On July 13, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule that includes proposals to update payment policies, payment rates and quality provisions for services furnished under the Medicare Physician Fee Schedule (PFS) on or after Jan. 1, 2018. The proposed rule (CMS-1676-P) proposes to add telehealth reimbursements and bolster payment for office behavioral healthcare by factoring in overhead costs and ease reporting requirements for telehealth medical providers.
In order for Medicare to make payments for telehealth services under the PFS, the services must meet the following requirements: the service shall be furnished through an interactive telecommunications system; the service shall be furnished by a physician or other authorized practitioner; the service shall be furnished to an eligible telehealth patient; and the patient receiving the telehealth service must be located in a telehealth originating site. Practitioners furnishing Medicare telehealth services submit claims for telehealth services to the Medicare administrative contractors (MACs) that process claims for the service area where their distant site is located. Section 1834(m)(2)(A) of the Social Security Act requires that a practitioner who furnishes a telehealth service to an eligible telehealth individual be paid an amount equal to the amount that the practitioner would have been paid if the service had been furnished without the use of a telecommunications system. Once all four of these conditions are met, Medicare would pay a facility fee to the originating site and makes a separate fee to the telehealth practitioner furnishing the service.
