CMS Proposes to Overhaul Medicare Billing Standards, Pay for Telehealth

The U.S. Centers for Medicare and Medicaid Services (CMS) has proposed compensating doctors for telemedicine and overhauling decades-old Medicare billing standards, reports Modern Healthcare . In a proposed rule, the agency said it would pay doctors for their time when they contact beneficiaries virtually to determine whether an in-person visit or other service is necessary. "This is a big issue for senior and disabled population for which transportation can be a barrier to care," CMS Administrator Seema Verma said. "We're not intending to replace office visits but rather to augment them and create new access points for patients." Most physicians bill Medicare for patient visits under a set of codes that distinguish level of complexity and site of care, known as evaluation and management visit codes, which CMS has used since 1995. CMS proposed allowing practitioners to designate the level of a patient's care needs using their medical decisionmaking or time they spent with the patient instead of applying the old documentation guidelines. In addition, the agency wants to remove the requirement to justify the medical necessity of a home visit in place of an office visit and is considering ending a policy that bars payment for same-day visits with multiple practitioners in the same specialty within a group practice. The proposed rule also includes some major changes to administration of MACRA, including an opt-in option for physicians with a low volume of Medicare Part B enrollees or reimbursements and a waiver for clinicians who participate in a new Medicare Advantage demonstration.