The Centers for Medicare & Medicaid Services (CMS) is proposing a “lower level” E/M code to be used for reimbursement for physician virtual visits and reviews of pre-recorded images (which would reimburse for a provider’s asynchronous review of “recorded video and/or images captured by a patient) in order to evaluate the patient’s condition” and determine whether or not an office visit is necessary. Video or image reviews are referred to as “store-and-forward” communication technology. The reasons for this proposal include quicker responses to patients, elimination of unnecessary, costly patient office visits and incorporation of technological resources that are available.
Reimbursement for these services is limited to “established” patients who have not been treated by the billing physician or another qualified health care professional within seven days before or after the service provided. The Virtual Visit or Review of Pre-Recorded Images fees will be bundled into the previous/later E/M code for those patients seen within the seven-day windows. In addition, the reimbursement will not be offered for the discussion of test results ordered by the physician or other health care professional.
CMS anticipates many questions pertinent to the proposal such as how to document the service, what is best technology, should pre-recorded imaging be expanded to new patient, patient consent, and limitation on number of times it can be used. It is unclear how clinician will determine that a patient was seen seven days before or after the virtual visit by “another qualified healthcare professional”. Clearly, the physician office and or health care facility would need the capability and resources to maintain such vigilance.
Input/Comments are due by 5p.m. on September 10, 2018: CMS is soliciting comments on the proposed rule until 5 p.m. September 10, 2018. Anyone may submit comments – anonymously or otherwise – via electronic submission, or via regular or express overnight mail to Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-1693-P, P.O. Box 8016, Baltimore, MD 21244-8016 (for regular mail); or Centers for Medicare & Medicaid Services, Department of Health and Human Services, Attention: CMS-1693-P, Mail Stop C4-26-05, 7500 Security Boulevard, Baltimore, MD 21244-1850 (for express overnight mail).