoverysolutions.com for any discussion or questions about RPM/Telehealth reimbursement from CMS or Commercial Carriers.

 

 

 

Tags: telehealth, reimbursement, COVID-19

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