Docs press CMS for permanent telehealth flexibility, relief from pay cuts in fee schedule comments

Several doctor groups are pressing the Biden administration to not just extend Medicare telehealth reimbursement flexibilities through 2023 but to be made permanent.

The Centers for Medicare & Medicaid Services proposed in the 2022 Physician Fee Schedule to extend telehealth flexibilities through 2023 instead of through the end of the COVID-19 public health emergency, which is expected to run through this year. Doctor groups in comments on the rule, the deadline for which expired Monday, called for a permanent solution and more flexibility for mental health telehealth services.

“Given the addition of a record number of eligible beneficiaries, telehealth may be the only way beneficiaries can gain access, especially those in rural or underserved communities,” according to a letter from 60 provider and health IT groups including the Health Information and Management Systems Society (HIMSS).

The Medical Group Management Association also commented that removing services after a “predetermined or prescriptive date” could create a major administrative burden for practices already strained financially by the pandemic.

“Member group practices report that adjusting workflows to operationalize the use of new telehealth codes requires additional resources, such as clinician and staff training and patient education,” MGMA said in comments. “Removing telehealth services from the covered code list will prove disruptive to both practices and patients alike, as patients have become accustomed to receiving these services virtually.”

RELATED: Hospital telehealth visits leveling off at 10-20% of appointments as claims hit lowest level since pandemic

Physician groups did applaud CMS for proposing to reimburse doctors for audio-only mental health visits. But they balked at a proposal in the fee schedule to require an in-person visit at least once within six months before each telehealth service.

MGMA said that a spending bill passed by Congress earlier this year included a provision eliminating the geographic and originating site requirements for providing mental health services via telehealth. The requirement for an in-person visit is arbitrary and doesn’t meet congressional intent, the group said.

“This arbitrary, six-month requirement will discourage patients from seeking necessary mental healthcare,” MGMA added.

The American Medical Association added in its own comments that “CMS should leave the determination of when in-person care is necessary up to the discretion of the treating physician.”

Seeking relief on payment cuts

Doctor groups were also worried about a looming 3.75% cut in the 2022 Medicare conversion factor, which calculates reimbursement for procedures under fee-for-service. The cuts are mandated under a budget neutrality provision in Congress and comes after a pay bump from Congress that expires in 2022.

The AMA said that it is urging CMS to work with Congress for relief on the budget neutrality issue.

“CMS should exercise the full breadth and depth of its administrative authority to avert or, at a minimum, mitigate these unconscionable payment cuts,” the group added.

MGMA said that the cuts are going to be especially difficult on physician practices as other cuts could come into effect, such as a 4% payment cut to Medicare reimbursements under the PAYGO law that mandates cuts if federal spending reaches a certain level.

Physicians also must likely brace for the return of a 2% cut to payments that was installed under the sequester. The cut has been put on pause for more than a year due to the pandemic, but lawmakers seek to use it as a pay-for in a bipartisan infrastructure bill expected to be considered in the House later this month.