Nathaniel Lacktman on Medicare

Telemedicine and Digital Health Companies Will Benefit from Newly-Proposed Fraud and Abuse Waivers

The OIG recently released proposed revisions to the Anti-Kickback Statute (AKS) and Civil Monetary Penalties (CMP) Law. Several of these changes, if finalized, will directly benefit companies offering telemedicine and digital...more

10/28/2019 / Anti-Kickback Statute , Centers for Medicare & Medicaid Services (CMS) , CMP Waivers , Digital Health , DMEPOS , Fraud , Health Care Providers , Healthcare Fraud , Medicare , OIG , Safe Harbors , Telemedicine , Value-Based Care , Waivers

Telehealth: Medicare Moves Forward by Proposing New Telehealth Services for 2020

On July 29, the Centers for Medicare and Medicaid Services (CMS) issued its proposed 2020 Physician Fee Schedule rule, which contains new telehealth services covered under Medicare. Surprisingly, CMS did not receive any...more

8/12/2019 / Centers for Medicare & Medicaid Services (CMS) , Comment Period , Health Care Providers , Medicare , Physician Fee Schedule , Physicians , Proposed Rules , Telehealth

Remote Patient Monitoring: Medicare Proposes Two Major Expansions

Last week, CMS proposed two significant changes to remote patient monitoring (RPM) services reimbursed under the Medicare program. The changes, part of the proposed 2020 Physician Fee Schedule, have been hotly anticipated by...more

8/7/2019 / Centers for Medicare & Medicaid Services (CMS) , Digital Health , Health Care Providers , Health Information Technologies , Medicare , Physician Fee Schedule , Proposed Amendments , Telehealth , Telemedicine

Medicare Remote Patient Monitoring: CMS Allows “Incident to” Billing

CMS just announced a clarification that remote patient monitoring under CPT code 99457 may be furnished by auxiliary personnel, “incident to” the billing practitioner’s professional services. An “incident to” service is one...more

3/19/2019 / Centers for Medicare & Medicaid Services (CMS) , Medical Monitoring , Medicare , Physician Fee Schedule

Virginia Lawmakers Pass Bill Requiring Insurance Coverage for Remote Patient Monitoring

Virginia lawmakers have taken new steps to expand the use of remote patient monitoring among the State’s residents, with both the House and Senate unanimously passing bipartisan legislation ensuring that commercial health...more

2/12/2019 / Centers for Medicare & Medicaid Services (CMS) , Digital Health , Governor Northam , Health Care Providers , Home Health Care , Medical Monitoring , Medicare , Telehealth , Telemedicine

Understanding Medicare’s New Remote Evaluation of Pre-Recorded Patient Information (Asynchronous Telemedicine)

Starting January 1, 2019, the Medicare program will cover certain medical services delivered via asynchronous telemedicine technologies. The Centers for Medicare and Medicaid Services (CMS) just published the final rule for...more

11/7/2018 / Anti-Kickback Statute , Centers for Medicare & Medicaid Services (CMS) , HCPCS , Health Care Providers , Medicare , Physicians , Telemedicine

Top 10 FAQs on Medicare’s Virtual Check-In Codes: The New Brief Communication Technology-Based Service

Telemedicine providers rejoice: Medicare will cover new virtual care services starting January 1, 2019. The Centers for Medicare and Medicaid Services (CMS) just published the final rule for the 2019 Physician Fee Schedule,...more

11/6/2018 / Anti-Kickback Statute , Centers for Medicare & Medicaid Services (CMS) , Final Rules , HCPCS , Health Care Providers , Medicare , Physician Fee Schedule , Physicians , Telemedicine

Medicare Remote Patient Monitoring Reimbursement FAQs: Everything You Need to Know About Chronic Care Remote Physiologic...

Remote Patient Monitoring (RPM) is the next big thing in medical care; patients just don’t know it yet. And, it seems, neither do many physicians. On Thursday, CMS published the final rule on its new RPM codes, officially...more

11/6/2018 / Centers for Medicare & Medicaid Services (CMS) , Chronic Care Managment (CCM) , Entrepreneurs , Final Rules , Health Care Providers , Healthcare , Medicare , Physician Medicare Reimbursements , Physicians , Telehealth

Medicare Proposes (and Rejects) New Telehealth Services for 2019

The telemedicine industry was pleased to learn CMS recently proposed adding new services to its list of Medicare-covered telehealth services. But what may be more interesting are the services CMS declined to add, and why....more

8/10/2018 / Bipartisan Budget Act , Centers for Medicare & Medicaid Services (CMS) , Comment Period , EMTALA , HCPCS , Health Care Providers , Hospitals , Medical Reimbursement , Medicare , Proposed Rules , Social Security Act , Telecommunications , Telehealth , Telemedicine

INSIGHT: CMS’s Virtual Care Codes Pave New Avenues for Telemedicine Services Delivery

The Centers for Medicare & Medicaid Services issued a proposed rule introducing monumental changes to the physician fee schedule, paving the way for asynchronous telemedicine and new technologies through a new set of virtual...more

7/27/2018 / Centers for Medicare & Medicaid Services (CMS) , Electronic Health Record Incentives , HCPCS , Health Care Providers , Health Information Technologies , Medicare , Physician Fee Schedule , Physicians , Proposed Rules , Public Comment , Regulatory Agenda , Telemedicine

Kentucky’s New Telehealth Law Expands Insurance Coverage and Reimbursement

Kentucky health care providers and patients will soon enjoy a revamped, and significantly improved, telehealth commercial insurance coverage law. Kentucky Governor Matt Bevin signed SB 112 into law on April 26, 2018, imposing...more

5/25/2018 / Commercial Insurance Policies , Governor Bevin , Health Care Providers , Health Plan Sponsors , Insurance Code , Medicaid , Medicare , New Legislation , Policies and Procedures , Telemedicine

OIG Report: CMS Paid Practitioners for Telehealth Services That Did Not Meet Medicare Requirements

The Office of Inspector General (OIG) at the Department of Health & Human Services (HHS) just published a new report on OIG’s review of Medicare payments for telehealth services. The objective of the OIG review was to...more

4/16/2018 / Audits , Bi-Partison Balanced Budget Act (BBA) , Centers for Medicare & Medicaid Services (CMS) , Department of Health and Human Services (HHS) , Health Care Providers , Medicare , MedPAC , OIG , Telehealth

Telemedicine Credentialing by Proxy: What Hospitals and Telehealth Companies Need to Know

Hospital-based telemedicine services continue to rapidly expand across the country, allowing providers to deliver care to rural areas and better allocate the staffing and availability of specialist physicians such as...more

2/20/2018 / Centers for Medicare & Medicaid Services (CMS) , Conditions of Participation (CoP) , Credentialing , Health Care Providers , Hospitals , Medicare , Telemedicine , The Joint Commission

Top 5 Ways Telehealth Will Change Under the New Federal Funding Bill

The telemedicine industry has been abuzz upon learning that provider-friendly legislation was included in the new federal Bipartisan Budget Act of 2018, signed into law by the President on February 9, 2018. But telehealth...more

2/16/2018 / ACOs , Bi-Partison Balanced Budget Act (BBA) , Centers for Medicare & Medicaid Services (CMS) , Department of Health and Human Services (HHS) , Health Care Providers , Health Information Technologies , Medical Reimbursement , Medicare , New Legislation , Physicians , Reimbursements , Telehealth , Telemedicine

Medicare’s New Remote Patient Monitoring Reimbursement: What Providers Need to Know

The new year continues to offer big opportunities for telemedicine and digital health companies, and one of the most notable developments is CMS’ decision to reimburse providers for remote patient monitoring (RPM). Effective...more

2/14/2018 / Centers for Medicare & Medicaid Services (CMS) , Health Care Providers , Medicare , Physician Medicare Reimbursements , Physicians , Reimbursements , Telehealth , Telemedicine

New OIG Project Expands Telemedicine Audits to State Medicaid Programs

Following on the heels of its plans to review Medicare payments for telehealth services, the federal Office of Inspector General (OIG) at the Department of Health & Human Services (HHS) just announced a new project to review...more

11/22/2017 / Audits , Department of Health and Human Services (HHS) , Medicaid , Medicare , Medicare Payment Reform , OIG , Provider Payments , State Medicaid Programs , Telemedicine , Work Plans

Medicare Payments for Telehealth Increased 28% in 2016: What You Should Know

Telehealth providers can celebrate another successful year of growth, as CMS reported a 28% increase over total 2016 payments for telehealth services under the Medicare program. Providers continue to successfully integrate...more

9/2/2017 / Centers for Medicare & Medicaid Services (CMS) , Health Care Providers , Medicare , Provider Payments , Telehealth , Telemedicine

OIG to Audit Medicare Telehealth Services: What You Need to Know

For what may be the first time, the Office of Inspector General (OIG) at the Department of Health & Human Services (HHS) recently announced a new project to review Medicare payments for telehealth services. Accordingly,...more

8/1/2017 / Audits , Department of Health and Human Services (HHS) , Health Care Providers , Medicare , OIG , Telehealth , Work Plans

Is Telemedicine Change Coming to Congress? The Medicare Telehealth Parity Act of 2017 Among Several New Federal Bills

Congress is reconsidering a nationwide telehealth coverage bill, named the Medicare Telehealth Parity Act of 2017, designed to introduce an incremental, though significant, expansion of coverage for telehealth services under...more

7/14/2017 / Medicare , Proposed Legislation , Provider Payments , Telehealth , Telemedicine

New Resources for Telehealth Chronic Care Management (CCM) Rules

More good news for hospitals, health care providers, and entrepreneurs interested in telehealth and Chronic Care Management (CCM). CMS just recently introduced a new educational initiative called Connected Care: the Chronic...more

3/30/2017 / Chronic Care Managment (CCM) , Health Care Providers , Hospitals , Medicare , Outpatient Prospective Payment System (OPPS) , Telehealth , Telemedicine

CMS Proposes New Medicare Telehealth Coding Rules

The Centers for Medicare and Medicaid Services (CMS) issued its proposed Medicare Physician Fee Schedule (PFS) for CY 2017 on July 7, 2016. In it, CMS would require practitioners to use a new place of service (POS) code to...more

8/2/2016 / Centers for Medicare & Medicaid Services (CMS) , Medicare , MPFS , Physician Fee Schedule , Public Comment , Telehealth , Telemedicine

Medicare Payments for Telehealth Increased 25% in 2015: What You Need to Know

More good news on the telehealth reimbursement front: CMS reported its total 2015 payments for telehealth services under the Medicare program and it was a 25% increase over last year. This reflects how providers are...more

3/4/2016 / Centers for Medicare & Medicaid Services (CMS) , Fee-for-Service , Health Care Providers , Medicare , Physician Medicare Reimbursements , Proposed Legislation , Telehealth , Telemedicine

2016 Will Be the Year of Telemedicine and ACOs

If 2015 was the year that brought telemedicine directly to consumers, 2016 will be the year of telemedicine and Accountable Care Organizations (ACOs). ACOs are expected to increase the use of telemedicine technologies as a...more

12/16/2015 / ACOs , Alternative Payment Models (APM) , Centers for Medicare & Medicaid Services (CMS) , Medicare , Medicare Shared Savings Program , OIG , Telemedicine

State Lawmakers Pushing Telemedicine Coverage in 2016

State legislation is heavily contributing to the expected reimbursement/coverage uptick in 2016, as more states consider legislation requiring coverage for telemedicine and in-person visits alike. To date, 29 states...more

12/8/2015 / Health Information Technologies , Licensing Rules , Medicare , Popular , Reimbursements , Telehealth , Telemedicine

Top Three Reasons ACOs Should Use Telehealth and Telemedicine

Accountable Care Organizations (ACOs) can share costs of telehealth and remote patient monitoring services among their hospitals, providers/suppliers, and other ACO participants, according to federal regulations under the...more

11/3/2015 / ACOs , Alternative Payment Models (APM) , Centers for Medicare & Medicaid Services (CMS) , Fee-for-Service , Fraud and Abuse , Health Care Providers , Health Information Technologies , Healthcare , Healthcare Reform , Hospitals , Medicare , Medicare Shared Savings Program , OIG , Suppliers , Telehealth , Telemedicine , Value-Based Purchasing , Waivers

Nathaniel Lacktman

Foley & Lardner LLP

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