MACRA & Telehealth Reimbursement


MACRA is of potential interest to the telehealth community for several reasons. First, let us give you a little background. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) is bipartisan legislation. It was signed into law on April 16, 2015 and is commonly called the Permanent Doc Fix. It is a United States statute that revises the Balanced Budget Act of 1997 to change the payment system for professionals who treat Medicare patients.

In May 2018, the Center for Medicare and Medicaid Services Administration (CMS) released a brief but noteworthy document entitled, Summary of Policies in the Calendar Year (CY) 2018 Medicare Physician Fee Schedule (MPFS) Final Rule, Telehealth Originating Site Facility Fee Payment Amount and Telehealth Services List, and CT Modifier Reduction List.

MACRA & Telehealth Reimbursement Facts

Given that Medicare is the “testing ground” for new healthcare policy in the United States, MACRA is not only of interest to Medicare providers, but also those who wish to glimpse the future of telehealth reimbursement trends in the U.S.  Among other key telehealth reimbursement facts outlined, the CMS report mentions:

  • 49 states and Washington DC provide reimbursement for some form of live video in Medicaid fee-for-service (up one state – Rhode Island – since the fall 2017 report);
  • 15 states reimburse for asynchronous or store-and-forward services other than teleradiology (unchanged since fall 2017, though Georgia was added to the list and Hawaii was subtracted);
  • 9 states reimburse for live video, store-and-forward, and RPM;
  • 32 states provide a transmission and/or facility fee (unchanged since fall 2017);
  • 39 states or jurisdictions have guidelines in place for private payer reimbursement of telehealth (up two states – Iowa and Utah – from the fall 2017 report); and
  • 31 states have a consent requirement in either Medicaid policy, law or regulation, an increase of one state.

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