Telemedicine Reimbursement – The Time is Now!

June 4, 2012, by Adam Kaiser in Healthcare, Video Conferencing

Health care organizations throughout the world continue to implement telemedicine solutions at a growing rate to help extend the reach of health care. The benefits are enormous, for both the patient and the health care provider:

  1. No matter where a patient is located, they can gain access to the specialists they need to diagnose and treat their ailments.
  2. A health care provider can check in with patients remotely, helping to reduce costly re-admissions.
  3. In an emergency setting, a patient’s specialized needs can be responded to in a quicker, more efficient manner.

While the list of benefits is extensive; a major challenge of telemedicine is the economics behind it. Health care organizations have been able to offer telemedicine-based consults to patients for some time; however, the business of health care has not kept up.

Insurance organizations (including Medicare and Medicaid) did not offer parity for these visits versus a real-life encounter. Providers would find themselves being denied reimbursement for the telemedicine services that they had provided.

But as with many other technologies, the bureaucracy is catching up. Over the last several years there has been a shift throughout the US and “reimbursement equity” is now being offered for telemedicine consultations. Most recently, Maryland and Pennsylvania have joined the list of states signing such legislation into law. Maryland’s law is simple: Insurance companies must pay the same fee for telemedicine services that would otherwise be covered with an in-person visit.

State laws regarding telemedicine reimbursement differ. Currently, there are fourteen states with some form of reimbursement equity: California, Colorado, Georgia, Hawaii, Kentucky, Louisiana, Maine, Maryland, New Hampshire, Oklahoma, Oregon, Pennsylvania, Texas, and Virginia.

Medicare has its own policy as well. Generally, the reimbursement is on par with the same service when it is provided face-to-face. There are some limitations that include the location of the facility, eligible medical services, and the eligibility of providers and facilities.  To read specific rules relating to Medicare, click here.

Telemedicine reimbursement is a complex issue, but one clear trend is emerging: it is moving into the mainstream. With so many states already moving towards parity, it is only a matter of time before more follow. The result of this will be continued growth of telemedicine practices and patients gaining more access to the affordable, specialized healthcare they need.

Additional Resources:
Telemedicine Solutions Overview
Extend the Reach of Healthcare with Telehealth

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Sound Masking Your Way to Medicare Reimbursement
Baltimore Business Journal – Maryland law may spur video Dr. ‘visits’
Pennsylvania Governor Corbett Improves Access to Quality Health Care through Telemedicine Initiative

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