Reimbursement Challenges
The 41 states that have passed laws aimed at improving the provision of telemedicine services have also sought to increase reimbursement for such services. Parity laws account for most of these reforms, which require both private payers and government payers providing Medicaid services to cover or reimburse telemedicine services at the same rate for the same services that would be provided in person to a patient in an office setting. Coverage rates still vary by policy, as do the covered telemedicine services under each state’s insurance laws and Medicaid regulations.
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May 2020Currently, 36 states and Washington, D.C., have existing laws that require private insurance companies to cover patients’ telemedicine services at equivalent rates to appointments held in person at physician offices, hospitals, or other clinical locations. Sixteen states also have parity laws that require that providers be reimbursed for telemedicine services at rates equivalent to services provided in person. Thirteen states have not adopted parity policies, but telemedicine is nonetheless covered to some degree by primary health insurance companies, including Aetna, Blue Cross Blue Shield, Cigna, Humana, and UnitedHealthcare.
Reimbursement for Medicaid-covered services, including those with telemedicine applications, must satisfy federal requirements for efficiency, economy, and quality of care. Medicaid covers some forms of telemedicine service in every state and offers coverage and reimbursement parity in the majority of states. (However, many states, such as Ohio, do not consider telephone services to be a reimbursable medium for the provision of telemedicine.)
Since 2018, the CMS has increased the telehealth services that are eligible for provider reimbursement beyond traditional consultation or inpatient and outpatient visits to include preventive services, education and counseling sessions, and even care management or virtual check-ins.
Like Medicare, Medicaid in some states has an originating site requirement, and 12 states actually consider a patient’s home to be an originating site for payment purposes. Nineteen states have not yet adopted Medicaid parity policies, so changes to the regulations in those states are anticipated at some point.
Is Telemedicine Right for You?
Consider the ways in which using telemedicine may benefit your practice. Many physicians in different practice areas have acknowledged the benefits of physician collaboration for consultation and second opinions; other providers have confirmed significant cost savings by seeing patients remotely and having the ability to reduce overhead costs. Moreover, telemedicine provides a way to expand your patient population to reach those individuals outside a saturated service area or to add new patients, while efficiently using available time that would not be possible with in-person patient visits.
The caveat remains—knowing the nuances of state and federal laws is critical to avoid potential malpractice lawsuits, HIPAA or privacy breaches, or fraud and abuse violations, among other things. Review the points below before implementing telemedicine in your practice.