Although there have been many discussions about changes to CMS codes and changes to E&M coding for 2019, some of the big changes coming to telemedicine have slipped under the radar. With changes to the 2019 Physician Fee Schedule and new legislation passed in 2018, there are a number of different changes your practice will need to know in the coming year. Here’s a closer look at some of the significant changes in telehealth for 2019 that may actually help your practice boost your bottom line.
Bipartisan Budget Act of 2018 and Telemedicine
The President signed the Bipartisan Budget Act of 2018 into law on February 9, 2018, and this legislation offers a number of benefits for the telemedicine industry. In fact, it introduced some of the biggest changes that have ever been made to Medicare law. According to HealthCareLawToday.com, some of the key elements included in the bill include:
- The expansion of coverage for stroke telemedicine. In 2019 the facility-type and geographic requirements for originating sites won’t apply for the purposes of evaluation, treatment of symptoms, or diagnosis of an acute stroke when it’s delivered at specific originating sites. These sites include critical access hospitals, hospitals, mobile stroke units, and other sites that Health and Human Services deems appropriate.
- Providing Accountable Care Organizations the chance to expand their use of telehealth services. In 2020, a patient’s home will qualify as an eligible originating site for telemedicine services offered by practitioners or physicians that participate in certain ACOs.
- Increasing access to home dialysis oversight via telemedicine. On Jan 1, 2019, individuals with end stage renal disease who receive dialysis at home may decide to receive oversight visits from home via telemedicine as long as they also receive “face-to-face” visits at least once each month during the first three months of home dialysis and then once every three months.
- Allowing telemedicine services to be included in the basic benefits of Medicare Advantage plans.
The RUSH Act of 2018 and Telemedicine
Right before the August Congressional recess, certain members of the House of Representatives introduced The Reducing Unnecessary Senior Hospitalization Act (RUSH) of 2018. Introduced by Reps. Diane Black and Adrian Smith, the purpose of the bipartisan legislation is to help prevent unnecessary hospitalizations by allowing telemedicine services to be provided by qualified physician group practices within skilled nursing facilities under the current Medicare program. Beyond preventing unnecessary hospitalizations, it’s also anticipated that this would result in significant savings for Medicare, skilled nursing facilities, and physician group practices.
Some of the things the Rush Act bill would do include:
- Offer skilled nursing facilities with increased facility fees to cover the cost of setting up and administering telemedicine services adequately
- Encouraging the use of two-way video conferences for skilled nursing facilities located in urban areas
- Allowing the “home of a patient” to be considered an eligible originating site for telemedicine services
HCPCS Code G2010 – Remote Evaluation of Pre-Recorded Patient Information
Along with the final rule for the 2019 Physician Fee Schedule, a new code was introduced: “Remote Evaluation of Pre-Recorded Patient Information.” It’s essential for providers to understand this new code and how it will work in the coming year. This code includes remote evaluation of recorded images or video that’s been submitted by an established patient, including the interpretation of them with follow-up within the next 24 business hours. However, these videos and/or images may not originate from a related E&M service that was provided in the past seven days or leading up to an E&M procedure or service that’s within the next 24 hours.
It’s only appropriate to use this code for store and forward/asynchronous telemedicine technologies involving patient-generated, pre-recorded video or still images. The video or images have to be submitted by the patient, and the evaluation cannot be based solely on non-image data like a questionnaire. Once the images/videos have been interpreted, then a follow-up response to the patient must be provided by the practitioner within 24 hours. This follow-up may be done via email, patient portal, phone call, secure text messaging, or audio/video technology.
Other important things to know about this new code include:
- Written or verbal patient consent is required for this service, including electronic confirmation noted on the patient’s medical record for the service.
- This code is only allowed to be used for established patients, not new patients.
- A patient co-payment is required of patients.
- While there are no frequency limitations on the code, like other services it needs to be medically reasonable and necessary to qualify for reimbursement.
- There are no patient location requirements that need to be fulfilled for this code.
From new codes in the 2019 Physician Fee Schedule to new legislation, many things are changing in telemedicine within the coming year. It’s a sign that the medical industry is taking steps towards encouraging providers to use new technologies efficiently to provide medical care. To learn more about billing telemedicine or other billing and coding changes for 2019, visit M-Scribe for more information.