Medicare bumps payments for Telephone only codes.

Medicare released an update today with a number of new rules to further expand remote access to medical services.  The full announcement includes changes for obtaining COVID testing and payments, hospital billing rules to accommodate the off campus billing capabilities and further expansion for telehealth via payment increases and the ability to add new codes.  Similar to announcements made March 17, 2020, we expect that further instruction is forth coming and PRS will attempt to keep you up to date.  Here are few items particularly relevant to Physician practices.  For a full review of the document follow this link: https://www.cms.gov/newsroom/press-releases/trump-administration-issues-second-round-sweeping-changes-support-us-healthcare-system-during-covid

  • CMS previously announced that Medicare would pay for certain services conducted by audio-only telephone between beneficiaries and their doctors and other clinicians. Now, CMS is broadening that list to include many behavioral health and patient education services. CMS is also increasing payments for these telephone visits to match payments for similar office and outpatient visits. This would increase payments for these services from a range of about $14-$41 to about $46-$110. The payments are retroactive to March 1, 2020.

It appears that the changes approach payment parity for the 99441-99443 with New Patient codes 99201-99203 and Established patient codes 99212-99214.  Without a further look at the methodology the information we cannot provide more detail in how this will be paid for each location.  Once this is available we will update you.  If you have already been paid for these services you would be eligible for reprocessing at the new higher rate.  It is unclear whether Medicare will automatically reprocess these claims for you.  Again, as we learn more we will inform you.

  • Until now, CMS only added new services to the list of Medicare services that may be furnished via telehealth using its rulemaking process. CMS is changing its process during the emergency, and will add new telehealth services on a sub-regulatory basis, considering requests by practitioners now learning to use telehealth as broadly as possible. This will speed up the process of adding services.

This will allow Medicare to continue to add services that can be provided remotely to the Telehealth list.  You may recall that CMS has already added 80 codes to the list since the PHE announcement.  If you have suggestions on services that can be safely provided remotely you will be able to suggest the addition of the service to the list.  NO Guarantees though.

  • Since some Medicare beneficiaries don’t have access to interactive audio-video technology that is required for Medicare telehealth services, or choose not to use it even if offered by their practitioner, CMS is waiving the video requirement for certain telephone evaluation and management services, and adding them to the list of Medicare telehealth services. As a result, Medicare beneficiaries will be able to use an audio-only telephone to get these services.

Very little back up information at this time for this statement.  This may be an attempt to allow for Medicare payment of E/M codes using telephone only if the state has mandated coverage of these services by phone only.  It may be a broader relaxation of the use of Telehealth.  We will need to wait for more information to provide additional guidance for this statement.

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Mark N. Painter is a managing Partner of PRS Consulting, LLC, the CEO of PRS, LLC and the Vice President of Coding and Reimbursement Information for Physician Reimbursement Systems, Inc. (PRS). Since co-founding PRS in 1989, Mr. Painter has served as the primary coding resource for the PRS products including Hotlines, Coding Manuals and quick reference tools, the Internet based application codingtoday.com and seminars. He has lectured to a variety of groups concerned with health care reimbursement. Mr. Painter's extensive knowledge of physician reimbursement issues has allowed him to assist insurance companies, physicians and their staff members, legal counsel, actuaries, Specialty Societies and consultants on a daily basis. He has serves has an expert to legal counsel, bio device companies and pharmaceuticals. He was a co-chair of the Colorado Clean Claims Task Force, a committee of nationally known industry experts charged with the development of single payment edit database for the state. Mr. Painter is a CPMA. Mr. Painter received his B.A. from Grinnell College at Grinnell, Iowa.