[TAO] MobiHealthNews Article: CMS to pay for telepsychiatry, but not remote ECG, fundus cameras in 2015 Shared by: Cathy Britain

[Cathy Britain]

TAO listserv,<br><br>

<strong>Cathy Britain</strong> has shared the following MobiHealthNews
article with you: <br><br>
<strong>CMS to pay for telepsychiatry, but not remote ECG, fundus cameras in
2015</strong><br>
<strong>By: </strong>Jonah Comstock<br>
<strong>Published: </strong>July 7, 2014 (1:29 pm)<br><br>

The full text of this article is available on MobiHealthNews at the
following URL: <a
href="http://mobihealthnews.com/34637/cms-to-pay-for-telepsychiatry-but-not-remote-ecg-fundus-cameras-in-2015/">http://mobihealthnews.com/34637/cms-to-pay-for-telepsychiatry-but-not-remote-ecg-fundus-cameras-in-2015/</a><br><br>

Cathy Britain also shared the following remarks, relevant to this article: A
bit of movement from CMS, but movement in the area of home monitoring
remains VERY disappointing.

Cathy<br><br>

Below is an excerpt of the full MobiHealthNews article:<br><br>


The Center for Medicaid and Medicare Services (CMS) has released an
unpublished proposed rule that will soon lead to changes in coverage under
Medicare Part B. Notably, the proposed rule will expand the range of
telehealth services that can be reimbursed under medicare

Since 2002, CMS has acknowledged that the range of use cases for
telemedicine is always changing, and has provided a mechanism for the public
to request coverage for additional services. When CMS publishes its lengthy
rule change documents (this one is 600 pages), it provides both a list of
additions it will be making, and a list of proposed additions it will not be
making with explanations as to why. New coverages have to fit into one of
two categories: either they are sufficiently similar to an existing covered
use case (category 1), or they are novel but the requester provides evidence
that offering the service via telehealth confers a clinical benefit
(category 2).

As we've noted before, the process is not a quick one. The current document
contains requests that were submitted in 2013 and will go into effect in
2015. Anything submitted now, would go into effect in 2016 at the earliest. 

In the new rule, CMS proposes to add seven new telehealth reimbursement
codes, all category 1, that fit into three general areas. In the area of
mental healthcare, CMS has added codes for psychoanalysis and family
psychotherapy (which has two codes, one for family therapy with the patient
present and one for family therapy with the patient absent). The next two
codes are ones that therapists use to report sessions that go overtime or
require additional time over the scheduled hour-long visit -- these will now
be eligible for reimbursement via telehealth.

Finally, outside the area of mental healthcare, CMS will add telemedicine
codes for an "annual wellness visit" including a personalized prevention
plan of service -- one code for the initial visit and another for subsequent
visits.

The restrictions on telehealth coverage of CMS still apply, of course. To be
reimbursed, CMS requires telehealth to include two-way audio and video
communication, making therapy over the phone still ineligible for
reimbursement. And for many services, an initial face-to-face visit is still
required.

Requests denied by CMS this time around include a number of applications of
new or recently developed mobile health tools. CMS still won't cover remote
interpretation and report for fundus photography or for any kind of ECG,
12-lead or otherwise. This affects technology like Welch Allyn's iExaminer
system or AliveCor's smartphone ECG.

"These services include a technical component (TC) and a professional
component (PC)," the guidance says. "By definition the TC portion of these
services needs to be furnished in the same location as the patient and thus
cannot be furnished via telehealth. The PC portion of these services could
be furnished without the patient being present in the same location."

Two other codes that were denied related to monitoring patients in their
homes with digital health devices -- one for "analysis of clinical data
stored in computers (eg, ECGs, blood pressures, hematologic data" and one
for "collection and interpretation of physiologic data (eg, ECG, blood
pressure, glucose monitoring) digitally stored and/or transmitted by the
patient and/or caregiver to the physician or other qualified health care
professional." These were denied on the basis that they're not reimbursable
outside of a telemedicine context.

"These services are not separately payable by Medicare," the document says.
"It would be inappropriate to include services as telehealth services when
Medicare does not otherwise make a separate payment for them."

The telepsychiatry and annual wellness visit expansions are potentially good
news for a lot of telemedicine companies that deal in those areas, as well
as for hospitals and private practice physicians looking to increase the
number of patients they treat by offering video visits. However, the
document still shows a glacial pace for telehealth reimbursement, with many
more requests denied than accepted, and a very dim view of reimbursement
requests that involve new technology. Large scale Medicare reimbursement for
telehealth still seems to be a long way off.

<br><br> 

<a
href="http://mobihealthnews.com/34637/cms-to-pay-for-telepsychiatry-but-not-remote-ecg-fundus-cameras-in-2015/"><strong>Click
here to read the full article on MobiHealthNews >></strong></a>
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