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CMS Expands Recognition of Technology-Enabled Services

Analysis  |  By HealthLeaders Media Staff  
   April 22, 2019

The expansion of technology benefits is key to cost reduction and the clinical management of patient cohorts using clinical teams.

This article appears in the March/April 2019 edition of HealthLeaders magazine.

By Valerie Rinkle, MPA, CHRI, Regulatory Specialist, HCPro

As the healthcare industry slowly transitions to value-based care and technology better enables that move, CMS has expanded Medicare coverage and payment for several technology-enabled services.

Expansion of these various technology benefits is important as they are key to cost reduction and the clinical management of patient cohorts using clinical teams versus traditional one-to-one clinician-patient encounters.

Terminology matters for this expansion of coverage: It is important not to make the mistake of calling these new benefits "telehealth" because telehealth has a specific statutory definition and limited benefits for Medicare that can only be expanded by Congress.

CMS has creatively and crucially recognized the importance of a variety of technologies by announcing coverage and separate payment for "technology-enabled" services that are not telehealth and, therefore, are not restricted by telehealth statutory limitations.

Until this year, Congress limited all Medicare telehealth to beneficiaries in rural areas. Now, Congress has removed both the rural and home restriction for telehealth services for home dialysis patients; beginning in July, the restrictions will also be lifted for substance use disorder (SUD) patients with or without co-existing mental health diagnoses. Congress also lifted the rural restriction completely for telehealth services for patients with acute stroke. So even classic telehealth is an expanded benefit that health systems should explore to better deliver expert stroke care as well as dialysis care to Medicare patients.

While the clinician service will be paid with these expanded benefits, it is important to note that Congress did not allow payment of the originating site fee in urban areas or for homes, so the facility originating site fee continues to be separately paid only for telehealth originating in rural locations. CMS has also finalized Medicare Advantage plans to cover telehealth without regard to the classic rural telehealth restrictions beginning in 2020.

What is exciting this year are some new technology-enabled services CMS has recognized for payment. These include:

  • Chronic care monitoring services such as remote monitoring of physiologic parameter(s) (e.g., weight, blood pressure, pulse oximetry, respiratory flow rate), enabled by smartwatches and various applications. These are billed for the initial setup; every 30 days for the data collection and software-enabled monitoring that should be integrated with the electronic medical record; and for at least 20 minutes of clinician work per month for interactive communication with the patient and caregiver.
  • Clinician-to-clinician interprofessional internet consultation services, where a patient-specific case can be securely discussed for the treating clinician to obtain advice designed to inform the patient’s treatment plan. These are time-based codes and require specific documentation.

Note that patient consent to bill these services is specifically required due to patient copayments, but that should not be a barrier to consideration of these technology-enabled services, adopted specialty-by-specialty in a manner designed to expand the reach of the provider as well as reduce visits and costs associated with clinical management.

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