A Look Inside CMS Reimbursements For Telemedicine

By Infinx
January 25, 2018

Telemedicine, also known as Telehealth, is growing by leaps and bounds. Physicians who adopt it are finding increased patient engagement and improved health outcomes, and not only with patients in rural areas. CMS is following suit with this trend, providing reimbursement codes for a range of telemedicine services.

In this blog, you’ll find some very compelling reasons to move forward with the service, both with and beyond CMS reimbursements. The main point is simple: If you don’t consider adopting telemedicine now, you risk losing your patients to another provider who offers it.

CMS reimbursement for telemedicine details in 2018

If your practice is hesitating to embrace telemedicine for fear of a lack of CMS reimbursements, fear no more: It’s covered. However, it pays to know the CMS criteria for telemedicine reimbursements. They do offer a fact sheet with codes and compliance details. Here are the CMS telemedicine reimbursement guidelines you need to be aware of, and we quote:

  1. Medicare pays for a limited number of Part B services furnished by a physician or practitioner to an eligible beneficiary via a telecommunications system.
  2. For eligible telehealth services, the use of a telecommunications system substitutes for an in-person encounter.

To obtain CMS telemedicine reimbursement, you must qualify as an authorized originating site, according to the following criteria:

  • The address does not fall within a metropolitan statistical area OR
  • If the address falls within a metropolitan statistical area, then the address must be in a rural area and be in a Primary Care or Mental Health geographic Health Professional Shortage Area (HPSA).

According to CMS, among the authorized originating sites are:

  • Physician offices
  • Hospitals
  • Community mental health centers
  • Skilled nursing facilities
  • Rural health clinics

Practitioners who can receive CMS reimbursement for telemedicine services (subject to state law) include:

  • Physicians
  • Nurse practitioners (NPs)
  • Physician assistants (PAs)
  • Nurse-midwives
  • Clinical nurse specialists (CNSs)
  • Certified registered nurse anesthetists
  • Clinical psychologists (CPs) and clinical social workers (CSWs) with some exceptions
  • Registered dietitians or nutrition professionals.

Telemedicine can improve outcomes

There are many excellent reasons to become familiar with telemedicine and to incorporate the service into your practice and daily appointments. The first is that telemedicine can vastly improve your delivery of care.

  1. UC Davis saved patients nine years of travel time (five million miles) and $3 million in healthcare costs: When UC Davis evaluated 19,246 inpatient and outpatient telemedicine visits between 1996 and 2013, it found that patients visited their primary care doctor and together they would consult a UC Davis specialist via video. Patients could visit a telemedicine center near their home instead of traveling to UC Davis Health in Sacramento for specialty care.
  2. New York Presbyterian’s (NYP) telestroke service can save 7 minutes of treatment time for a stroke victim, or about 140 million brain cells.
  3. NYP Express Care service replaced in-person encounters with a video visit and slashed admission-to-discharge times from an average of 2.5 hours to 31 minutes.
  4. MultiCare Health System in Tacoma instituted remote monitoring and telehealth as an improved way to deliver home care. Home health has become a bundled payment reimbursement, and the system needed to adapt to that. The system’s disease management home-health program has grown from 10 remote monitors to 100 and helps to manage chronic disease including chronic pulmonary obstructive disorder, pneumonia, and cardiac disease.

Reasons to integrate telemedicine in 2018

One of the more compelling reasons to integrate telemedicine into one’s practice now may surprise you. A recent survey showed that consumers are willing to change doctors to get telemedicine visits:

  • 34% of parents of children under age 18 would switch
  • 30% of those aged 35 to 44 would switch
  • 26% of consumers aged 18 to 34 would switch doctors to get access to video visits

A recent survey on the implementation and cost savings of telemedicine may provide a glimpse into the future. It found that fully 75 percent of all physician, urgent care, and emergency room visits would be classified either as “unnecessary” or as “manageable” when handled by telemedicine, either by phone or video.

Telemedicine is the wave of the future, and it is here today. Telemedicine allows physicians to stay in touch with patients who live in remote areas, triage questions of patients near and far, and close gaps in care to prevent adverse health events and manage chronic disease. Adopting telemedicine in your practice makes sense because it can increase patient volume, streamline the delivery of care, and be reimbursed by CMS, as appropriate.

About the Author



Infinx provides innovative and scalable payment lifecycle solutions for healthcare practices. Combining an intelligent, cloud-based platform driven by AI with our trained and certified coding and billing specialists, we help clients realize revenue, enabling them to shift focus from administrative details to billable patient care.

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