News: MedPAC offers temporary support for telehealth

CDI Strategies - Volume 15, Issue 12

The Medicare Payment Advisory Commission (MedPAC) is recommending continuing temporary payments for telehealth services after the COVID-19 public health emergency (PHE) expires, with the additional time used to gather evidence about the efficacy of remote care, HealthLeaders reported.

While MedPAC said that they applauded CMS’s embracing of telehealth to improve care access during the pandemic, the panel said questions remain about the effectiveness of remote care.

“The Commission has previously recommended that policymakers use the principles of access, quality, and cost to evaluate individual telehealth services before covering them under Medicare,” MedPAC said. “There are some clinical trials comparing telehealth and in-person care, but at this time, there is not yet evidence on how the combination of telehealth and in-person care affects quality and costs in the Medicare program.”

MedPAC is recommending that Medicare fee-for-service coverage of telehealth services be expanded after the PHE expires for up to two years “to gather more evidence about the impact of telehealth on access, quality, and cost, and they should use this evidence to inform any permanent changes,” HealthLeaders reported.

During this limited period, MedPAC said Medicare should temporarily:

  • Pay for specific telehealth services for all fee-for-service beneficiaries regardless of their location;
  • Cover some telehealth services with services covered before the PHE if there is a potential clinical benefit;
  • Cover some audio-only telehealth calls if there is potential for clinical benefit.

When the PHE ends, MedPAC said Medicare should return to paying the fee schedule’s facility rate for telehealth services and collect data on the cost of providing these services.

The panel added that providers should not be allowed to reduce or waive cost sharing for telehealth services after the PHE, and that CMS should implement safeguards to protect Medicare and its beneficiaries from unnecessary spending and potential telehealth fraud.

Those safeguards could include additional scrutiny to “outlier clinicians” who bill for a high percentage of telehealth visits, mandated face-to-face visits before ordering expensive durable medical equipment or lab, and banning “incident to” billing for telehealth services provided by a clinician who can bill Medicare directly.

Editor’s note: This article was originally published by HealthLeaders. For more ACDIS coverage of telehealth news, click here.

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