CMS Proposes More Medicare Reimbursement For Telehealth, RPM

July 13, 2018 – The federal government is once again moving toward acceptance of telehealth and remote patient monitoring with new rules on how Medicare reimburses providers for their use of connected health technology.

The Centers for Medicare & Medicare Services’ proposed 2019 Medicare Physician Fee Schedule and Quality Payment Program, unveiled this week, opens the door to more remote patient monitoring services by reimbursing for certain mHealth services. The proposals, included in a 1,500-page document, would also benefit providers who want to use mobile health technology to confer with a patient on whether to schedule an in-person visit.

“Today is a huge win for patients and providers as CMS is proposing historic changes to modernize Medicare and restore the doctor-patient relationship,” CMS Administrator Seema Verma said in a press release and during a late-day phone call with reporters.

Public comments on the proposals are due by September 10.

CMS’ plan to increase the use of virtual care focuses on three procedures. 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.”

“Under this proposal, Medicare will start paying for virtual check-ins, meaning patients can connect with their doctor by phone or video chat,” Verma said during the phone call. “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.”

“This is a big issue for our elderly and disabled populations where transportation can be a burden to care as well as to caregivers,” she added. “We’re not intending to replace office visits but rather to augment them and provide new access points for patients.”

The proposals drew praise from ACT|The App Association, whose executive director said CMS has apparently been listening to strong lobbying from Congress and healthcare organizations to open up the purse strings and embrace mobile health.

Of particular importance are efforts to increase RPM services, giving providers the opportunity to connect with their patients at home and gather data for care management and coordination. Many health systems have been reluctant to launch RPM programs without a clear path to reimbursement.

“While we continue to we parse through the Centers for Medicare and Medicaid Services (CMS) new proposed rulemaking, it is clear that our voice has been heard,” Morgan Reed said in an e-mail. “We applaud CMS for its range of proposals to bring connected health tools into the continuum of care, including three new remote monitoring reimbursement codes in the Physician Fee Schedule. Last month, we gathered fifty connected health stakeholders to urge CMS Administrator Seema Verma to activate CPT codes 990X0, 990X1, and 994X9 to reimburse for chronic care remote physiologic monitoring. Today, CMS proposed those new codes in its latest schedule.”

“Remote patient monitoring solutions continue to emerge, and we are encouraged that CMS upheld its commitment to advance the uptake of innovative connected health tools in its rulemaking,” Reed added. “We commend CMS for proposing new digital health reimbursement codes to better utilize and realize the full potential of these life-saving technologies.

Earlier this month, CMS proposed changes to the Home Health Prospective Payment System so that home health agencies can include the cost of remote patient monitoring on the Medicare cost report form.

“Today’s proposals would give doctors more time to spend with their patients, allow home health agencies to leverage innovation and drive better results for patients,” Verma said in a press release announcing that proposal. “The redesign of the home health payment system encourages value over volume and removes incentives to provide unnecessary care.”