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Telemedicine Reimbursement: What You Need to Know

telemedicine reimbursementIn today’s interconnected, web enabled world, it is simply no longer necessary for two people to be in the same room to have a meaningful interaction. The opportunity to use video technology to take some of the friction out of healthcare delivery is enormous. When used for follow up appointments or chronic illness management, video visits can save patients time and money. Plus, make them more likely to stay on track with follow-up care. But what about the provider? Can healthcare professionals be compensated for these types of visits? In a quickly growing number of states, the answer is yes. Below are the high level details of what you need to know to get reimbursed for video visits in your practice.

Private Payer Reimbursement Varies by State

At present, 26 states and the District of Columbia have parity laws that mandate private payer telemedicine reimbursement. Ten more have similar laws that are proposed or pending. While the laws vary, all states with parity laws mandate telemedicine reimbursement for real-time video visits. A few also cover the store-and-forward approach. Look for the term “real-time” to determine if store-and-forward is excluded.

Insurance Industry is Onboard

Insurers are embracing telehealth as a way to expand access, increase convenience for patients and reduce costs. In addition to improving health outcomes by making follow-up care easier for patients, it also reduces the number of patients in waiting rooms, where contagious illnesses can spread. Healthier and happier customers are good news for insurers.

Reimbursement Levels

State laws vary in terms of required telemedicine reimbursement. Most states let the payers make this decision, but we have found that the majority reimburse at levels equivalent to in-person visits. A typical telehealth visit falls under the 99213 or 99214 billing code and is reimbursed in the $70-$100 range.

Patient Location

Unlike the requirement for most Medicare and Medicaid patients, private insurers, and the state laws governing them, generally do not require that the patient be located at a designated “originating site.” This means that patients can connect from home, the office, or virtually anywhere and they do not need to have a healthcare professional at their location.

Medicare and Medicaid

For now, in most cases Medicare and Medicaid uses a spoke and hub model of telehealth delivery, requiring that the patient report to a designated location where a health professional is with them. This is useful primarily for consultations with specialist rather than routine follow-up care. For this reason, most practices are focusing their telehealth efforts on privately insured patients. There is a notable exception, however. Providers who treat Medicare patients with two chronic conditions via video visits can be reimbursed through the new Chronic Care Management (CCM) program.

Concerns about reimbursement need not stop practices from taking advantage of the opportunity to leverage telehealth in providing services to patients. At Chiron health we leverage our technology and subject matter expertise to make sure that providers are able to provide excellent remote care and get the compensation they are due. Let us know if you’d like to learn more about how to get reimbursed for telemedicine.