On December 1, the Centers for Medicare and Medicaid Services (CMS) released the annual Physician Fee Schedule (PFS) final rule for 2021. Key sections of the CMS announcement of relevance to the telebehavioral health community are introduced and posted verbatim below. As predicted in earlier TBHI summaries of CMS announcements, the intent of Medicare and Medicaid is to continue the expansion of medicare telehealth rather than shrink it from its COVID position, unlike some of the 3rd party carriers and insurance plans who have already started rolling back telehealth payments. See States Taking Immediate Action to Prevent Payer Telehealth Coverage Rollbacks for details.
Adding to previous statements about telehealth reimbursement being here to stay in some CMS arenas, HHS Secretary Alex Azar announced, “Medicare beneficiaries will now be able to receive dozens of new services via telehealth, and we’ll keep exploring ways to deliver Americans access to health care in the setting that they and their doctor decide makes sense for them.” Similarly, CMS Administrator Seema Verma added, “… the pandemic accentuated just how transformative it [telehealth] could be, and several months in, it’s clear that the health care system has adapted seamlessly to a historic telehealth expansion that inaugurates a new era in health care delivery.”
Permanent Expansion of Medicare Telehealth Reimbursement
The PFS announcement gave a fair amount of detail about current plans for finalizing telehealth, particularly in rural areas. It adds 60 telehealth-reimbursed services to the current list:
…. This final rule delivers … by adding more than 60 services to the Medicare telehealth list that will continue to be covered beyond the end of the PHE, and we will continue to gather more data and evaluate whether more services should be added in the future. These additions allow beneficiaries in rural areas who are in a medical facility (like a nursing home) to continue to have access to telehealth services such as certain types of emergency department visits, therapy services, and critical care services. Medicare does not have the statutory authority to pay for telehealth to beneficiaries outside of rural areas or, with certain exceptions, allow beneficiaries to receive telehealth in their home. However, this is an important step, and as a result, Medicare beneficiaries in rural areas will have more convenient access to health care.
CMS also announced that it is funding a study of telehealth to:
…explore new opportunities for services where telehealth and virtual care supervision, and remote monitoring can be used to more efficiently bring care to patients and to enhance program integrity, whether they are being treated in the hospital or at home.
Administrative Simplification of E/M Codes
The CMS announcements contained a fair amount of information about changes to the E/M Codes, claiming that the policy overhaul represents a significant change involving administration simplification to reduce the burden on professionals wishing to use the Medicare system. In the words of the CMA announcement:
“This finalized policy marks the most significant updates to E/M codes in 30 years, reducing burden on doctors imposed by the coding system and rewarding time spent evaluating and managing their patients’ care,” Administrator Verma added. “In the past, the system has rewarded interventions and procedures over time spent with patients – time taken preventing disease and managing chronic illnesses.” In addition to the increase in payment for E/M office visits, simplified coding and documentation changes for Medicare billing for these visits will go into effect beginning January 1, 2021… These changes will significantly reduce the burden of documentation for all clinicians, giving them greater discretion to choose the visit level based on either guideline for medical decision-making (the process by which a clinician formulates a course of treatment based on a patient’s information, i.e., through performing a physical exam, reviewing history, conducting tests, etc.) or time dedicated with patients….
Testing, Supervision & Delegation to Increase Access to Care
The change is designed to allow non-physician practitioners more flexibility with regard to performing diagnostic tests as well as supervising. CMS also announced these services:
- Physical and occupational therapists will be able to delegate “maintenance therapy” – the ongoing care after a therapy program is established – to a therapy assistant.
- Physical and occupational therapists, speech-language pathologists, and other clinicians who directly bill Medicare can review and verify, rather than re-document, information already entered by other members of the clinical team into a patient’s medical record. As a result, practitioners have the flexibility to delegate certain types of care, reduce duplicative documentation, and supervise certain services they could not before, increasing access to care for Medicare beneficiaries.
If your profession is not mentioned above or if you have other questions, you may want to speak with your billing agent or contact CMS directly. Some links are provided for you below. If all else fails, it may be reasonable to submit your billing for a session or two and see what happens. If your claim gets rejected, your rejection notice should give you information about the reasons for the rejection. If you have more information about this issue and think it might be of help to other readers, please share them with the TBHI community by posting them below. Let’s all pitch in to help each other grow telehealth for the benefit of the people we serve!
More Information about Expansion of Medicare Telehealth
The full CMS announcement cited above can be seen here.
- Final Rule
- Physician Fee Schedule Final Rule fact sheet
- Quality Payment Program Final Rule fact sheet and FAQs
- Medicare Diabetes Prevention Program fact sheet
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