Reimbursement.

VIPatient - Telemedicine Reimbursement

Posted: June 19, 2016.

Telemedicine has grown rapidly in recent years. Over 1,000,000 virtual visits occured in 2015*, and that number is projected to continue growing rapidly.

Reimbursement

Medicare

There are many circumstances in which telemedicine visits are covered by Medicare. Many "telehealth" services, such as remote radiology, pathology and some cardiology, are simply covered as "physician services." For traditional fee-for-service beneficiaries living in rural areas, Medicare covers physician services using videoconferencing. The ~14 million beneficiaries participating in Medicare Advantage (managed care) plans have complete flexibility in using telehealth, as long as their provider offers the service.

Medicaid

Almost every state Medicaid plan specifically covers some telehealth services, however states vary greatly in their coverage. For details on state-specific coverage, we suggest reading material from www.atawiki.org or the 50 State Telemedicine Gaps Analysis: Coverage and Reimbursement.

Private Payer

State parity laws

There are currently 29 states with telehealth parity laws that require private insurance companies to reimburse providers for care delivered via real-time telemedicine. These parity laws prevent health plans from withholding reimbursement for telehealth services based on a patient’s location. What this means is that patients can be seen from their home or office rather than a qualified originating site.

Provider Eligibility

Deciding which professionals are permitted to practice telemedicine is left up to the state medical board. The general rule however, is that any provider who would bill for an in-office visit is allowed to bill for a telemedicine consultation as well.

Reimbursement levels

The telemedicine reimbursement amount varies on state legislation. Some states specifically mandate that private payers match the telemedicine reimburseement amount with the same service provided in-person. However, most states with reimbursement mandates leave this determination up to the payers. We have found the majority of private payers still reimburse at levels equivalent to in-person visits.

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