Telehealth Reimbursement: 3 Changes Providers Should Know

– Written by Cathy Kuhn, PharmD, BCACP, FAPhA, director of Strategy Consulting, Updox

A recent survey of 100 healthcare executives identified several common challenges that physicians experience – with declining reimbursements topping the list. In an effort to sustain profitability, providers often cut costs in other ways, negatively affecting the patient experience.Cathy_Headshot (1)

The Centers for Medicare & Medicaid Services (CMS) recognized these challenges and sought to alleviate them. At the end of 2019, CMS finalized and issued several policies to its Medicare Reimbursement strategy, with the goal of helping practices become more patient-centric, reduce costs and understand workflow barriers. Here are the top three telemedicine reimbursement guidelines you need to know in order to help your practice: 

1. Coming to An Office Near You: Telehealth & Patient Engagement

Healthcare leaders have been looking forward to telehealth services for years – in fact – a 2014 survey by Foley & Lardner, reported that 89% of healthcare leaders expected telehealth services to transform U.S. healthcare in the following decade.  

However,  some providers might not be able to receive reimbursement for telehealth services due to the patient case, service provided or practice location. Therefore, uncertainty over reimbursement was flagged by 77% of providers as a key reason for not using telehealth. But, that is changing.

In 2020, Medicare Advantage enrollees will have greater access to innovative technology and telehealth benefits. Prior to these amendments, senior enrollees weren’t eligible for all telehealth benefits. Now, patients can virtually check-in and connect with doctors by phone or video chat, broadening their access to quality care. Additionally, CMS is streamlining policies for dually eligible Medicare and Medicaid beneficiaries and improving Star Ratings, which helps patients identify high-value plans.  

2. Managing Your EMR to Take Back ‘Pajama Time’

Providers often find themselves working late into the night, spending countless hours catching up on paperwork and updating electronic medical records. On average, providers spend nearly two hours managing documents at home (aka “pajama time”)

To reduce this burden and increase profitability, CMS is implementing sub-regulatory documentation requirements, as part of its Documentation Requirements Simplification Initiative, allowing providers to review and verify records instead of having to re-document notes from other providers. This aligns with its Patients over Paperwork Initiative, allowing providers to focus on caring for patients and less time shuffling through paper documents.

3. Using Technology to Combat Drug Misuse

About 21 to 29% of patients that are prescribed opioids misuse the medication. To combat this growing epidemic, CMS is finalizing opioid use disorder treatment services that include individual and group therapy.

In order to make this available to beneficiaries in all parts of the country, CMS implemented a reimbursement policy that allows providers to offer counseling and therapy services via two-way interactive audio-video communication. As part of the revised reimbursement guidance, CMS also noted that beneficiaries will no longer have copayments moving forward, allowing providers to offer these services to a broader population.

Reimbursement policies can change lives. By making it easier for providers to care for patients without having to worry about costs or payments, they can focus on quality care. Ready to embrace some of these technologies in your practice? Click here to find a solution that works for you.

About the Author: Cathy Kuhn, PharmD, BCACP, FAPhA, is director of Strategy Consulting for Updox and serves as “voice of the clinician” for Updox solutions and services. She is past president of the Ohio Pharmacists Association and current president of the American Pharmacist’s Association’s (APhA) Academy of Pharmacy Practice and Management and APhA board member.

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