New telehealth opportunities await! According to a recent telehealth update from the Center for Connected Health Policy (CCHP), some of the new opportunities in telehealth reimbursement will result from implementation of regulations, even though some of the changes officially went into effect in 2019.
Relaxed restrictions for a few conditions
Last year CMS made changes that relaxed geographic restrictions for several specific conditions. Although the changes went into effect last year, the mechanism for billing did not start until this year, according to CCHP Executive Director Mei Kwong, J.D., in a recent National Consortium of Telehealth Resource Centers webinar. Now organizations outside of rural areas can begin billing for services related to treatment for acute stroke and end-stage renal disease. Additionally, substance use disorder with co-occurring mental health conditions and counseling for opioid use disorder can be reimbursed outside rural areas. This year opioid treatment programs were also added as an eligible provider through the Physician Fee Schedule.
Services delivered via technology
Kwong said there are several services delivered via technology that were also added in 2019 but for which organizations are just beginning to bill. Using the term “technology” instead of “telehealth” is a sort of work-around since changes to “telehealth” require legislation. Most of these services are related to remote patient monitoring:
- Chronic care management
- Transitional care management
- Remote physiologic monitoring services
- Principal care management
There was a notable change to principal care management eligibility (G2064 and G2065), which previously required patients to have at least two chronic diseases – now only one chronic disease is required, enabling providers to care for a somewhat healthier population. This measure endeavors to stave off complications or additional chronic illnesses. Other notable additions include e-visits and provider-to-provider consultations, which can better facilitate team-based care. The "internet professional consultation" provision will pay out to both the primary care provider and the specialist.
Medicare Advantage
Another exciting change is that Medicare Advantage plans, private payers that cover additional services to traditional Medicare, now have more flexibility to offer services via telehealth. Though the rule went into effect last April, some payers said that this didn’t give them a lot of time to consider which services to add, so this year’s plans may be more reflective of the increased ability to offer services through telehealth. The new rule relaxes restrictions on geography and facility but does not add any eligible provider types.
State and federal trends
Regarding trends on both a state and federal level, Kwong said to anticipate continued interest in telehealth related to opioid treatment, school-based telehealth and promoting telehealth to consumers. On a federal level, there is continued interest in telehealth’s role in maternal health, HIV and mental health. State governments are also exploring telehealth as a way to meet network adequacy requirements. Network adequacy, codified by the Affordable Care Act, is an effort to increase populations’ access to timely primary care and specialty care covered under health plans.
For more information, you can watch the webinar or contact HTRC for guidance at 877-643-HTRC.
