UPDATE: Telehealth Reimbursement Changes

telehealth reimbursement

Recent telehealth reimbursement changes in legislation are transforming health care services in the United States. Many of these changes start with the largest payer in the United States, Medicare. As the hub for legislative reimbursement change, the Center for Medicare and Medicaid Services (CMS) sets the tone for reimbursement reform that reverberates throughout other U.S. payer systems, from federal to state to private payers. Medicare telehealth reimbursement advances then, serve as the bellwether for other telehealth reimbursement from U.S. payers. Understanding significant shifts in Medicare’s telehealth reimbursement is therefore key to understanding what’s ahead for state-based and private payer models for telehealth reimbursement.

Telehealth Reimbursement Changes

In this update, we’ll summarize the telehealth-related ramifications of Chronic Care Management (CCM), the Medicare Access and CHIP Reauthorization Act (H.R. 2), and the 2016 CONNECT for Health Act and the 2016 Proposed Budget.

Chronic Care Management 

In January of 2015, telehealth-based Chronic Care Management (CCM) became a reimbursable new service through Medicare. Optimized by telehealth-based systems, CCM allows providers to harness telehealth technology to better manage complex staffing scenarios; increase clinician-patient contact by allowing for briefer, more frequent contacts with providers and their office personnel; decrease length of stay for hospital inpatient care; improve quality of care and hopefully, reduce overall patient costs. Paying providers on a monthly, capitated (per patient, per month) basis, the new CPT code for CCM is CPT 99490. As a result, various parties from hospitals to small group practices are looking at how telehealth can be maximized to develop patient population health and care coordination services. Similarly, third party chronic care companies are now considering how to use telehealth platforms to offer contracted CCM services.

Medicare Access and CHIP Reauthorization Act

Following on the heels of the Medicare Access and CHIP Reauthorization Act (H.R. 2), Medicare is undergoing sweeping changes that have the potential to dramatically advance telehealth service delivery in the United States. The act introduced an important shift away from the traditional fee-for-service model; a shift towards Accountable Care Organizations and risk-based payment; and a focus on quality and population health. It also directly addressed telehealth by suggesting reimbursement for “Alternative Payment Models,” even if the telehealth services are not otherwise covered by traditional Medicare programs. 

CONNECT for Health Act

In 2016, more proposed legislation continues to be advanced by bi-partisan groups. More recently, a group of lawmakers in the Senate introduced legislation to continue the push to expand telehealth services through Medicare. Supported by the American Telemedicine Association, the CONNECT for Health Act would expand the use of telehealth and remote patient monitoring to serve patients in their homes, rather than only in designated telehealth reimbursement settings, such as hospitals, clinics, physician’s offices, psychologist’s offices and other traditional healthcare settings. This recent bill would not only allow health care professionals to be reimbursed for using to video conference technology to intervene and assist high-risk patients, but also allow for asynchronous medical data transfers, otherwise known as “store-and-forward” services. Such services are currently unreimbursed.

Federal Budget

President Obama’s budget proposal on February 9, 2016 enabled the HHS Secretary to expand the ability of Medicare Advantage organizations to deliver medical services via telehealth. Estimated to generate more than $160 million in savings over 10 years, the budget change could impact over 16 million Medicare beneficiaries in Medicare managed care (Medicare Advantage).

Replaced by short, frequent meetings or “touch points” mediated by telehealth, clinical services can be enhanced by a variety of digital tools that allow for a broader variety of interventions and engagement strategies for patients. It also can significantly reduce costly delays, extensive travel time and expense previously suffered by the patient. Telehealth platforms can serve a much larger number of patients per day by providing 10-15 minute contacts; quick and easy access to specialists; accumulate big data and metrics that allow new and more accurate assessment and intervention; scheduling and other administrative solutions that are unprecedented, and shared information portals for providers, pharmacists, payors, patients and caregivers.

Current US legislation is headed toward the widespread support of telehealth. If your national association is not active in supporting telehealth reimbursement as part of health care, we at TMHI encourage you to send them a letter and ask them to get involved. If you want to learn more, consider attending the American Telemedicine Association’s yearly meeting, scheduled for Minneapolis, Minnesota for May 4, 2016. In fact, I encourage you to join me there. I’ll be speaking on Saturday, May 14 for the E-Prescribing Short Course sponsored by the Telemental Health Special Interest Group (SIG).

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