Medicare Payment Rules for FY 2015 Have Health IT Implications

November 3, 2014 in News

CMS’ final regulations for its fiscal year 2015 Medicare Physician Fee Schedule — which were released on Friday — include several health IT-related changes, The Hill reports (Viebeck, The Hill, 10/31).

Telehealth Coverage Expansion

Under the final rules, Medicare beginning Jan. 1, 2015, will expand its covered telehealth services to include wellness and behavioral health visits for beneficiaries.

In addition, the rules will allow physicians to bill Medicare $40 per patient per month for non-face-to-face chronic care management services for patients with more than one chronic condition (Evans, Modern Healthcare, 10/31).

CMS had proposed requiring providers to have certified electronic health records to be eligible to receive the separate chronic care management payment. However, providers expressed concern that EHRs currently are not interoperable enough to support chronic care management services.

To address this issue, CMS in its final rule said it will allow practices to use EHR systems that meet the 2011 or 2014 certification criteria to be eligible to receive the chronic care management payment in calendar year 2015 (Goedert, Health Data Management, 11/3).

CMS also said providers must use the chronic care management “certified technology to fulfill the [chronic care management] scope of service requirements whenever the requirements reference a health or medical record.” CMS said that the agency will ensure billing requirements are consistent throughout each payment year and “are automatically updated annually according to the certification criteria required for the EHR Incentive Programs” (Walsh, Clinical Innovation Technology, 11/3).

Rules on Physician Compare Website, Open Payments System

Meanwhile, the CMS rules will expand the Physician Compare website by significantly bolstering “the quality measures available on this website by making group practice and individual physician-level measures available for public reporting, including patient experience measures” (The Hill, 10/31).

Separately, the rules also finalize the elimination of a reporting exemption under the Affordable Care Act’s Sunshine Act that excluded payments to physicians associated with accredited continuing medical education from the payments that have to be shared on the Open Payments System. CMS said the new rules will require group purchasing organizations and affected manufacturers to report compensation given to physician speakers at continuing education events in most cases.

In addition, the rules will eliminate exemptions under the Sunshine Act that did not require the reporting of indirect ties between physicians and certain industry stakeholders. The rules clarify the types of indirect payments that must be reported to CMS when industry stakeholders underwrite certain continuing medical education for physicians (Modern Healthcare, 10/31).       

Home Health Final Rule Details

In separate rules for home health payments released Thursday CMS said it will continue to promote EHR adoption in home health services but did not explicitly recommend their use in such settings, Health Data Management reports.

In the rule, CMS wrote that “HHS believes all patients, their families and their health care providers should have consistent and timely access to their health information in a standardized format that can be securely exchanged between the patient, providers and others involved in the patient’s care.” CMS added that it “believe[s] that [health information exchange] and the use of certified EHR technology … can effectively and efficiently help providers improve internal care delivery practices, support management of patient care across the continuum and enable the reporting of electronically specified clinical quality measures” (Slabodkin, Health Data Management, 11/3).

ATA Reaction

The American Telemedicine Association applauded the rules, saying that “Medicare beneficiaries got an important treat for home care of chronic care management, remote patient monitoring of chronic conditions and other services when provided via telehealth.”

ATA CEO Jonathan Linkous said, “It has been a long time coming, but this rulemaking signals a clear and bold step in the right direction for Medicare” (Gold, “Morning eHealth,” Politico, 11/3).

 

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