We see a lot of movement toward a more standard and accepting approach to telemedicine reimbursement. But right now there is a patchwork of policies that makes figuring out if you can get paid for video visits quite a challenge. If you choose the right telemedicine software, you don’t have to become a reimbursement expert, but it helps to know the basics.
State Parity Laws
As of this writing, 26 states have laws that require private insurers to reimburse healthcare providers for services delivered via telemedicine. Ten more states have pending or proposed laws to do the same. In most cases, these laws restrict private plans from considering the patient’s location when making a reimbursement decision. This makes it so patients can conduct their video visit from their home or office, setting private payers apart from Medicare.
Eligible Technologies and Providers
Real-time video conferencing is an acceptable form of telemedicine in all states with parity laws. A few also cover store-and-forward telemedicine. In general, any provider that can bill for an in-person visit can be reimbursed for a remote visit. However, each state medical board determines which professionals it covers under the parity law.
The amount of reimbursement also varies by state. Some laws specifically require that insurers pay the same amount for video visits as they do for in-person ones. Others leave it up to the provider. The good news is that most private payers choose to reimburse at the same level as an in-person visit. In fact, some providers reimburse for telemedicine even in states that don’t require them to do so.
A Few Exceptions
Many states have excepted some types of insurance plans from their telehealth reimbursement mandates. Small group plans and worker’s compensation plans may have the choice to opt out of telemedicine coverage.
Although getting paid for video visits isn’t exactly as straightforward as one might hope, there are a couple of pieces of good news for providers who want to increase revenue and flexibility by introducing remote visits to their practice.
First, everything is trending in the right direction. State legislators and insurance companies alike recognize the advantages of telehealth for individual patients and the healthcare system at large.
Next, we are telemedicine reimbursement experts, so you don’t have to be. We’ve built the best rules engine on the market for determining if a patient is eligible for video visit reimbursement. We’re so confident in our solution that we even guarantee payment.
Don’t let concerns about the complexity of private payer reimbursement for telemedicine keep you from exploring the benefits it could bring to your practice.