Does CMS need to improve telehealth reimbursement code?

Does CMS need to improve telehealth reimbursement code?

There’s more evidence that CMS’ attempt to reimburse for telehealth isn’t hitting its mark. A recent survey finds that almost 70 percent of physicians don’t understand how to use the proper CPT code and less than 20 percent are using it.

Launched at the beginning of this year, the Centers for Medicare and Medicaid Services enabled physicians to be reimbursed at an average rate of $42 per patient per month for non-face-to-face chronic care management (CCM) services. CPT Code 99490 was seen as a step in the right direction to prompt physicians to use telehealth and mobile tools to connect with their chronic care patients outside of normal office visits and develop a continuing care plan.

According to the survey, conducted by Cary, N.C.-based SmartLink Mobile Systems, though only 20 percent are using the code, 84 percent said they felt the program “is having a positive impact on patient care,” and nearly 70 percent expect to participate this year. Of those not enrolled, the survey said, 41 percent said they’re waiting on a corporate decision to take part, indicating that more than 80 percent of physicians could use the program before the end of the year.

SmartLink CEO Siu Tong said he was “very surprised” at the confusion surrounding the program and the lack of participation, but heartened by the number of doctors planning to use it. He said the survey sends a clear signal to CMS that “this is not a very clear way to communicate” to providers.

SmartLink sent the survey to some 45,000 primary care physicians in August and September, and received 300 responses.

For those physicians using the program, it isn’t always smooth sailing. A majority of those surveyed said they’re missing out on billing more than half of their enrolled patients each month, and more than half are trying to log patient time and activities either through an EHR or a paper spreadsheet – neither of which are considered optimal. The biggest challenges, said all physicians, are staffing, enrolling patients, keeping an auditable record of tasks and time, and meeting the electronic requirements.

It’s also worth noting that a program like CCM is a radical change for many physicians, and is thus even more difficult to implement. “For clinicians who have built their practices based on face-to-face sick and episodic care encounters, it is no surprise that enrolling patients in an ongoing care management program is outside of their comfort zone,” the study concluded. One emerging best practice, it noted, was a hybrid model in which practices added staff to enroll patients and work out the complexities of the new program, then scaled staffing back to normal numbers once everyone if comfortable.

There’s also some concern that the program will be harm more than help physicians because of its complexity. Less than 10 percent of the physicians consider themselves “very familiar” with the program’s requirements, while almost 17 percent are using the program. If that trend holds, the report says, some 30 percent of program participants would be likely to have to give back money to CMS for noncompliance.

Siu said the survey’s results will help SmartLink in preparing another survey – this one focusing on what providers would suggest to CMS to improve the program. Aside from making the requirements a lot easier, he said, he expects providers to suggest that “20 minutes a month isn’t enough” to properly manage chronic care patients.

“This is a step in the right direction, but many providers are not using the program, they’re not in compliance … and they’re missing out on revenues,” he said.

See also:

AMA workgroup targets telemedicine and CPT codes

$46 for 20 minutes of mHealth is ‘a good start’ for doctors

Why are doctors skipping chronic care reimbursement?