CMS Announces Proposed Telehealth Changes for 2018

On July 21, 2017, CMS published proposed telehealth revisions and additions for 2018 in the Federal Registry. CMS is moving at a cautious pace with only 37 telehealth services currently, and is proposing expansion of services to include five new types of telehealth services and the proposed deletion of the GT modifier. The new proposed services relevant to behavioral health for 2018 are identified by the following CPT®/HCPCS codes:

• G0506 (care planning for chronic care management) • 90839 and 90840 (psychotherapy for crisis)• 90785 (interactive complexity)

CMS welcomes all comments on the proposed rules and will accept comments until September 11, 2017. If you or your hospital clients have comments they wish to present to CMS on the proposed telehealth changes, please email them to Susan Frazier, sfrazier@diamondhealth.com, no later than September 8, 2017. The Corporate Integrity Department will submit all comments received and monitor the proposed legislation. You may also submit comments directly to CMS by September 11, 2017. For a complete listing of the telehealth proposed rules, please refer to: https://www.gpo.gov/fdsys/pkg/FR-2017-07-21/pdf/2017-14639.pdf.

Telehealth Changes for 2018

Telehealth Services Added to the Office of Inspector General’s (OIG) 2017 Work Plan; An Increased Area of Focus for Regulators

In July of 2017, the OIG announced they were adding telehealth services to the 2017 Work Plan for auditing and monitoring. The OIG’s Office of Audit Services will be conducting audits related to Medicare payments for telehealth services “provided at distant sites that do not have corresponding claims from originating sites to determine whether those services met Medicare requirements.”2

As telehealth becomes an increased focus for regulators and services continue to expand, be cognizant that telehealth is vulnerable to abuse or allegations of abuse and has specific regulatory challenges.

For example, last year, prosecutors settled the first False Claims Act lawsuit in a telehealth case. Connecticut psychiatrist Anton Fry and his Danbury-based mental health practice, CPC Associates, Inc., agreed to pay $36,704 to resolve allegations that they billed Medicare for services provided over the phone from Jan. 1, 2008, to June 1, 2015. Fry allegedly didn’t meet patients or treat them in person and services didn’t qualify for telehealth.1

Additionally, there are several issues that have arisen with telehealth since its inception. Licensure is one of those issues as eight states offer special telemedicine licenses and last year, 44 states introduced 150 telehealth-related laws. Some states are more restrictive than others. The variations in state requirements can cause confusion for hospitals, providers and telehealth vendors. Hospitals need to refer to their state’s laws and regulations regarding the delivery of telehealth services. Another issue is HIPAA privacy and security: (1) knowledge of where the medical records reside is paramount (originating or distant sites) and (2) whether the telehealth vendor HIPAA compliant and what monitoring processes the hospital has implemented to ensure the telehealth vendor’s statement of compliance with HIPAA standards.1

References:1Report on Medicare Compliance, Vol. 26, No. 28, August 7, 20172https://oig.hhs.gov/reports-and-publications/workplan/summary/wp-summary-0000236.asp

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