CMS Bets on Telehealth Innovation in 2019

CMS Bets on Telehealth Innovation in 2019

The Centers for Medicare & Medicaid Services is promoting innovation & modernization of home health care by allowing the cost of remote patient monitoring to be reported by home health agencies as allowable costs on the Medicare Physician Fee Schedule (PFS). In early November CMS issued the final rule that includes updates to payment policies, payment rates & quality provisions for services furnished under the Medicare PFS on or after Jan 1 2019. This allows for more telehealth & remote patient monitoring service options for the Medicare Advantage enrollees. Officially approving three new billing codes for remote patient monitoring – industry experts agree that this is the biggest financial incentive to date in the history of digital Medicine.

Their support comes behind CMS own official’s belief that telemedicine can sustain Medicare and improved patient access. Giving patients new ways to access care, connecting patients with providers & providing more options to those in rural areas. All while improving the value of care by raising quality & lowering costs. Patient populations who are comorbid or have chronic conditions will better be enabled to maintain their own health, causing reduced readmission rates for hospitals & providers while allowing them to connect more frequently with their care team from anywhere via mobile or Bluetooth devices.

The final rule allows remote consultations & evaluations of remote pre-recorded images and video & allowing certain patient populations access to monthly clinical assessments via remote monitoring. Starting Jan 1 2019 the new CPT codes 99453, 99454, 99457 cover remote patient monitoring equipment, setup and monitoring services.  Which is especially financially beneficial to providers, as these codes can be combined with chronic care management services which have been in place for several years.

“These are exciting changes which will increase access to care, give patients new choices and foster the type of innovations we need to strengthen Medicare and ensure its sustainability into the future,” said Seema Verma, Administrator for the Centers of Medicare and Medicaid Services going on to say “Healthcare innovation is in fact serving as a catalyst to improving quality of care, enhancing access to care, increasing efficiency in the system, and lowering healthcare costs.”

This program may seem too good to be true for primary care providers who have been underpaid in comparision to their specialist peers. However, CMS is aware that affordable technologies for remote patient monitoring & telehealth exist, will help people stay out of the hospital more and initial roll outs of such technologies have been promising. These programs have just not had enough reimbursement attached to them to make financial sense for most physicians – until now. While this new approach creates new revenue streams for providers it’s impact on helping to reduce overall medical spending as a whole cannot be forgotten. Innovation in the telehealth & remote patient monitoring will now be able to grow at an even more rapid rate, fueled by the financial support from CMS & drive adoption by physicians as well as more investment by technology providers.

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