The AMA's new CPT codes streamline virtual care visits, simplifying and incentivizing telehealth services for mainstream clinical practices.

Recently, the American Medical Association revealed the 2019 Current Procedural Terminology (CPT) code set. These codes make it possible for physicians and other healthcare providers to bill insurers for services provided to patients. With this year’s changes to the CPT codes making provisions for telemedicine services, the practical effect will be that physicians can more easily bill insurers for virtual care consultations.

Consumers of telehealth services will benefit from worry-free coverage for high-quality, convenient care delivered remotely. These changes reflect the technological and scientific advancements available to mainstream clinical practice. The new CPT codes streamline virtual care visits, simplifying and incentivizing telehealth services for mainstream clinical practices.

Telehealth services poorly understood

In the past, providers and insurers have suffered from an inadequate understanding of telehealth provisions. In April 2018, the Office of the Inspector General for the Department of Health and Human Services (HHS) found that 31% of claims made by providers did not meet the Medicare requirements for telehealth services. Following the HHS findings, hospitals and healthcare providers could expect to have their claims subject to further review to ensure patients were eligible.

Quality assurance is another key area of concern for virtual care. As recently as last year, doubts were raised about telehealth services’ ability to set and meet quality-of-care standards. This year, however, the American Medical Association (AMA) introduced policies for physicians providing guidelines to ensure quality when using virtual care.

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These policies reflect the growing acceptance of virtual care services. Mainstream clinical practices are now able to deliver quality virtual care with the knowledge that insurers and payers are able to smoothly process their claims.
Acceptance of Virtual Care

By adopting virtual care services in mainstream clinical practices, physicians will be able to provide consultations for patients in real time eliminating the need for costly and time-consuming appointments.

The Center for Medicare Services and Medicaid Services (CMS) in July proposed a rule which allowed for asynchronous telemedicine and new technologies through a new set of virtual care codes. In a statement describing the impetus for these changes, the CMS declared, “We now recognize that advances in communication technology have changed patients’ and practitioners’ expectations regarding the quantity and quality of information that can be conveyed via communication technology.” Recognizing that advances in communications bring higher expectations from telehealth services for physicians and patients alike, the CMS opted to also propose codes for remote patient monitoring along with two telehealth codes for prolonged preventive services.

Remote patient monitoring is one area that virtual care is set to revolutionize. One survey found that stroke recovery patients were able to receive therapy five times more often using telehealth services. These convenient and more frequent sessions were linked to a 20% improvement in cognitive and language processing speed after just 100 exercises.

By the time patients had completed 500 exercises, the improvement in processing speed had jumped to 80%. Advancements in telehealth technologies have evolved patient monitoring by providing convenient and frequent access to quality care, improving patient outcomes.

The future of virtual care is the future of healthcare

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There will be a projected shortage of 100,000 physicians in the United States by the year 2030. Patients will have a difficulty securing a face-to-face appointment with general practitioners and specialists. It already takes an average of 24 days to secure an appointment with a physician, and that wait time is ballooning with each passing year. With the increased demand for care from patients and a decreased supply of doctors, quality of care is sure to decline across all fields of medicine.

When the Centers for Medicare and Medicaid Services (CMS) issued a proposed rule to introduce changes to the physician fee schedule, the organization paved the way for mainstream clinical practices to adopt asynchronous telemedicine and new technologies through a new set of virtual care codes. The CMS explained the reasoning behind the revolutionary changes saying, “We now recognize that advances in communication technology have changed patients’ and practitioners’ expectations regarding the quantity and quality of information that can be conveyed via communication technology.”

Recognition from the CMS indicates that the technological and scientific advancement behind telehealth will have broad influence in healthcare, including in mainstream clinical practices. Virtual care services will be critical to decreasing healthcare spending over the next decade. Medicare and Medicaid spending are projected to increase rapidly between now and 2026, the result of an aging population. In less than ten years, healthcare spending will account for almost 20% of the country’s GDP.

The CMS recognized the capability of virtual care services, saying, “From the ubiquity of synchronous, audio/video applications to the increased use of patient-facing health portals, a broader range of services can be furnished by health care professionals via communication technology as compared to 20 years ago.”

The CMS proposal to cover asynchronous telemedicine and non-face-to-face services is a major recognition of the validity of asynchronous telemedicine (i.e., store & forward medical care without the use of interactive audio-video or a face-to-face exam). Asynchronous telemedicine is efficient and patient-centered, and aligns with how many service providers deliver non-healthcare and online services today.

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CMS’ coverage of these services sends a strong message, both to medical boards and commercial health plans, that asynchronous telemedicine is an important and clinically-valid tool through which providers can deliver healthcare services.

By adopting virtual care services in mainstream clinical practices, physicians will be able to provide consultations for patients in real time eliminating the need for costly and time-consuming appointments. As such, virtual care services are being accepted and implemented by federal organizations like the AMA not out of convenience, but out of necessity.

Joey Truscelli is co-founder and CEO of Hello Alvin.

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