AMA, HIMSS among organizations urging CMS to waive restrictions on telehealth

Telemedicine consultation
CMS proposed seven new codes to expand telehealth reimbursement for physicians, but providers and IT groups say the agency can do more. (Credit: Getty/AndreyPopov)

Provider groups and health IT advocacy organizations are generally pleased with a proposal issued by federal officials to expand Medicare coverage for telehealth services under the 2018 physician fee schedule, but several are pushing for even more flexibility to integrate connected health technology.

In July, the Centers for Medicare and Medicaid Services issued a proposal to add seven new codes to the list of telehealth services covered by Medicare’s physician fee schedule in 2018. The new codes expanded reimbursement for counseling patients about the need for a lung cancer screening, chronic care management, psychotherapy for crisis and health risk assessments.

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CMS also requested feedback about unbundling payments for remote patient monitoring, particularly for physiological data.  

In comments submitted to the agency, a broad range of provider and health IT groups uniformly supported the agency’s decision to both expand telehealth services and restructure remote patient monitoring payments. But several groups, including the American Medical Association (AMA) and the HIMSS say CMS can do more to remove payment restrictions.

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  • AMA led the charge by “strongly” urging CMS to initiate “a far broader range and scope of demonstration projects that waive geographic and originating site restrictions.” Referencing recommendations by its Digital Medicine Payment Advisory Group (DMPAG), assembled in January, AMA said it supports the agency’s proposal to add seven new telehealth codes and unbundle remote monitoring payments, but wants CMS to utilize its waiver authority to provide better care at a lower cost and raised concerns that the proposed codes for remote monitoring were too general.
  • HIMSS also called on CMS to “consider applying waivers as broadly as is legally permissible” on telehealth restrictions, including originating site limitations and geographic areas where telehealth services are allowed. Referencing the work done by AMA’s DMPAG, the group also urged CMS to use its “significant discretion” to expand coverage for remote patient monitoring by creating a new code that specifically covers remotely acquired patient generated data.
  • AMGA wrote that it believes “substantially expanding Medicare telehealth and [remote patient monitoring] coverage is past due,” highlighting the ability to reduce readmissions and emergency room visits and provide self-management for patients.  
  • The Personal Health Connected Alliance said CMS’s decision to add seven telehealth billing codes to the physician fee schedule was a “step in the right direction,” but that the new codes “insufficiently incorporates the entire range of telehealth services.” The HIMSS-organized group also urged CMS use the full weight of its waiver authority to expand telehealth payments.
  • The Center for Connected Health Policy called on CMS to rework its definitions for services provided by a rural health provider or a federally qualified health center to allow for “store-and-forward” forms of telehealth and expand reimbursement through Medicare Advantage plans.
  • Referencing a previous letter to the Federal Communications Commission that classified broadband access as a “social determent of health,” the American Medical Informatics Association (AMIA) called for CMS to work with the FCC to assess connectivity in rural parts of the country. Like HIMSS and AMA, the group also called for CMS to “extend telehealth coverage waivers to more [alternative payment models] to encourage experimentation with telehealth services.”