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How Are Physicians Reimbursed for Telemedicine

April 27th, 2019 - By Chris Ferguson

TelemedicneTelemedicine is transforming the way we treat people and looks set to define the future of medicine. This healthcare technology is creating efficiency in doctor to patient interaction and is also a highly cost-effective way of dealing with medical appointments and helping physicians treat more patients.

Not only this, but there are other advantages related to including telemedicine as part of a care delivery system. One of the biggest benefits for medical practitioners is that they can get reimbursement for using telemedicine. It is kind of an incentive on the part of the government to encourage more people to start implementing and using telemedicine. Here are some of the ways in which practitioners can be reimbursed for using telemedicine services.

 

Medicare

CMS through Medicare is encouraging the adoption of telemedicine by providing reimbursements which are similar to a face to face visit. CMS is also consistently adding more eligible CPT codes every year.  Medicare does have the following conditions attached to reimbursement –

  1. The location of the patient (called the “Originating Site”) must fall within any one if the following Health Professional Shortage Area (HPSA) –
  • Physicians or practitioner offices
  • Hospitals
  • Critical Access Hospitals (CAH)
  • Rural Health Clinics
  • Federally Qualified Health Centers
  • Hospital-based or CAH-based Renal Dialysis Centers
  • Skilled Nursing Facilities (SNF)
  • Community Mental Health Centers (CMHC)

2. The person delivering the treatment must be one of eight eligible professionals – Physicians, Nurse Practitioners, Physician Assistants, Nurse Midwives, Clinical nurse specialists, Clinical Psychologists, Clinical Social Workers, and Registered dietitians or nutrition professionals.

3. The interaction must be via audio-video and should take place in real time.

 

Medicaid

Medicaid which is a state-specific program also incentivizes for telehealth services but like Medicare, they also work within certain boundaries.  Medicaid programs in 48 states offer some form of reimbursement for telemedicine.  This program also provides greater flexibility for states to choose the type of telemedicine service provided, the type of healthcare provider and the patient location at the time of interaction. For instance, Michigan state reimburses for a variety of different telehealth services –  live video calls, education services, training programs, substance treatment, and more.

Medicaid reimbursement based on state-run specifications:

  1. Live telemedicine services ( like a video chat) are mandated by 9 states (California. Colorado, Kentucky, Maryland, Minnesota, Mississippi, Nebraska, Texas, Vermont) and District of Columbia.
  2. Some states have specification on the types of healthcare providers who can apply for reimbursements.
  3. Like Medicare, some Medicaid programs are particular about the patient location at the time of interaction/treatment called “Originating Site” (like a health clinic or so). The good news is that currently, 36 states accept a patient’s home as an intended location.

 

Commercial Payers

The third way to get reimbursed for telemedicine is through commercial payers, and this means private insurers. Now, these payers have been the most active when reimbursing for telemedicine. Commercial insurers have to abide by state laws, but they can also be more selective about their reimbursements. Since telemedicine is policy-dependent, you will have to verify whether the patient’s insurance company reimburses for telemedicine or not. There will be greater scope for negotiation when it comes to reimbursement contracts when you are dealing with commercial payers, and this is certainly an attractive prospect. 

These are the three main channels for telemedicine reimbursement.  It is essential that you familiarize yourself with the different forms of reimbursements and choose the one that best suits your settings. Make sure you understand what it takes to make the most from your telemedicine reimbursements, and understand how to overcome the obstacles involved in reimbursement. 

Click here to learn more about how you can make telemedicine a part of your practice.


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