Population Health Insights

CMS Proposes Major Expansion of Reimbursement for Telehealth Services


2017 and 2018 have been eventful years for advocates of digitally delivered healthcare, as government officials have moved more quickly and decisively than ever before to expand reimbursement for telehealth services (which in turn expands the availability of these services).

Reimbursement for telehealth services by the Centers for Medicare and Medicaid Services (CMS) has long been a point of contention. As the nation’s single largest healthcare payor, the CMS’ policies on telehealth reimbursement go a long way towards setting the standards in healthcare facilities of all types across the United States.

Up until the last couple of years, and particularly since the beginning of 2018, these policies were fairly strict, allowing for very little reimbursement for telehealth services like virtual visits between patients and doctors, or remote patient monitoring for a range of chronic conditions.

Medicare “remains one of the most restrictive payors” for telehealth, with reimbursement rules that Marki Stewart at the Dickinson Wright Health Law Blog calls “exceptionally limiting.” She goes on to describe the requirements that, “with some exceptions,” the CMS mandates for telehealth reimbursement, including:

  • The patient must be located in a rural area
  • Delivery of care must be via “one of 8 eligible professionals”
  • The originating site must meet specific location requirements
  • The modality used must be “real-time, interactive, and face-to-face” (which prohibits the store-and-forward, an important aspect of telehealth delivery)

Reimbursement for Telehealth Services Rapidly Expanding

But this all seems to be changing. With the full vocal support of a number of high-profile lawmakers, the CMS is finally expanding its available reimbursement for telehealth services. At the beginning of the year, for instance, the agency increased the billable hours available for a number of remote patient management (RPM) services.

With the unbundling of Medicare/Medicaid CPT code 99091, the CMS now allows providers to receive separate reimbursement for remote care services that include time spent collection and interpreting remotely generated patient data for a number of specific chronic conditions.

But that was, apparently, just the beginning: Under the newly proposed 2019 Medicare Physician Fee Schedule and Quality Payment Program, the agency “opens the door to more remote patient monitoring services by reimbursing for certain mHealth services,” writes Eric Wicklund for mHealthIntelligence.com.

“Under the proposed rule changes, CMS will begin reimbursing for virtual check-in services and remote evaluation of recorded image and video submitted by patients, as well as expanding reimbursement opportunities for ‘prolonged preventive services,’” Wicklund explains.

Under this proposal, Medicare will start paying for virtual check-ins, meaning patients can connect with their doctor by phone or video chat,” a CMS administrator told Wicklund. “Many times this type of check-in will resolve patient concerns in a convenient manner that gets them the care that they need and avoids unnecessary cost to the system.”

The CMS has also proposed significantly expanding the range of benefits available to Medicare Advantage beneficiaries to include such non-traditional healthcare-adjacent services like the installation of wheelchair ramps or bath rails, transportation to medical appointments, and even meal delivery.

Senators: Medicare Reimbursement Restrictions Are ‘Outdated’

Elected lawmakers are also working to increase reimbursement for telehealth services available via Medicare. The biggest of a series of recent legislative moves in this direction is the CHRONIC Care Act, which aims to remove “outdated restrictions that limit Medicare from reimbursing for telehealth,” as co-authors Sen. Roger Wicker and Sen. Brian Schatz said in a joint statement.

Calling these efforts “a rare instance of bipartisan cooperation on a major policy initiative, embraced by members of Congress from both parties,” The New York Times’ Robert Pear explains that the changes are “also supported by Medicare officials and insurance companies that operate the fast-growing Medicare Advantage plans serving one-third of the 60 million Medicare beneficiaries.”

“These new rules are an important step forward for America’s connected health innovators, doctors, and most importantly patients,” as the Connected Health Initiative (CHI) stated in a news release. “Until now, connected health technologies have been effectively locked out of the most important part of America’s healthcare system, Medicare and Medicaid.”

The FCC is also getting into the act of telehealth expansion, recently approving $100 million in additional funding for a pilot program to expand broadband development in rural areas. The idea is to increase telehealth access for veterans living in areas with poor network connectivity.

According to Senator Todd Young of Indiana, the move builds on success the VA has already seen with telehealth. “The Veterans Health Administration indicates that, according to the population they’ve already served using remote monitoring, there’s a roughly 20 percent reduction in hospital admissions,” he told Northeast Indiana Public Radio.

Got questions about whether reimbursement for telehealth services are available to your practice or organization? We’re standing by with more info! Contact us here to schedule a complimentary consultation with a Care Innovations telehealth specialist.

Contact Care Innovations