Insider: Rachel Dixon on new ways to get paid for telehealth services

Podcast - March 26, 2019

Patient Access

Reimbursement

Chris Harrop


While more providers are embracing telehealth services as part of their care options, the need to build a successful financial model to support the services remains a crucial factor – especially as reimbursement requirements evolve.

Rachel Dixon, chief strategy officer for Care on Location, a telehealth medical service, hardware, software and consulting company, and acting executive director of Prime Health, a nonprofit that drives digital health innovation in the safety net space, says that numerous key initiatives are in place for 2019 and 2020 for providers to embrace telemedicine and bill Medicare and Medicaid for them, particularly in the areas of:
  • Substance use disorder treatment
  • Chronic condition treatment
  • Care coordination
  • Interprofessional team services
  • Store-and-forward methods

Remote patient monitoring

Dixon notes that three CPT codes – 99453, 99454 and 99457 – enable providers to bill for new types of remote monitoring of physiologic measures (weight, pulse oximetry and others) and associated treatment management services. Furthermore, the final code allows clinical staff, such as medical assistants or registered nurses, to perform the services.

Substance use disorder (SUD) treatment

Geographic restrictions long have been a barrier for providers to offer telehealth services, but Dixon noted that the Centers for Medicare & Medicaid Services (CMS) issued an interim final rule – a provision of the Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act – to make a home an originating site for furnishing telehealth services on or after July 1, 2019, for the purposes of treatment of SUD or co-occurring mental health disorder.

Home health visits

Dixon notes that, for calendar years 2019 and 2020, payment and policy changes by CMS will no longer require home health agencies and home infusion therapy suppliers to prove medical necessity for a home visit in place of an office visit, which will give those providers more options for using remote patient monitoring and other forms of telemedicine.

Interprofessional internet consultation

CMS also finalized reimbursement for interprofessional internet consultation, covering consultations between medical professionals via communications technology (e.g. telephone or internet), which support team-based approaches to care. The finalized codes include:
  • 99446 - 99449
  • 99452
  • 99451

Learn more

Dixon will co-present a four-hour online seminar, “Using Telemedicine to Improve Your Bottom Line,” on April 25, along with Jonathon Savage, chief executive officer of Care on Location. The course will provide in-depth review of telemedicine billing, reimbursement and financial management strategies, as well as how to interpret state-specific rules and find the resources for proper documentation to support successful telemedicine models.
 

About the Author

Chris Harrop
Chris Harrop
Senior Editorial Manager MGMA

Chris Harrop, senior editorial manager, MGMA, serves as editor of MGMA's flagship print publication, MGMA Connection magazine, and oversees various association content publications while also serving as a contributing author for the organization. Prior to MGMA, he was managing editor of multiple news organizations in the Denver metro area. Email him.

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