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Virtual care reimbursement proposed by Medicare: 5 things to know

Written by Julie Spitzer | July 17, 2018 |
CMS made a series of suggestions to expand telehealth in its latest Medicare Physician Fee Schedule and Quality Payment Program, a 1,473-page proposal released July 12.

Here are five telehealth changes CMS proposed:

1. Although CMS has bundled “routine non-face-to-face communication” into the cost of in-person visits, the agency is proposing to reimburse physicians for video or audio check-ins even if they don’t result in an office visit.

2. Medicare would pay $14 per virtual check-in, compared to the cost of a $92 patient visit.

3. Clinicians would be able to review photos or videos submitted by patients via prerecorded “store and forward” video or image technology to determine whether an in-person visit is needed.

4. The proposal seeks to allow physicians to practice telehealth without establishing a prior in-person relationship with each beneficiary, marking a win for direct-to-consumer telehealth.

5. CMS may be opening the door to new opioid and substance abuse treatment options, including virtual medication-assisted therapy.

“For a lot of our beneficiaries, it’s a challenge to get to a doctor,” CMS Administrator Seema Verma told Politico’s morning eHealth newsletter. “This is just another access point for communication with clinician. It doesn’t replace office visits.”

Comments on the proposed rule are due Sept. 10.