Washington, DC (April 8, 2020) —In a letter sent this afternoon to Seema Verna, Administrator, Centers for Medicare and Medicaid Services, ACP and over 30 Leading Medical Organizations request that CMS take additional emergency actions to further enable physicians on the front lines to provide necessary care to their patients during the COVID-19 pandemic.
The letter urges CMS to take actions on the following items:
- Provide payment parity between telephone evaluation and management (E/M) codes (99441-99443) and office visit E/M codes.
- Immediately provide guidance to Medicare Administrative Contractors (MACs) to ensure that recent CMS guidance and rules are followed appropriately to enable the payment of telephone E/M claims.
Pay Parity for Telephone E/M Claims
During this time of national emergency, patients are foregoing visits with their doctor all-together or speaking to their physician via telephone audio only. Recently, CMS began paying for these telephone visits, however, the rates for audio-only phone calls are considerably lower than that for office visit E/M codes. This creates a significant financial hardship for practices using these audio-only calls at a time when they are already struggling to stay afloat. Such a payment disparity disproportionally affects physicians and practices taking care of older adults and underserved patients. Many of these patients are managing multiple chronic conditions, do not have smartphones, or may have a smartphone, but do not know how to use FaceTime or Skype. Therefore, it is critically important that these audio-only telephone services be paid at the same level as in-person visits.
Guidance to MACs on Telephone Visits
The letter further urges CMS to provide guidance/instructions to MACs as soon as possible to enable them to transmit reimbursement for these claims now that they are billable under Medicare. We also urge CMS to include within this guidance, instruction to MACs to remedy telephone E/M claims that have been rejected so far. It is critically important that physician practices not have interruptions in reimbursement of claims during this pandemic so that they can move swiftly to care for patients.
“While ACP applauds recent steps taken to provide regulatory relief for physicians, more is needed to help physicians deliver the critical care patients need during this public health emergency and to help physicians weather the financial hardships many are facing due to loss of revenue,” said Robert McLean, MD, MACP, president, ACP in the letter to the CMS. “Now, more than ever, physicians need to be able to facilitate and be paid appropriately for both telehealth and telephone only visits.”
ACP and the other organizations hope to work with CMS to build on efforts to support the nation’s frontline physicians.
Contact: Jackie Blaser, (202) 261-4572, firstname.lastname@example.org
About the American College of Physicians
The American College of Physicians is the largest medical specialty organization in the United States with members in more than 145 countries worldwide. ACP membership includes 159,000 internal medicine physicians (internists), related subspecialists, and medical students. Internal medicine physicians are specialists who apply scientific knowledge and clinical expertise to the diagnosis, treatment, and compassionate care of adults across the spectrum from health to complex illness. Follow ACP on Twitter, Facebook, and Instagram.