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About Tele-Health and Medicare

Medicare TeleHealth Enhancement Act of 2009

By Staff Reporters

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According to Richard S. Bakalar, MD, past president of the American Telemedicine Association, many physicians think that telehealth is a wave of the future for Medicare, but so far the program has been slow to embrace technology. Congressional legislation in 1997 and 2000 largely established the telehealth component of Medicare, yet in 2006 the program spent only $2 million on medical services conducted electronically, out of more than $400 billion in total spending.

The Physical Presence Blockade

Remote patient visits, consultations and other care can generate payment only if they fall under a handful of Medicare payment codes approved for telehealth applications, while the patient must be physically present with a health professional at the originating call site located outside of a metropolitan area. Some types of facilities are not approved to get paid for these services, and Medicare will only pay for home telehealth devices and care as part of an approved pilot project.


A major factor in Medicare’s cautious stance is concern that a large expansion would strain the system’s finances by opening the doors for physicians and others to bill for a whole host of costly and potentially unnecessary telehealth services. For further discussion, see www.atmeda.org.

Current Updates for 2010

Link: Medicare Telehealth


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23 Responses

  1. Telemedicine Medicare Consultation Codes

    Starting this year, Medicare eliminated the use of all consultation codes except telemedicine consults.

    It directed physicians instead to bill for the visits using only the evaluation and management [E&M] codes that apply.



  2. SD Senator Introduces Medicare Telemedicine Bill

    Sen. John Thune has introduced a bill aimed at promoting long-distance telemedicine for Medicare recipients. The Fostering Independence Through Technology Act would provide incentives for home health agencies, particularly in rural areas, to use home monitoring and communications technologies.

    “Access to high-quality healthcare in rural areas can be costly and limited,” Thune, R-SD, said in a statement. “Telehealth technology stands to bridge the distance gap between patients and specialized healthcare providers through new and innovative measures and can bring down the cost of healthcare in rural communities.” Under the bill, agencies that participated in the telemedicine pilot program would receive annual payments based on Medicare savings through telemedicine technology. Thune said the bill does not increase the federal deficit.

    Source: Rapid City Journal [3/8/11]


  3. Is Red Tape Holding Back Telemedicine’s Promise?

    By Mary Jo Gorman, M.D.

    This author suggests that telemedicine is emerging as a viable option for addressing nursing and physician shortages in the years to come.


    But, many bureaucratic obstacles are still standing in the way of realizing this goal.

    Ann Miller RN MHA


  4. ACO Rules Limit Patient Telehealth Options

    The American Telemedicine Association wants HHS to waive five Medicare restrictions on telehealth payments.


    What do you think?

    Ann Miller RN MHA


  5. CMS Finalizes New Rule on Telemedicine

    A final rule from the CMS will change the process that hospitals use to credential and grant privileges to physicians and other practitioners who provide care through telemedicine.

    According to the CMS, the agency’s regulations before the final rule had required hospitals—including critical-access hospitals—to grant practice privileges to remote-site physicians and other practitioners who were already credentialed in distant-site facilities after they considered qualifications on a practitioner-by-practitioner basis.

    As a result, those practitioners could not provide care through telemedicine services unless they had been granted privileges by their home hospital and the remote hospital or critical access hospital where the telemedicine services were delivered.

    The new rule—which takes effect in 60 days—says a hospital or critical-access hospital that provides telemedicine services to patients through an agreement with a so-called distant hospital or telemedicine entity can now rely on the information from the distant hospital or telemedicine entity when making the credentialing and privileging decisions for those physicians and practitioners at the distant site who will supply the services.

    Source: Jessica Zigmond, Modern Healthcare [5/2/11]


  6. The VBP start to ‘historic change’ in payment

    Ann – Hospitals will be paid based on quality not quantity under this new program, and that will ultimately benefit all patients, according to HHS Secretary Sebelius




  7. Study Finds Remote Dermatology Consults Help Treatment and Outcomes

    Live interactive telemedicine consults with dermatologists appeared to result in improved treatment and positive outcomes, according to a report in the American Medical Association’s Archives of Dermatology journal.

    In a study funded by HHS’ Agency for Healthcare Research and Quality, researchers examined the records of 1,490 patients who had a live teledermatology visit with a physician at the University of California at Davis between 2003 and 2005, and compared diagnoses and treatment plans between the referring physician and the dermatologist.

    These visits resulted in changes in diagnosis for 69.9% of the patients and changes in disease management for 97.7%. Clinical improvement was seen in 68.7% of the 313 patients who were identified to have two or more virtual visits.

    The most common changes from the referring physician’s original diagnosis were changing the diagnosis from skin infection to “primary inflammatory process,” such as psoriasis or eczema appearing as a fungal infection; changing from malignant lesion to benign; and from changing a benign lesion diagnosis to malignancy.

    Source: Andis Robeznieks, Modern Healthcare [1/16/12]


  8. VA Tests Teleconference Training for Primary-Care Docs

    The U.S. Veterans Affairs Department is testing a new take on telemedicine at 11 sites across the country. The three-year, $15 million pilot program, called Specialty Care Access Network-Extension for Community Healthcare Outcomes, aims to train VA primary-care physicians to provide specialty medical care to veterans living in rural settings where specialists are scarce. If successful, such Internet-based specialty training for primary-care physicians could be rolled out throughout the VA system, according to VA officials.

    The program uses one-and-a-half hour weekly video conference training sessions for primary-care physicians. Sessions are led by panels of medical specialists in select areas of medicine. The training uses specific cases to simulate the training that physician specialists receive. The aim of the program is to serve as a “force multiplier” that allows the same number of physicians to treat a larger number of patients by expanding primary-care physicians’ knowledge of select specialty areas of medicine.

    Rich Daly
    Modern Healthcare [7/11/12]


  9. Report Finds Telehealth Services are Cost-Effective, Clinically Successful

    Studies of healthcare systems in the U.S. and abroad show providers have achieved financial and clinical success with implementing telehealth services, according to a report by the healthcare research arm of Computer Sciences Corp. The four-page report, by the Falls Church, VA-based defense, intelligence, and information technology consulting firm’s Global Institute for Emerging Healthcare Practices, reviews telehealth studies in Germany, the U.K., as well as the U.S.

    While there remain problems with properly quantifying the return on investment in telehealth programs, “the evidence shows that, implemented properly, telehealth can be cost-effective, with benefits accruing across the whole healthcare system, not just acute care providers,” the report authors said.

    Source: Joseph Conn, Modern Healthcare [7/11/13]


  10. Telemedicine Guidelines Adopted by State Medical Boards
    [An Update]

    In April 2014, the State Medical Boards’ Appropriate Regulation of Telemedicine (SMART) Workgroup passed The Federation of State Medical Boards Model Policy, which is a new model for telemedicine policy. The Model Policy addresses each aspect of telemedicine, including appropriate online medical care; physician-patient relationship; HIPAA compliance; patient privacy; informed consent; and, drugs prescriptions.

    The Model Policy also ensures that patients are protected in an era where advancement of medical and communications technology is becoming more prevalent and attractive in the healthcare industry. This redefinition by FSMB has generated a heated debate from advocates like American Telemedicine Association, which asserts that the policy could impede the innovative progression in the field because the policy “does not appear to reflect current regular uses of telemedicine and raises significant barriers to its use.”

    Click to access Telemedicine.pdf

    Robert James Cimasi MHA CVA CMP™


  11. Verizon Introduces Virtual Visits
    [New Telehealth Offering]

    Verizon is taking another step into healthcare with the introduction of its Virtual Visits program.

    The goal is to facilitate connections via phone, tablet, or laptop between healthcare providers who contract with Verizon and their patients for what Verizon terms routine, urgent care.

    An interested patient would boot up the system, have eligibility verified and co-payment collected, and then be led through a series of questions. Depending on the answers, the patient would be triaged into the appropriate groups by a provider for a virtual video visit.

    From there if, for example, a prescription is needed, a doctor would send it to the appropriate pharmacy.

    Source: Darius Tahir, Modern Healthcare [6/25/14]


  12. Proposed CMS Rule Expands Telehealth Payments

    Wellness and behavioral health visits are among a few telehealth coverage expansions the CMS wants to add to the list of Medicare-reimbursable telehealth activities under a proposal released Thursday. Providers also would be paid for telehealth services in rural areas nearer big cities under a geographical expansion in the proposed rule.

    Rule writers are also attempting to further harmonize reporting requirements under the Medicare physician quality reporting program and similar “meaningful-use” requirements for clinical quality reporting under the federal EHR incentive payment program created by the American Recovery and Reinvestment Act.

    : Joseph Conn, Modern Healthcare [7/7/14]


  13. Patient-Driven Teledermoscopy for Atypical Nevi Successful

    Mobile devices equipped with cameras can effectively enable patients to monitor atypical nevi and send images to their healthcare providers, according to an article published online January 28 in JAMA Dermatology. Nevus monitoring typically spans 2.5 to 4.5 months. Approximately 19% of lesions change during that time, with 11% to 18% of them eventually becoming malignant. Clinically significant changes seen by comparing images side-by-side is evidence for excision of the lesion.

    Patient-driven mobile teledermoscopy uses an application, DermScope, on an iPhone to transmit images from the patient to the healthcare provider. The technology may help alleviate the increased patient load in dermatology resulting from the aging U.S. population and increased numbers of insured patients.

    Source: Medscape News [1/30/15]


  14. Medical License Reciprocity is Paving the Way to Telemedicine

    For physicians in rural states, the “windshield time” — the hours spent driving from one rural community to another — is often non-productive and frequently unnecessary. Telemedicine is one alternative, but regulations preventing physicians from treating patients across state lines are a barrier.

    Now, lawmakers in several states are advancing a proposal, called the Interstate Medical Licensure Compact, to fast-track the licensure process enabling qualified doctors to practice in more than one state. The compact would expand opportunities for eligible providers to practice telemedicine across state lines. It could also increase access through face-to-face visits in rural areas near state borders, allowing doctors to have clinic hours and make house calls on both sides of the line.

    To date, the compact has been introduced in over a dozen state legislatures. Chambers in three — South Dakota, Utah, and Wyoming — have passed proposals related to the compact. South Dakota’s Senate passed the Compact with abundant support, and the House chambers in Wyoming and Utah voted unanimously in favor of the proposal, according to a press release from the Federation of the State Medical Boards (FSMB). The concept is fairly straight forward. Any qualified physician interested in obtaining licensure in multiple states could do so through an alternative pathway, said Lisa Robin, MLA, chief advocacy officer for the FSMB.

    Source: Shannon Firth, Medpage Today [2/20/15]


  15. How Telehealth Is Reshaping Care Delivery

    Agreed – Telemedicine is booming, fueled by promises of consumer convenience and better access for the underserved. Nearly half of employers will offer telehealth benefits this year.

    Yet, the use of virtual visits continues to be limited by state licensure requirements, reimbursement issues, and concerns about quality and patient safety.



  16. Interstate Licensing Bill for Telemedicine Gathers Support

    Twenty-one organizations have signed onto the Telemedicine for Medicare (TELE-MED) Act of 2015, which was recently introduced in both the U.S. House of Representatives and the U.S. Senate. The bill, which was previously proposed in 2013, would enable physicians licensed in one state to care remotely for Medicare patients in other states without getting additional medical licenses in those states. It would not, however, affect the severe restrictions that Medicare now places on telemedicine coverage.

    Among the organizations that expressed support for the measure in letters to its bipartisan House and Senate co-sponsors are the American Telemedicine Association (ATA) and an assortment of employer groups, technology companies, patient support groups, and giant health insurer Anthem. In addition, the American Health Information Management Association, representing health Internet technology professionals, and the College of Health Information Management Executives, which consists mainly of chief information officers, support the legislation.

    Source: Ken Terry, Medscape News [8/18/15]


  17. E-Prescribing of Controlled Substances Legal Nationwide

    On August 28, Vermont became the 50th state to legalize electronic prescribing of controlled substances, making the practice available nationwide.

    However, while 78 percent of pharmacies can accept e-scripts for controlled substances, only 2 percent of physicians electronically prescribe for these schedule II-V narcotics, according to SureScripts, which operates a nationwide electronic prescribing network.

    Source: Joseph Goedert, Health Data Management [8/31/15]


  18. 2% Have Access to Video Physician Visits in 2015

    Nielsen Strategic Health Perspectives recently conducted a survey on access to digital tools for healthcare. Here are some key findings from the report:

    • 15% use email to communicate with their provider.
    • 1 in 5 (21%) have access to online appointment scheduling with their doctors.
    • 9% receive appointment reminders by text.
    • Less than half (45%) receive telephone appointment reminders.
    • 3% are able to send a photo of a medical condition over email.
    • Video visits are available to 2% of those surveyed.

    Source: Nielsen Strategic Health Perspectives, November 4, 2015


  19. Most Family Physicians Would Use Telehealth if They Were Compensated

    The Robert Graham Center for Anthem, Inc. and the American Academy of Family Physicians recently conducted a survey on physician attitudes toward telehealth. Here are some key findings from the report:

    • 9 in 10 family physicians say they would use telehealth if they were compensated.
    • 15% of physicians surveyed said they used telehealth in their practices.
    • 3 in 4 recognize that telehealth is a way to improve access to care for their patients.
    • 49% of physicians using telehealth reported using real-time video the past 12 months.
    • 1 in 4 physicians using telehealth use it for chronic disease management.
    • 55% of physicians using telehealth use it for diagnoses or treatment.

    Source: Anthem, Inc., November 16, 2015


  20. Bipartisan Senate Bill Seeks to Expand Telemedicine Services

    A bipartisan group of U.S. senators Wednesday are introducing a bill aimed at expanding telemedicine service through Medicare benefits. “Telehealth is the future of healthcare. It saves money and improves health outcomes,” co-sponsor Sen. Brian Schatz (D-HI) said. “Our bipartisan bill puts us on a path to transform healthcare delivery, making it less costly and more convenient for patients and providers.”

    The bill, called the Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act would expand the use of remote patient-monitoring for some patients with chronic conditions, increase telemedicine services in community health centers and rural health clinics, and provide basic telemedicine benefits through Medicare Advantage.

    Source: Joseph Conn, Modern Healthcare [2/3/16]


  21. IN Governor Signs Telehealth Bill

    While licensure requirements for physicians don’t vary much from state to state, rules governing telehealth historically have been cumbersome. That has changed over the past few years as telehealth gains acceptance. Three states, Alaska, Arkansas, and Texas, require that a provider-patient relationship be established — through a face-to-face encounter — before telehealth visits can take place. In Indiana, telehealth patients must undergo a physical examination before a prescription can be written. That rule, however, is about to change. On March 21, Indiana Gov. Mike Pence (R) signed H.B. 1263, a telehealth bill that will give providers authority to write prescriptions for non-controlled substances through telehealth visits. The law goes into effect July 1, says John Jesser, president of Anthem’s LHO operations.

    Jesser says some primary care doctors are concerned that patients, particularly younger ones who don’t have a regular doctor, could turn to telehealth as a replacement for office visits. Blues plans that have launched a telehealth option tout it as a convenient service for members who might not have time for an office visit, or who might need care outside of their doctor’s normal office hours.

    Source: Steve Davis, AIS Health [April 2016]


  22. Telehealth 2017

    According to a recent survey conducted by SERMO; 41% of U.S.-based physicians think their state has done a “fair” job in adopting telehealth.

    * 44% have negative feelings about their state’s telehealth programs.

    * 22% of Ohio physicians believe their state implemented telehealth “well” or “very well”, and 20% of California physicians had the same response.

    New Jersey was among the lowest ranking, with 59% responding that their state’s implementation is “poor” or “very poor”.

    Source: Business Wire


  23. CMS Proposes to Overhaul Medicare Billing Standards, Pay for Telehealth

    The CMS proposed paying doctors for virtual visits and overhauling Medicare billing standards it has had in place since the 1990s. In a lengthy proposed rule, the agency said it would pay doctors for their time when they reach out to beneficiaries via telephone or other telecommunications devices to decide whether an office visit or other service is needed. In addition, the CMS also proposed paying for the time it takes physicians to review a video or image sent by a patient seeking care or diagnosis for an ailment.

    The CMS proposed allowing practitioners to designate the level of a patient’s care needs using their medical decision-making or time they spent with the patient instead of applying the decades-old E/M documentation guidelines. In addition, the agency wants to eliminate the requirement to justify the medical necessity of a home visit in lieu of an office visit and is considering eliminating a policy that prevents payment for same-day visits with multiple practitioners in the same specialty within a group practice.

    Source: Modern Healthcare [7/12/18]


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