Telemedicine: A Guide to Public and Private Reimbursement

The public appetite for telehealth is large and growing. A recent study by The Alliance for Connected Care found that 64% of consumers said they would be willing to have a video visit with their doctor. Research further proves that telehealth is as effective and significantly less costly than in-office care. With these factors in place, you would think that practices would be jumping over themselves to implement telehealth programs, but adoption has been slower than one might expect. (Watch this webinar to see how medical practices can benefit from telehealth and how to get started: How Telehealth Helps Improve Care Delivery and Increase Revenue) 

One of the reasons that some practices have put off offering video visits is lack of clarity about how practices are reimbursed for telehealth. It is, no doubt, a complex picture, but it is possible to get paid for remote encounters. Smart practices have the knowledge and tools in place to boost profits. In addition, public and private payers are beginning to appreciate the cost reduction possibilities of telehealth and increasing the circumstances under which video visits get paid.

Medicare

More than 49 million Americans rely on Medicare for their healthcare, and a recent bill signed into law has significantly loosened the restrictions on telehealth reimbursements by Medicare.

According to this summary provided by mHealthIntelligence, the  new law:

• Eliminates geographic restrictions on telestroke consultation services, beginning in 2019.
• Expands telehealth coverage under Medicare Advantage Plan B, beginning in 2020.
• Gives ACOs more flexibility to use telehealth services.
• Adds the patient’s home freestanding dialysis facilities, without geographic restriction, to the list of originating sites for monthly telehealth assessments with a nephrologist, beginning in 2019, though Medicare would not provide a separate originating site payment if the service was conducted at home.
• Extends for two years the Centers for Medicare & Medicaid Services’ Independence at Home demonstration, which establishes home-based primary care teams for Medicare beneficiaries with multiple chronic conditions, and increase the cap on the total number of participating beneficiaries from 10,000 to 15,000.

Technology: Medicare has a fairly broad definition of the technologies that constitute telehealth. Its definition included, “interactions between a healthcare professional and a patient via real-time audio-video technology.

Provider Type: The range of providers eligible for reimbursement under Medicare is broad and includes physicians, psychologists, dietitians, nurse practitioners, social workers and others.

For practices that have put off delivering care via telehealth to Medicare patients, now is the time to take another look, especially for Medicare Advantage patients. Commercial payers have been forerunners in recognizing the advantages of telehealth and adding it as a supplemental benefit. But Medicare is catching up.

Medicaid

As you might guess, the policies and practices governing Medicaid reimbursement for video visits vary widely from state to state. However, 48 states and the District of Columbia have some type of coverage for telehealth. Many go much further than Medicare in terms of expanding the use of remote clinical encounters. For example, 25 states recognize the home as a qualifying originating site, others do not make any requirements regarding the patient setting. Each state makes its own rules about the type of technology that can be considered telehealth, but in this case, some even recognize technologies like store-and-forward that are not accepted by Medicare. Provider type is likewise variable, but only four states restrict reimbursement to physicians.

Private Payers

Private insurers have been quite progressive when it comes to paying for telehealth visits. They recognize the importance that telehealth will play in meeting the healthcare needs of a growing, aging, and sicker population. They also realize that telehealth is an extremely cost-effective channel for healthcare delivery.

In addition to insurers acting voluntarily to cover telehealth, 30 states and DC have enacted laws that require commercial payers to provide coverage for video visits that is on par with in-office coverage. More are expected to do so soon. Providers should be familiar with the laws of their state and understand any rules regarding reimbursement.

Eligibility Verification

Given the complex landscape of provider reimbursement for telehealth, the best bet for practices is to invest in a telehealth platform that has eligibility verification built in. When a video appointment is scheduled, the solution automatically verifies that the patient is covered for telehealth. That way, coverage is never an issue. The best solutions even offer a guarantee that payment will be received, or they work with the payer to get you paid.

The use of telehealth will continue to expand as more patients begin to insist on providers who offer it. The good news is that reimbursement policies both on the government and private sides are becoming more telehealth friendly and there are many opportunities to earn revenue from video visits today. Smart practices will take advantage of this trend to offer better service to patients, increase provider flexibility, and boost the bottom line.

Now is the time to find the right telehealth solution for independent practices. Join our webinar to learn about the benefits to revenue, efficiency and patient care!

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_{This updated article first appeared on Chironhealth.com}