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CMS Gives Telehealth a Nudge With Coverage for Virtual Check-Ins

November 05, 2018 | Eric Wicklund | mHealth Intelligence

Last week’s release of The Centers for Medicare & Medicaid Services’ 2019 Physician Fee Schedule and Quality Payment Program offered good news for providers looking to implement telemedicine for virtual check-ins.

While much of the attention was focused on expanded reimbursement for remote patient monitoring services, an overlooked section of the 2,378-page document detailed Medicare coverage for “Brief Communication Technology-Based Service” (HCPCS code G2012). Simply put, this new code gives providers an opportunity to use telehealth to check in with their patients at certain times on care management issues.

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“The new code represents a sizeable change to allow providers to efficiently use new technologies to deliver medical care,” says Nathaniel Lacktman, a partner and health care lawyer with Foley & Lardner who chairs the firm’s Telemedicine Industry Team and co-chairs its Digital Health Work Group. “By reimbursing for virtual check-ins, the new code exemplifies CMS’ renewed vision and desire to bring the Medicare program into the future of clinically-valid virtual care services.”

The new code, scaled down considerably from what CMS had proposed in July, enables a provider to use “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” to check in with an established patient on a care plan.

The CMS proposal for virtual check-ins drew flak from a number of organizations, including the Medicare Payment Advisory Commission (MedPAC), and was the subject of a critical article in Kaiser Health News. According to PHI's the Center for Connected Health Policy, some physicians worried that the check-in, which includes a patient co-pay, could lead to over-use and poor provider adoption.

According to the CCHP, some physicians “expressed concern that patients will be reluctant to use check-in calls due to the cost-sharing. Many physicians and hospitals say that they already provide this service for free and reimbursing for it will actually hinder patient access while increasing Medicare spending. CMS Administrator Seema Verma and other CMS officials have stated that the service will save Medicare money by reducing unnecessary office visits and treating health problems before they become a burden to the Medicare system.”

Whether the final, pared-down version of the service meets those concerns remains to be seen.

Read the full article here.