CMS Proposes Paying for Telehealth and Overhauling Medicare Billing

The Centers for Medicare and Medicaid Services (CMS) is proposing a plan to pay doctors for virtual visits and overhaul Medicare billing standards put in place in the 1990s.

For telehealth, doctors would be paid for their time spent reaching out to beneficiaries via telephone or other telecommunications devices to decide whether an office visit or other service is needed, as well as when they review a video or image sent by a patient seeking care or diagnosis. “This is a big issue for [the] elderly and disabled population for which transportation can be a barrier to care,” said CMS Administrator Seema Verma. “We’re not intending to replace office visits, but rather to augment them and create new access points for patients.”

With current Medicare billing standards, doctors bill Medicare for patient visits using a set of codes that distinguish level of complexity and site of care. Instead, CMS is proposing allowing practitioners to designate the level of a patient’s care needs using their medical decisionmaking or time spent with the patient rather than applying the coding. In addition, CMS seeks to eliminate the requirement to justify the medical necessity of a home visit in lieu of an office visit, and is considering eliminating a policy that prevents payment for same-day visits with multiple practitioners in the same specialty within a group practice. “Today’s proposals deliver on the pledge to put patients over paperwork by enabling doctors to spend more time with their patients,” Verma said in a statement. “Physicians tell us they continue to struggle with excessive regulatory requirements and unnecessary paperwork that steal time from patient care. This administration has listened and is taking action.”