…and what they mean for companies like TeleSpecialists.
Recently the Centers for Medicare and Medicaid Services (CMS) released the advance copy of the proposed 2021 Physician Fee Schedule rule. These proposed changes are geared toward the expansion of telehealth in the United States and to support the growth of telehealth amongst Medicare beneficiaries.
According to The National Law Review’s article, the most notable change is “to allow physicians to fulfill direct supervision requirements while remote, provided the physician is immediately available to engage via audio-video technology if needed.”
How does this proposed change affect telemedicine providers? It allows the supervising physician to be remote and use real-time, audio/video technology that permits interactivity between the supervising physician and the patient. However, this may not be appropriate in all clinical situations, such as high-risk, interventional, complex, or similar surgeries, where “hands-on” examinations are needed. This also would not apply to patients with dementia. CMS is seeking information on what risks this policy might introduce.
This proposed change also expands opportunities for telemedicine and incident-to- billing. While there are no Medicare regulations that specifically prohibit eligible telehealth providers from billing for telehealth services provided incident-to their services; the current definition of direct supervision requires the physician to be on-site, making it difficult to bill for services.
CMS is also proposing to change frequency limitations in nursing facilities from a restriction of once every 30 days to once every 3 days. CMS has been persuaded that telemedicine can help more than hinder in these types of situations. Ultimately, the treating clinicians should be deciding if treatment would be better served in-person or via telemedicine, based on the needs of the patient.
The nursing facility frequency limitation comes in conjunction with an inquiry seeking comments on changing the frequency limitations on inpatient services, capped at once every three days. They did not propose any changes but are looking into the need to remove frequency limitations altogether and how patient care would be affected.
Other proposed changes include:
Allowance of HCPCS codes G2061 through G2063 to be billed by, for example, licensed clinical social workers, clinical psychologists, physical therapists, occupational therapists, and speech-language pathologists who bill Medicare directly for their services when the service furnished falls within the scope of these practitioner’s benefit categories.
New additional telehealth services have been requested and the following codes have been proposed: Visit Complexity Associated with Certain Office/Outpatient E/Ms, Prolonged Services, Group Psychotherapy, Neurobehavioral Status Exam, Care Planning for Patients with Cognitive Impairment, Domiciliary, Rest Home, or Custodial Care services, and Home Visits. Full descriptions of the services can be found here.
Interested in anonymously submitting comments to CMS? You can do so here.