CMS Increases Telehealth Payments and Makes ACO Changes

On April 30th, 2020 the Centers for Medicare & Medicaid Services (CMS) announced the newest round of regulatory waivers to expand care to Medicare beneficiaries and provide more flexibility to Providers.

There are significant changes to Telehealth and the Medicare Shared Savings Program. The new policies will be in effect for the duration of the COVID-19 public health emergency. The full CMS announcement is available here.

Following are highlights of the changes:

Changes to telehealth policy

• CMS is increasing payment for audio-only telephone E/M services (CPT codes 99441-99443) so that they are paid at the same rate as similar office and outpatient E/M visits, resulting in increased payments from $14-$41 to $46-$110. CMS believes that the resources required to furnish these services during the Public Health Emergency are better captured by RVUs associated with level 2-4 established office/outpatient E/M visits. CMS is not increasing payment for CPT codes 98966-98968, which are intended for practitioners that cannot separately bill for E/M. This policy is retroactive to March 1, 2020.
• Telehealth services (other than CPT codes 99441-99443 and 98966-98968) are now added to the list of covered telehealth services. Medicare continues to require modalities that have both audio and video capabilities.
• CMS is forgoing its typical rulemaking process to add new services to the list of Medicare services that may be furnished via telehealth. Instead, CMS will add new telehealth services on a sub-regulatory basis to speed up the process of adding codes to the list.

Changes to Medicare Shared Savings Program

• There will be no application cycle for a Jan. 1, 2021 start date, and ACOs in the last performance year of their current agreement period will be allowed to voluntarily extend their agreement period by an additional performance year in 2021.
• ACOs participating in the BASIC track glide path will be permitted to maintain their current risk level under the BASIC track for PY 2021 and freeze progression to higher risk.
• CMS is removing all Part A and B payment amounts for episodes of care involving the treatment of COVID-19 for the purposes of determining benchmark year and performance year expenditures.
• The list of primary care services used for beneficiary attribution will be expanded to include additional telemedicine services.