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CMS Loosens Restrictions on Telehealth for Certain Shared-Risk ACOs

Published Thursday, February 13, 2020

Author: Eric Wicklund

 - Accountable Care Organizations who are at risk of owing money back to Medicare because they haven’t met spending targets on shared-risk beneficiaries now have more freedom to use telehealth.

Under a guidance document released last month by the Centers for Medicare & Medicaid Services, ACOs participating in a Medicare Shared Savings Program that is under two-sided risk and who have selected prospective payment can remove geographic limitations normally applied to fee-for-service plans and allow beneficiaries to receive certain telehealth services at home.

“CMS allows clinicians in applicable ACOs to begin providing and receiving payment for covered telehealth services to prospectively assigned beneficiaries without geographic restriction, including, for many services, where the originating site is the and in beneficiary’s home,” the agency said in a fact sheet on the new rules, which took effect on January 1. “There is no special application or approval process for applicable ACOs or their ACO participants or ACO providers/suppliers. Clinicians in applicable ACOs can provide these covered telehealth services and bill Medicare according to existing telehealth billing rules.”