Medicare takes another step toward telehealth

By Anthony Brino
01:20 PM

Medicare is expanding coverage for telehealth consults next year, as part of a gradual embrace of the technology that mobile and remote healthcare advocates have been hoping to accelerate.

In Medicare’s 2014 physician fee schedule, the Centers for Medicare and Medicaid Services outlined several new telehealth services and service regions that will be reimbursed by the federal government.

CMS is expanding the geographic areas where Medicare will cover telehealth from strictly-defined rural areas, in counties that are not part of a metropolitan statistical area, to rural areas defined by the Office of Rural Health Policy — basically expanding coverage into “the fringes of metropolitan areas,” as the American Telemedicine Association said.

CMS is also adding coverage for patient-physician communications in transitional care management and chronic care, and is slightly increasing telehealth reimbursement for physicians from $24.43 to $24.63, up from $20 in 2011.

“While incremental,” the new coverage is “another step toward integrating the use of telecommunications technology into the delivery of healthcare," Jonathan Linkous, CEO of the American Telemedicine Association, said in a media release.

The ATA and other groups have been prodding CMS to embrace telehealth as part of health reform and to move beyond what Linkous has called “the strict restraints” placed on telehealth reimbursement since Medicare telehealth coverage pilots began more than a decade ago.

Since the proposed physician fee schedule was published in July, CMS received a number of comments on the telehealth changes, including from some rural health clinics expressing concern that they may be excluded from providing telehealth to Medicare beneficiaries because the rural health professional shortage areas used to establish geographic coverage areas for telehealth does not entirely align with the Census-based shortage area classification used for rural health clinic qualification.

“Although RHCs are among the types of locations that are statutorily authorized to serve as originating sites for telehealth services, they also must meet the geographic requirements specified in the statute in order to serve as a telehealth originating site,” CMS officials wrote in a response. “We do not have the authority to waive the geographic telehealth requirements for those RHCs that do not meet any of the requirements to serve as an originating site.”

Other commenters warned CMS that determining the new geographic eligibility to serve as a telehealth originating site may be so complex that it deters providers from offering the services.

“We share the commenters’ concern that expanding the geographic definition of ‘rural’ to include more telehealth originating sites has increased the complexity in determining the eligibility of a particular location to serve as an originating site,” CMS officials responded, noting that they’re working with the Health Resources Services Administration (HRSA) to develop a website helping providers determine eligibility.