The CMS is proposing allowing physicians to bill for follow-up inpatient consultations delivered via telehealth, a move that could spur health insurers to do the same.
In the proposed fee-schedule rule released this week, and up for public comment until Aug. 29, the CMS suggests three new inpatient codes to bill for these consultations. The idea is such visits would be strictly for follow-up inpatient visits, and not subsequent hospital care, according to the CMS. A final rule will be issued Nov. 1.
As defined, these inpatient telehealth consultations, or e-visits, would include monitoring a patient's progress, recommending care-management changes or advising on a new plan of care in response to changes in the patient's status. E-visits would be done in real time, using an interactive communications system, except in Alaska and Hawaii, where store and forward technology is being used in federal telemedicine demonstration projects, the CMS said.
Payment for these follow-up visits would include all consultation-related actions done before, during and after communicating with the patient remotely, such as reviewing patient data and talking with other health providers on the care team and family members as well as completing medical records, according to the CMS.
The three new billing codes would each reflect the complexity of the e-visit. The first would be a straightforward visit, taking about 15 minutes, the second would include medical decisionmaking that is somewhat complex and taking about 25 minutes, while the third code would reflect a patient visit of about 35 minutes that includes a more thorough conversation and decisionmaking, the CMS said.
The American Medical Association has called for e-visit reimbursements that accurately reflect the scope and complexity of the work involved. Without reviewing all the details yet, the AMA would be, in concept, "all for it," a spokeswoman said.
While e-visits are still new, some health plans have already started reimbursing providers for them, said Jonah Frohlich, senior program officer at the California HealthCare Foundation, a not-for-profit research group in Oakland. Five health plans in California pay $40 per e-visit, and some national health plans are piloting the concept, he said.
"The biggest benefit is that using e-visits for routine question and answer can help deal with physician backlog and be convenient for the patient," Frohlich said, adding that health plans tend to adopt billing practices led by the CMS.
To read more on the subject of inpatient telehealth consultations, see Andis Robeznieks' "Dont LOL at virtual visits."
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