Telehealth Reimbursements Expanded, But Struggles Persist

telehealth

Earlier this month, through its final rule, the Centers for Medicare and Medicaid Services (CMS) announced it will be expanding the range of telehealth services that can be reimbursed under Medicare starting in 2015.

CMS has added seven new payment codes to its 2015 Medicare physician fee schedule for telehealth services, including behavioral health, prolonged office visits, and annual wellness visits. For instance, CPT code 99091 allows providers to be reimbursed by Medicare for remote patient monitoring of chronic conditions through a monthly unadjusted non-facility fee of $56.92.

“It has been a long time coming, but this rulemaking signals a clear and bold step in the right direction for Medicare,” said American Telehealth Association CEO Jonathan Linkous. “This allows providers to use telemedicine technology to improve the cost and quality of healthcare delivery.”

Medicare payments to telehealth originating sites are supposed to increase by 0.8 percent in 2015. That said, according to a new survey, a good portion of providers are still struggling to get reimbursed for telehealth services.

The survey by Foley & Lardner found that 41 percent of healthcare organizations are not reimbursed for their telehealth services. Here are some more key findings from the survey:

  • In addition to those providers who receive no reimbursements for telehealth services, 21 percent say they receive lower payment rates for telehealth than they do for the same services performed in-person.
  • Over 20 percent of respondents said Medicare’s lacking coverage of telehealth prevents a broader roll out of programs.
  • Only 11 percent believe they will realize increased profitability from telehealth alone, because the fee-for-service model does not incentivize telehealth.
  • There is strong provider support for telehealth services, with 84 percent of the survey’s respondents saying that developing those services is an important goal. Only 8 percent of the respondents said they haven’t started developing telehealth capabilities at their organization. Just 3 percent said it’s not important.
Also read: American Academy of Neurology Wants Telemedicine for Everyone

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