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November 24, 2021 in Medical Billing, Uncategorized

5 Things to Know About Telehealth Reimbursements [Guest Post]

To make the most out of telemedicine, you must be aware of the general rules and trends governing telemedicine reimbursements.

With telemedicine on the rise, healthcare providers are looking for new ways to boost their practice revenues. The new technology allows the providers to see more patients per day, and even add evening and weekend appointments to increase the number of patients further. However, you won’t be able to boost your revenue stream until you are reimbursed for the video visits that you conduct. The question then is simple, “Will payers cover and reimburse for televisits?” But the answer is not so simple. Here are five crucial things that you must know about telehealth reimbursements:

Every state has different laws for telehealth reimbursement

The states are increasingly realizing the value of telemedicine for improving the quality of care and expanding patient access to providers. Over 38 states have passed some form of legislation that governs telehealth reimbursements. Many states also have ‘parity’ laws that equate a televisit to an in-office visit. However, what remains imperative to note is that each state has a different set of laws that govern telehealth.

Every state has a different Medicaid plan

Every state is responsible for administering its own Medicaid programs. This means that telehealth coverage for Medicaid patients also varies across states. Interestingly, there is an increasing trend toward covering telemedicine. Hence, providers must be mindful of these variations in Medicaid plans as well as the changing landscape regarding eligibility verification.

Some insurers offer telehealth reimbursement even when they don’t have to

It often happens that the insurers reimburse you for your services even if they are not mandated by law. Are you wondering why this is so? Well, because they’ve come to realize that telehealth significantly improves patient outcomes and reduces hospital readmissions to improve patient outcomes eventually. Hence, they are happy to pay out claims for televisits. For instance, UnitedHealthCare happily pays out claims for video visits across the country to more than 21 million members on various plans.

Make sure your telemedicine solution validates eligibility and guarantees reimbursement

We have already discussed that every state has a different set of laws about telehealth reimbursements. Hence, it can be a challenge for the providers to determine which patients are eligible for reimbursement for telehealth and which patients must be seen in-person. Foreseeing this, most modern telemedicine platforms have built-in rules engine and eligibility verification algorithms to verify patients’ eligibility. So, when the provider conducts a televisit, the system automatically digs out the necessary patient information from the EMR for Small Practice to check his eligibility. Moreover, the best telemedicine solutions also offer a reimbursement guarantee. The telemedicine vendor then works on your behalf with the payer in case a claim is denied.

Medicare is complicated

Medicare generally only covers video visits under a spoke-and-hub model. This means that the patient needs to see the provider over a designated healthcare site, such as the physician’s office or hospital. Here the provider will then initiate a remote visit with a provider at another location. Although this arrangement is excellent for care coordination, it’s not ideally flexible and has geographical limitations. However, there are exceptions to this model. For instance, the Medicare Chronic Care Management Program is a national policy that eliminates the originating site restrictions for telemedicine. This then offers better monthly care to patients with two or more chronic conditions through televisits. Patients can potentially be located anywhere and still be able to receive services from any facility. This further creates an opportunity for providers to generate additional revenue and offer enhanced care to patients with multiple chronic conditions.

Hence, to make the most out of telemedicine, you must be aware of the general rules and trends governing telemedicine reimbursements. The benefits accruing from telemedicine for the providers, patients, payers, and the overall healthcare systems are way too large to be disregarded.

Author BIO:

Summer Larson background in healthcare stretches over 11 years. He is a well-renowned health IT expert and contributes regularly to popular blogs and websites. Summer covers topics ranging from health reforms to the application of IT in healthcare. In 2013 he formed EMR Specialist, a company specializing in assisting providers with the adoption and implementation of electronic health records (EHR) and working with EHR vendors on usability and certification projects. Summer Larson is also an avid Star Wars fan.


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