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Telemedicine Reimbursement Restrictions

The American Association of Family Practitioners (AAFP) recently asked CMS to revoke some of the elements of Medicare physician fee schedule that block reimbursement on telemedicine for ED services, observational cares, and store-and-forward services. AAFP Board Chairman, Robert Wergin, wrote a letter to CMS stating that, “In light of the growing amount of evidence suggesting the effectiveness of various forms of telehealth services, the AAFP supports revisions to policies that create unnecessary barriers to the responsible and appropriate use of telemedicine services.”

Most of the complaints are against the CMS requirement that the patient should be in “telehealth-origination site” to avail reimbursable care. This requirement eliminates store-and-forward services, even though almost nine of the US states reimburse the technology via Medicare programs.

Wergin said, “Both the appropriateness of telemedicine/telehealth services as the modality of treatment, and the appropriateness of an originating site, should be determined by whether standards of care can be met for a given condition and clinical scenario. Standards of care are impacted by current technology capabilities, but should not be dictated by arbitrary policies or statutes that become antiquated as a result of improvements in technology capabilities.”

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American Association Of Family Practitioners

“Increasing numbers of state Medicaid programs are reimbursing for store-and-forward technology in response to heightened awareness that improvements in technology are enabling standards of care to be met using telehealth as the modality for service for an increasing number of clinical conditions. We urge Medicare to likewise provide reimbursement for use of asynchronous store-and-forward technology,” he added.

Wergin also criticized CMS for their plan to reject new CPT codes that are related to emergency department care and observation visits. “A physician is capable of assessing a patient’s physical condition in an observational setting and determining an appropriate course of treatment via telemedicine routes of delivery,” Wergin further said in the letter. “With the physician shortage issues and increasing lack of ideal access to care that can occur in any geographic region – most especially in rural areas – it is important that these services be allowed to be provided both as in-person or reimbursable telemedicine services.”

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