CMS Proposed Updates Suggest Reimbursement for Virtual Care

On July 12, 2018, The Centers for Medicare & Medicaid Services (CMS) proposed reforms that would bring us one step closer to a modern health care system that delivers better care for Americans at a lower cost. The proposed changes to the Medicare Physician Fee Schedule and Quality Payment Program would streamline clinician billing and expand access to high-quality care.

This proposal brings great advancements to virtual care. Provisions in the proposed CY 2019 Physician Fee Schedule would modernize Medicare payment policies by supporting access to virtual care. This would allow Medicare to reimburse physicians for care using telecommunications.

The provisions would support access to virtual care by:

  • Paying clinicians for virtual check-ins – brief appointments via communications technology
  • Paying clinicians for evaluation of patient-submitted photos
  • Expanding Medicare-covered telehealth services to include prolonged preventive services

The proposals would expand reimbursement opportunities for virtual check-in services as well as preventative services available through telehealth. They would save beneficiaries time and money while improving their access to high-quality services no matter where they live.

The update would also allow clinicians to review photos/videos submitted by patients via image technology to determine whether an in-person visit is needed.  Physicians could then practice “telehealth” without first establishing a prior in-person relationship with the patient.

CMS Administrator Seema Verma explained that “CMS is committed to modernizing the Medicare program by leveraging technologies, such as audio/video applications or patient-facing health portals, that will help beneficiaries access high-quality services in a convenient manner.”

In addition to virtual care, the proposed reforms would also reduce the burden of paperwork that clinicians face when billing Medicare, thus increasing the time physicians have to spend with patients.  By encouraging clinicians to use their electronic health records (EHRs) to document clinical information, instead of information only used for billing purposes, the doctor-patient relationship will improve along with the quality of care patients receive. Removing unnecessary paperwork increases clinician productivity, resulting in superior patient care.

If finalized, the proposals would save individual clinicians an estimated 51 hours per year if 40 percent of their patients are in Medicare. Changes in the QPP proposal would collectively save clinicians an estimated 29,305 hours and approximately $2.6 million in reduced administrative costs in CY 2019.


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