More telemedicine services are expected to become available to Medicare patients in 2015.
The Centers for Medicare and Medicaid Studies (CMS) defines telemedicine for its purposes as the provision of healthcare services using multimedia equipment including at a minimum, both audio and video equipment that permits real-time, two-way interactive communication between the patient and practitioner.
While that eliminates telephone and email service delivery, it includes video conference type services, which are technologically much more feasible today than even a few years ago. The new CMS rules for 2015 define billing procedures for certain Medicare services provided as telemedicine services to patients who would virtually visit providers from “eligible originating sites.”
New Proposed Medicare Rules for 2015
New proposed rules for the 2015 Medicare Part B physician fee schedule would expand payment for a handful of specific medical and mental health services provided through telemedicine technology. Those services include:
- Annual wellness visits
- Psychoanalysis
- Psychotherapy
- Prolonged evaluation and management services
The mental health services are assigned specific payment codes depending on the precise nature of the services provided (such as whether the patient’s family also participates in family psychotherapy services). Likewise, the prolonged evaluation and management services are billed as “prolonged service in the office or other outpatient setting requiring direct patient contact beyond the first service; first hour listed separately in addition to code for office or other outpatient evaluation and management service,” or “prolonged service in the office or other outpatient setting requiring direct patient contact beyond the usual service: each additional 30 minutes listed separately in addition to code for prolonged.” The codes are made to be very specific to prevent errant or abusive billing practices.
Although Medicare defines telemedicine as involving audio and video real-time interaction, “store-and-forward” technology, where patient information is transmitted to a provider to be reviewed at a later time is also permitted in telemedicine demonstration programs in Alaska and Hawaii. Legislative efforts are moving forward, though slowly, to expand Medicare coverage of certain store-and-forward medical services to be available in more locations.
Services That May Soon Be Added
Though only a few new telemedicine services are currently written into 2015 CMS rule changes, other services may be added soon. Some dermatology and wound care services are expected to be added to the CMS telemedicine list once the organization receives appropriate billing codes mapped to codes physicians currently use to cover equivalent in-person visits.
The CMS received requests to permit payment for certain medical imaging services like electrocardiogram and echocardiogram procedures. It also received requests for other mental health treatments and specific gynecological services, but currently the services do not meet the CMS criteria for inclusion on Medicare’s approved telemedicine procedures list.
Why Medicare Is Expanding Telehealth Slowly
It wasn’t that long ago that CMS refused to cover any telemedicine services, and the Center is taking a very cautious approach to adding coverage for telemedicine. The reasoning given is the possibility of overuse of the technology. But some telemedicine researchers, like Rashid Bashshur, PhD, Director of Telemedicine for the University of Michigan Health System, say that the CMS’s fears are unrealistic, telling Medscape Medical News, “They’re afraid because they’ve been burned before.”
Bashshur believes in particular that CMS is being too restrictive with store-and-forward technology, which he says is a more efficient way to deliver healthcare services, particularly for certain conditions like dermatologic diseases. CMS already allows some store-and-forward processes, including radiological scans. The key to expansion of Medicare coverage of telemedicine services will likely be a joint effort by CMS and Congress to determine how best to cover payment for telemedicine services and how to define and prevent overuse of telemedicine services.
Proposed Medicare Telehealth Parity Act of 2014
Congressional representatives Mike Thompson (D-Calif.) and Glenn Thompson (R-Penn.) plan to introduce a telemedicine bill in the House of Representatives titled the Medicare Telehealth Parity Act of 2014. The bill is designed to amend Title XVIII of the Social Security Act, which limits government reimbursement of telemedicine to specific use cases and rural areas. The bill is in keeping with CMS’s careful and slow expansion of telemedicine services, expanding Medicare telemedicine services over a period of four years, and establishing data collection requirements throughout that timeline.
Under the proposed bill, the Secretary of Health and Human Services would be responsible for developing and maintaining standards for remote patient monitoring. Within two years of passage of the bill, the US Comptroller would be required to conduct a study to determine the potential savings to Medicare from telemedicine and identify additional use cases that are good candidates for inclusion in telemedicine programs.
Previous proposed legislation has attempted more sweeping changes to restrictions on telemedicine, but have failed. For example, Rep. Mike Thompson’s last proposed bill, the Telehealth Promotion Act of 2012, tried to make it so telemedicine would be covered in any case in which the corresponding in-person treatment would be covered, but that bill didn’t make it past the committee stage.
Conclusions
At present, telemedicine services by Medicare can only be reimbursed in rural areas. Should the Medicare Telehealth Parity Act of 2014 pass, after six months Medicare would be required to cover telemedicine in urban areas with populations of 50,000 or less. Also, acceptable care sites would be expanded from hospitals and doctors’ offices to include retail clinics. After two years, larger population areas would be added, and home telemedicine services would start to be included, as would services like speech and physical therapy.
As of this writing, the Medicare Telehealth Parity Act of 2014 has not been assigned a tracking number, so its status cannot be tracked through Congress yet. But the CMS rule changes are expected to take effect January 1, 2015.
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