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CMS Proposing Expansions to Telehealth Coverage

Written by: Rebecca Bowden on Monday, August 15, 2016 Posted in: HME/DME, Home Infusion, Specialty Pharmacy

Navigating the Medicare Appeals ProcessStarting next year, telemedicine providers may be paid for more of their services, as well as use a new place of service (POS) billing code that’s specifically for telehealth. These proposed changes come from the Centers for Medicare and Medicaid Services (CMS). With the possibility of expansions being made in the telemedicine industry, do you have the capabilities to adapt to the changes?

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CMS wants to expand its reimbursable telehealth coverage by adding eight more CPT codes; this would include services for end-stage renal disease (ESRD), advance care planning services, and critical care consultations. (1)  In addition, they believe creating a POS code specifically for telehealth will eliminate confusion for the provider when reporting the service location. Currently, the provider is supposed to bill using a POS code for the patient’s location, not the provider’s, but the new code would specify that the service was done remotely. (2)

For the most part, the reimbursement rates will stay the same, so this doesn’t mean providers will be getting paid more per service, but you will have the opportunity to generate more profit by having extended options. Because of this, you should be prepared to offer additional services now that CMS wants to expand its coverage. How might you talk with your patients about planning for their health care in the future, or what care options would you offer to ESRD patients as a specialty pharmacist? If passed, the CMS changes would go into effect on Jan. 1 of 2017, so providers have less than a year to start planning how they could expand their care services. With the changes coming quickly, how do you plan on growing your service lines?

Providers have until September 6 to share thoughts or concerns about the proposed changes, which can be done online. Mediware technology is adapted to telehealth delivery. Prepare your business with CareTend.




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