Limits on nursing home telemedicine will stand, CMS announces

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Medicare will continue to reimburse only one telehealth visit per month for skilled nursing facility residents, according to a recent proposed rule from the Centers for Medicare & Medicaid Services. The proposed physician fee schedule for 2014 seeks to expand telehealth in other healthcare settings. 

Under the 2011 PFS final rule, Medicare beneficiaries can be covered for one telehealth visit per 30-day period for subsequent skilled nursing facility services. The American Telemedicine Association asked CMS to remove this limitation, citing new studies and plans to create a national broadband network dedicated to healthcare.

The broadband project aims to improve rural providers' access to urban specialists, and there are already no limitations on how often urban specialists can use G-codes related to medically reasonable and necessary SNF consultations, CMS noted. 

The studies cited by the association do not provide persuasive evidence that more frequent telehealth visits would benefit SNF residents, according to CMS.

Telehealth is appropriate for SNF inpatients if it enables “appropriately frequent, medically reasonable and necessary encounters with their admitting practitioner,” the proposed rule states. However, if the current limits are removed, telehealth may be used too frequently, compromising care for “this potentially acute and complex” population.

While maintaining these limits on SNF telemedicine, the proposed rule would create new codes for physicians to provide more non-face-to-face management for certain beneficiaries with complex, chronic care needs. 

The proposed physician fee schedule will be published July 19 in the Federal Register. Click here to access a CMS fact sheet on the proposal.

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