CMS’ New Fee Schedule Signals Modern, Cost-Conscious Approach to Telehealth for Medicare Patients
On November 1, 2018, the Centers for Medicare and Medicaid Services (CMS) released the 2019 Medicare Physician Fee Schedule for public inspection.
Following up on their proposal earlier this year, the new fee schedule provides the final rule for providers seeking to implement telemedicine practices.
Previously, telehealth delivered services under Medicare were limited by 1834(m) of the Social Security Act. Under this law, healthcare providers using telehealth services are only allowed to interact with patients through video, and these patients must live in certain geographical areas. In an effort to provide patients access to services utilizing existing technology, CMS has now decided that certain communications do not need to abide by the regulations under 1834(m), as they do not qualify as “telehealth services.” The three billing codes below exemplify this effort to bring technology into the provider/patient relationship. These codes were proposed earlier this year and made it into the finalized version without any changes.
Brief Communication Technology-based Service[i]
Now, a provider may bill for brief technology-based check-ins. To qualify, a communication with a patient must be through “audio-only real-time telephone interactions in addition to synchronous, two-way audio interactions that are enhanced with video or other kinds of data transmission.” Essentially, this allows for qualified practitioners to call patients to determine whether an in-person visit is necessary. These “virtual check-ins” can be used for any patient located anywhere across the country. The carve-out for these types of communications will allow for practitioners to evaluate patients without forcing them to make unnecessary office visits. This could prove to be especially useful for providers who offer treatment plans for opioid use and other substance use disorders, as a virtual check-in could determine whether a patient’s condition requires a physical office visit.
While many physicians and providers previously provided this service for free, the new fee schedule will allow providers to collect $14 for each “check-in.”[ii] The goal is to provide practitioners an incentive to use this practice instead of forcing a patient to make an unnecessary visit to the provider that would have cost the patient $92. Further, the new fee schedule seeks to create a more efficient use of the healthcare provider’s time by eliminating needless patient visits.
Although there are benefits to allowing a healthcare provider to use the new virtual check-in, there are certain restrictions. First, providers are required to obtain verbal consent each time that a patient uses this new service. The provider cannot simply store the consent on file, which would have provided a better user experience for the patient and a more efficient check-in.
In addition, the check-in must be conducted by a physician or a qualified healthcare professional and only with established patients. Thus, a provider cannot determine whether a new or potential patient could save a trip to the healthcare provider with a simple check-in.
Finally, the final rule affirms the timeframe limitations on when a virtual check-in may be billed separately. If a check-in occurs within seven days of a previous evaluation and management (E/M) service provided by the same practitioner, then the virtual check-in will be bundled with that visit and not separately billable. Similarly, if the virtual check-in leads to an E/M service with the same practitioner within the next 24 hours or the next available appointment, the virtual check-in will be considered bundled into the pre or post visit time associated with the E/M service. If no visit is associated with the interaction, then the service can be separately billable.
Remote Evaluation of Pre-Recorded Patient Information[iii]
CMS has finalized another new code that is similar to the virtual check-in and will allow the evaluation of patient-transmitted information conducted via pre-recorded “store and forward” video or image technology. This essentially means that a patient may now take a picture or video of an ailment and then send it to the practitioner for evaluation. The code requires that the practitioner have a verbal follow-up and interpretation of the media within 24 business hours.
As with the virtual check-in, this code may only be billed separately if it does not occur within seven days after or 24 hours prior to when E/M services are given. If it does occur within one of those two time periods, it will be bundled with the corresponding code for the E/M services given.
Interprofessional Internet Consultation[iv]
Under the new fee schedule, consultations performed via communications technology are now given a separate billing code. This allows for a more collaborative approach to patient care, as practitioners will be able to seek the advice of specialists utilizing this technology.
Providers will be required to receive consent from patients prior to the consultation and record this consent in the patient’s medical record. This includes making the patient aware of any applicable cost-sharing that may occur due to the consultation.
These new changes to the fee schedule demonstrate the CMS’ desire to bring the Medicare program into the 21st century by utilizing technology to create a more efficient and cost-conscious experience for patients.
[i] Finalized code G2012: Brief communication technology-based service (e.g., virtual check-in) by a physician or other qualified health care professional who can report E/M services provided to an established patient, not originating from a related E/M service provided within the previous seven days, nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion.
[ii] Page 2052 of the Fee Schedule.
[iii] Finalized code G2010: Remote evaluation of recorded video and/or images submitted by the patient (e.g., store and forward), including interpretation with verbal follow-up with the patient within 24 business hours, not originating from a related E/M service provided within the previous seven days, nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment.
[iv] Finalized code 99446 – 99449: Interprofessional telephone/internet assessment and management service provided by a consultative physician, including a verbal and written report to the patient’s treating/requesting physician or other qualified health care professional; 5-31 minutes of medical consultative discussion and review (depending on code). Finalized code 99452: Interprofessional telephone/Internet/electronic health record referral service(s) provided by a treating/requesting physician or qualified health care professional; 30 minutes. Finalized code 99451: Interprofessional telephone/Internet/electronic health record assessment and management service provided by a consultative physician including a written report to the patient’s treating/requesting physician or other qualified health care professional; 5 or more minutes of medical consultative time.
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Alex S. Fisher is a senior associate with an emphasis in health care related boards, including the Tennessee Board of Medical Examiners and the Tennessee Board of Nursing. Alex is also currently a faculty member at the Vanderbilt Center for Professional Health.