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occupational therapy

Texas Considers Expanding Telemedicine Reimbursement for Workers’ Comp Cases

Now that Texas state officials have finally opened the doors for telemedicine expansion, they certainly aren’t wasting any time: The Texas Division of Workers’ Compensation (DWC) has proposed an informal rule that would eliminate Medicare-based restrictions on originating sites and reimbursement for workers’ comp cases. Read more

medical claim form with stethoscope and pen

New Telemedicine CPT Codes Created

After a long wait, the Current Procedural Terminology (CPT) codes have finally been updated to include telemedicine. A “95” modifier can be added to CPT codes for real-time remote encounters with a video and audio component; the list includes outpatient evaluation and management (E/M) codes, consultation codes, and behavioral health codes, among others. Additionally, a new place of service (POS) code, telemedicine CPT code 02, is required for clinicians who bill for telemedicine services. Read more

MACRA consists of the APM and MIPS programs

Medicare Reimbursements Shift towards Quality of Care

In an open letter last Friday, October 14, the Centers for Medicare and Medicaid Services (CMS), announced the finalized policies for implementing the new Medicare Quality Payment Program (QPP). Although the rule takes effect on January 1, 2017, several components will be phased in over the next few years to give physicians time to adjust accordingly. Many of the policies have been updated from the previous proposal in response to feedback from clinicians across the country. Read more

Doctor holding sign that says, "Medicare"

Telemedicine Use Rising Rapidly among Medicare Beneficiaries

In one of the first published studies to measure exactly how often telemedicine is utilized, Harvard Medical School researchers discovered that telemedicine use among Medicare patients grew roughly 28 percent each year between 2004 and 2013. This rise is even more impressive in light of Medicare’s restrictive reimbursement policy: Medicare only pays for telemedicine visits if the patient lives in a rural area and travels to a clinic for the telemedicine visit. Read more

Doctor with tablet

ATA and AMA Team Up to Increase Reimbursement for Telehealth

In a move aimed at increasing reimbursement for telehealth services, the American Telemedicine Association (ATA) and American Medical Association (AMA) are working together to suggest new CPT codes to the Centers for Medicare & Medicaid Services (CMS) later this month. If accepted, the new codes would allow CMS to recognize and reimburse more telemedicine services. Read more

reimbursement for telemedicine

Medicare Falls Behind in Reimbursement for Telemedicine

You might think that the passage of the Affordable Care Act in 2010 and the resulting opportunities for telemedicine would have led to widespread telemedicine usage to increase access to healthcare while reducing costs, but the reality is that reimbursement from government agencies—such as Medicare—has fallen far behind the rhetoric. And when good intentions aren’t backed up with adequate funding, progress can become slower than molasses.

Telemedicine has certainly grown steadily, but the impact has been felt more significantly among those with private insurance that provides reimbursement for telemedicine visits. Among Medicare beneficiaries, less than 1% have coverage for telemedicine (1). And of those who are fortunate enough to enjoy such coverage, particularly those in rural areas, Medicare often requires the beneficiary to already be at a clinic. So much for making healthcare more convenient. Read more

New York Telehealth

New York joins the Telemedicine Party…er, Parity

New York Telehealth

Making a momentous step forward, last week New York Governor Andrew Cuomo signed into law a bill requiring private insurers to cover telehealth and telemedicine coverage, retroactive to January 1st, 2015 (Happy New Year!).

That was not a redundant sentence: New York has differentiated between telehealth and telemedicine in the bill, with the primary difference being that telemedicine must include Read more

Maybe You Can get Reimbursed for That…

Treasure In Paper

Last week I posted a press release from the ATA about expanded Medicare coverage for Telemedicine.  Well, I decided to actually read the 1200 page rulemaking from the Centers for Medicare and Medicaid Services (CMS).  You can guess why it’s taken a week to write a follow up article…

Actually, no.  I didn’t read the entire rulemaking, only the pages relevant to all things “tele” in medicine and healthcare.  In doing so, I was reminded of something interesting:

There are a number of procedures already covered by Medicare without specific telemedicine codes.  In fact, of the seven bullet points listing the 22 codes rejected or deleted from inclusion, five noted the affected codes were largely unnecessary due to either an existing telehealth code or because Medicare does not distinguish whether the procedure is tele or not.

Here are a few examples:

Regarding electrocardiograms and echocardiograms: “By definition, Read more