124 in january 2016 cms un veiled this new aco model

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124 In January 2016, CMS un- veiled this new ACO model, which allows provider groups to take greater 120 See Perry Payne, What Physicians Need to Know About Medicare’s New Telemedicine Reimbursement Rules , I M EDICAL A PPS (Jan. 14, 2015), physicians-medicare-telemedicine-reimbursement/ [] (providing the new service codes for psychotherapy, prolonged services, and for annual wellness visits). CPT and HCPCS codes are used to report health care services to payers for reimbursement. See F URROW ET AL ., supra note 85, at 447. 121 Chronic Care Management Services , C TRS . FOR M EDICARE & M EDICAID S ERVS . (May 2015), Products/Downloads/ChronicCareManagement.pdf []. In order for providers to use the code, the Medicare patient must have multiple chronic conditions expected to last at least one year or until the patient dies, and the patient’s condition must lead to significant risk of health deterioration or death. Id. A physician can use the code to “receive as much as $42.60 per patient per month for 20 minutes of contact.” Eric Wicklund, Doctors Struggle to Find Value in Telehealth , M H EALTH I NTELLIGENCE (Jan. 22, 2016), news/doctors-struggle-to-find-value-in-telehealth [] (explaining that despite the additional code, providers are not necessarily using it because the code is very limited and the guidelines are confusing). Physicians are also deterred by the simple fact that tracking each mi- nute for specific conversations on chronic care takes a lot of additional effort. Eric Wicklund, Why Are Doctors Skipping Chronic Care Reimbursement? , M H EALTH N EWS (Sept. 4, 2015), . mhealthnews.com/news/why-are-doctors-skipping-chronic-care-reimbursement?single-page=true []. 122 See Bresnick, supra note 77. 123 See id. ; Chronic Care Management Services , supra note 121. 124 See Next Generation ACO Model , C TRS . FOR M EDICARE & M EDICAID S ERVS ., https:// innovation.cms.gov/initiatives/Next-Generation-ACO-Model/ [] (last visited Jan. 30, 2016). ACOs are patient-centered organizations consisting of groups of doctors, hospitals, and other health care providers, which aim to improve quality of care while reducing costs. Id. The Next Generation ACO model is designed for ACOs already experienced in care coordination through other ACOs like the current Pioneer Model and Shared Savings Program. Id.
2016] Limited Medicare Coverage Hinders Telemedicine 1837 financial risks and share in potentially more savings. 125 The Next Generation ACOs are also provided waivers for some of the Medicare restrictions on tel- emedicine. 126 The Telehealth Rule Waiver eliminates Medicare reimburse- ment restrictions such as the originating site requirement and the rural Short- age Area requirement.

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