Manchin, Capito Lead Bipartisan Call For Equal Telephone-Based Health Services Reimbursements
Charleston, WV – U.S. Senators Joe Manchin (D-WV) and Shelley Moore Capito (R-WV), today led 37 Senators in advocating for the U.S. Department of Health and Human Services (HHS) and Centers for Medicare & Medicaid Services (CMS) to increase telephone-based, or audio-only, telehealth reimbursements to equal other audio-visual and in-person visitation reimbursements. Many West Virginians do not have access to reliable broadband, making it nearly impossible to use video-sharing to receive telehealth services during the COVID-19 pandemic. Instead they must turn to telephone-based telehealth services. However, healthcare professionals who provide these services are not receiving the same reimbursement for their telephone-based consultations as they would for visual or in-person consultations.
The Senators said in part, “As COVID-19 continues to spread in communities across the United States, millions of people are following directives to stay home and avoid risking exposure to the virus. In conjunction with those directives, health care providers have shifted to offering audio-visual telehealth services to patients, so that patients can receive evaluations, medical consultations, checkups and other services in their own homes, instead of risking exposure at a health care facility. However, for instances where a patient has no home access to internet, broadband or other cell phone services, physicians and other providers are furnishing these medical consultations through audio-only formats, such as telephone calls.”
“The West Virginia Board of Medicine recognizes that the citizens of West Virginia are among the most vulnerable in relation to the COVID-19 virus. Therefore, any temporary modifications that will allow for increased patient access, via telemedicine, to qualified providers during these unprecedented times is crucially important. We appreciate Senators Manchin and Capito and their commitment and leadership during this pandemic,” said Kishore K. Challa, MD, FACC, President of the West Virginia Board of Medicine.
“The West Virginia State Medical Association thanks Senator Manchin and Senator Capito for leading the charge to ensure our members are being properly reimbursed for their audio-only telehealth consultations. We are proud to care for our fellow West Virginians and we understand that many do not have access to broadband, making it difficult to use visual telehealth options and because of the COVID-19 pandemic, the majority of our patients are unable to visit us in-person. That is why it is essential our providers are reimbursed equally for their audio-only consultations so they can continue to run their offices and provide care to West Virginians throughout this pandemic,” said Danny Scalise, Executive Director of the West Virginia State Medical Association.
The letter can be read in full below or viewed here.
Dear Secretary Azar and Administrator Verma:
We write to draw your urgent attention to concerns that we have heard from health care providers and patients regarding Medicare’s coverage and payment rules during the outbreak of the novel coronavirus or “COVID-19.” In order to ensure that Medicare beneficiaries in all regions of the country can have access to health care services during this time, we strongly urge you to address Medicare payment differences that exist between audio-visual telehealth services and audio-only medical consultations.
As COVID-19 continues to spread in communities across the United States, millions of people are following directives to stay home and avoid risking exposure to the virus. In conjunction with those directives, health care providers have shifted to offering audio-visual telehealth services to patients, so that patients can receive evaluations, medical consultations, checkups and other services in their own homes, instead of risking exposure at a health care facility. However, for instances where a patient has no home access to internet, broadband or other cell phone services, physicians and other providers are furnishing these medical consultations through audio-only formats, such as telephone calls.
Access to audio-only telephone-based services during this time is not only important for Medicare beneficiaries with limited means, but is also vital for Medicare patients who live in communities that lack sufficient broadband and internet connectivity. For these communities, telehealth services provided through internet based visual platforms are simply not an option.
While we appreciate the effort of CMS to provide expanded coverage for audio-only services, the current reimbursement rates for audio-only services are not sufficient to make audio-only medical consultations a viable option for many health care providers. While audio-only consultations may not be appropriate in all clinical circumstances, providers across the country who have been able to conduct successful audio-only telephone visits with patients when clinically appropriate. We support their efforts to continue offering medical care to our most at-risk populations in their homes and ask that CMS make this care sustainable for providers by ensuring sufficient payment for telephone consultations when clinically appropriate during the COVID-19 outbreak. Your access to healthcare should not be determined by your access to broadband when other approaches are available.
In light of this critical need to better support the provision of audio-only services for Medicare beneficiaries who may lack access to broadband or have limitations that prevent the use of audio-visual telehealth services during the COVID-19 outbreak, we urge you to:
1. Increase Medicare payment rates for telephone-based evaluation and management (E/M) codes (99441-99443) to bring payments for these codes equal to Medicare’s established in person visit codes (99212-99214) that will ensure that patients without advanced video-sharing capabilities are able to get care virtually, while helping to sustain physician practices.
2. Immediately provide guidance to Medicare Administrative Contractors (MACs) to ensure that recent CMS guidance and rules are followed appropriately to enable the payment of telephone E/M claims.
3. Provide Members of Congress with a briefing on your efforts to address this issue by May 8, 2020.
We appreciate recent steps taken to expand telehealth for health care providers. Expanding access to telehealth services has been vital to our collective effort to respond to the COVID-19 crisis. In order to maximize the potential of at-home care during this public health emergency, CMS must provide adequate payment for audio-only services, in addition to audio-visual telehealth services. Thank you for your attention to this matter.
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