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Physician Resistance to CMS Proposal for Virtual Check-Ins

By | National Telehealth Policy Resource Center Blog

On July 12, 2018, the Centers for Medicare and Medicaid Services (CMS) released a proposal of revisions to the Physician Fee Schedule (PFS) for CY 2019. The proposal includes reimbursement for a virtual check-in service intended to “restore the doctor-patient relationship” by motivating physicians to communicate with patients outside of the office. The calls would help patients decide if they need to schedule an in-person appointment. CMS proposes to reimburse physicians $14 per five to ten-minute check-in call, and according to a Kaiser Health News article, physicians worry that patients would be required to pay 20% in cost-sharing.
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CMS Releases First Performance Year Evaluation of Next Generation ACO Model

By | National Telehealth Policy Resource Center Blog

On August 27th, the Centers for Medicare & Medicaid Services (CMS) released results from an evaluation of the first performance year of the Next Generation ACO model. CMS Administrator, Seema Verma, discussed the evaluation in a webinar on the day of release, announcing “promising results” that support the agency’s recent position regarding two-sided risk models that was part of a proposed rule, released earlier this month, to redesign participation options under the Medicare Shared Savings Program. The results of the evaluation, conducted by NORC at the University of Chicago, show net savings of approximately $62.12 million to Medicare, corresponding with a $11.20 decrease in per patient per month spending.
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CMS Proposes to Expand Telehealth Reimbursement Among Some ACOs

By | National Telehealth Policy Resource Center Blog

The Centers for Medicare and Medicaid Services (CMS) has released a proposed rule to redesign participation options under the Medicare Shared Savings Program to encourage Accountable Care Organizations (ACOs) to transition into two-sided models designed to increase savings for the Trust Funds and mitigate losses, reduce gaming opportunities and promote regulatory flexibility and free market principles. The proposal includes a new section of the Shared Savings Program regarding payment for telehealth services provided in accordance with 1899(l) of the Social Security Act, as added by the Bipartisan Budget Act, which allows ACOs to expand the use of telehealth services by including the home as an originating site and removing geographic limitations. CMS would therefore treat a beneficiary’s home as an originating site and would not apply originating site restrictions for telehealth services provided by a physician or practitioner in an applicable ACO. The home would not be eligible for a facility fee.

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Telehealth in Medicare Comprehensive End-Stage Renal Disease Care

By | National Telehealth Policy Resource Center Blog

Effective October 1, 2018, the Centers for Medicare and Medicaid Services (CMS) will implement a new telehealth waiver within the Comprehensive ESRD Care (CEC) Model, aimed at services provided to Medicaid End Stage Renal Disease (ESRD) beneficiaries. The model was first implemented in October 2015, under authority granted to CMS by Section 1115(A) of the Social Security Act, to test new ways to improve care for Medicare beneficiaries with ESRD.
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Medicare’s New Virtual Care Codes: A Monumental Change and Validation of Asynchronous Telemedicine

By | Recent Telehealth News

Article Author: Nathaniel M. Lacktman

Source: The National Law Review

The Centers for Medicare and Medicaid Services just issued a proposed rule introducing monumental changes to the physician fee schedule, paving the way for asynchronous telemedicine and new technologies through a new set of virtual care codes. CMS explained the impetus for the bold changes, declaring:

“We now recognize that advances in communication technology have changed patients’ and practitioners’ expectations regarding the quantity and quality of information that can be conveyed via communication technology. From the ubiquity of synchronous, audio/video applications to the increased use of patient-facing health portals, a broader range of services can be furnished by health care professionals via communication technology as compared to 20 years ago.”

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The Centers for Medicare and Medicaid Services Release CY 2019 Proposed Physician Fee Schedule

By | National Telehealth Policy Resource Center Blog

Last week CMS released its proposed Calendar Year (CY) 2019 Physician Fee Schedule (PFS) containing its proposal for momentous changes for Medicare, aiming to modernize the healthcare system and help “restore the doctor-patient relationship” by reducing administrative burden.  Among the changes, the proposed rule not only expands telehealth reimbursement, but communicates a new interpretation by CMS of the applicability of their statutory requirements for reimbursement of telehealth.  Telehealth delivered services under Medicare are limited in statute by 1834(m) of the Social Security Act which limits the use of telehealth to certain services, providers, technology (mainly live video) and patient locations (needing to be in certain types of healthcare facilities in rural areas).  CMS, in their rule, expresses concern that these requirements may be limiting the coding for new kinds of services that utilize communication technology.

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Telehealth Advocates Respond to CMS ‘Virtual Visit’ Proposal

By | Recent Telehealth News

Article Author: David Raths

Source: Healthcare Informatics

Among all the proposed changes the Centers for Medicare and Medicaid Services (CMS) rolled out last week, ones related to telehealth drew considerable interest. Although it can’t use its regulatory power to change the laws that restrict telehealth services paid for by Medicare to rural settings, the agency has instead defined new “communication technology–based services” that could be used for virtual visits with established Medicare patients regardless of such patients’ location, effective Jan. 1, 2019.

In its proposed rule about virtual visits, CMS is seeking comment on whether telephone interactions are sufficient or whether interactions enhanced with video or other kinds of data transmission should be required. CMS also proposes to create a new code to permit separate Medicare payment for store-and-forward technology such as when a dermatologist examines an image of a patient’s skin asynchronously.

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