Earlier this summer, the Centers for Medicare & Medicaid Services (“CMS”) published the proposed Physician Fee Scheduled (“PFS”) for calendar year 2022, which included several proposed changes affecting telehealth and digital health.
Extension of “Category 3” Telehealth Coverage Through CY 2023
As a result of the COVID-19 public health emergency (“PHE”), CMS added 135 services to the Medicare telehealth list. This expansion enabled such services to be performed via telehealth and billed for the duration of the PHE. For certain “Category 3” telehealth services that have not otherwise been permanently adopted into the Medicare telehealth list, CMS has proposed expanding coverage until December 31, 2023, regardless of when the public health emergency ends.
Removal of Site Requirements for Mental Telehealth Services, With In-Person Visits Required Every 6 Months
As a result of recent statutory amendments, Medicare geographic and originating site restrictions were permanently relaxed by Congress for some mental health services. To effectuate such amendments, the proposed rules set forth the requirements for engaging in such encounters. Namely, payment for telehealth services furnished for the purpose of diagnosis, evaluation, or treatment of a mental health disorder will require that a physician or practitioner furnish an in-person, non-telehealth service to the beneficiary within 6 months prior to the first time the physician or practitioner furnishes a telehealth service to the beneficiary, and every 6 months thereafter.
Permanently Enabling Audio-Only Encounters for Mental Telehealth Encounters
With respect to audio-only encounters, CMS made note that the agency had concerns that “the use of audio-only communications technology for Medicare telehealth services could lead to inappropriate overutilization.” Nevertheless, as a result of the PHE, CMS temporarily waived certain restrictions and enabled certain practitioners to bill for audio-only encounters. Since that time, and based on an initial review of claims data, CMS noted that a significant number of patients receiving audio-only care were those receiving behavioral health services. In light of the foregoing, and in light of the generalized shortage of mental health care professionals, CMS has proposed permanently revising the existing definition of “interactive telecommunications system” in CMS regulations to include audio-only communications technology when used for telehealth services for the diagnosis, evaluation, or treatment of mental health disorders.
Remote Therapeutic Monitoring
Of note, CMS proposed a new category of digital healthcare services, termed Remote Therapeutic Monitoring (RTM). RTM, a family of five codes, would enable practitioners to use approved devices in order to monitor patient health conditions, including musculoskeletal system status, respiratory system status, therapy (medication) adherence, and therapy (medication) response, and as such, allow non-physiologic data to be collected. Although the new RTM codes are related to the existing Remote Physiological Monitoring (RPM) codes, the equipment used for RTM services is envisioned to differ from those of RPM. In particular, as discussed in the proposed rules, RTM data may potentially be self-reported by the patient, as well as digitally uploaded by the device. Moreover, according to the PFS, the primary billers for the RTM codes are projected to be nurses and physical therapists, which would provide a mechanism for such practitioners to bill for remote monitoring services, given that those practitioners are limited in their ability to bill for RPM services under the RPM codes.
Key Takeaways
As described by CMS, “at the conclusion of the PHE for COVID-19, associated waivers and interim policies will expire, payment for Medicare telehealth services will once again be limited by the requirements of the [Social Security] Act, and we will return to the policies established through the regular notice-and-comment rulemaking process, including the previously established Medicare telehealth services list.” Of note, and absent action by Congress to amend the Social Security Act, at the conclusion of the PHE, Medicare’s more stringent restrictions on “originating sites” will again apply, limiting patients’ ability to engage in telehealth encounters from their homes for most services.
How Frier Levitt Can Help
Frier Levitt has extensive experience advising a variety of clients on the launching and refinement of their telehealth models, both individual practitioners seeking to engage in telehealth on a local basis, to telehealth startups and private equity investors seeking to launch national telehealth management services organizations (MSOs). Contact us today for a review of your telehealth model, its compliance, and related billing concerns that may be impacted by the PFS.
