Telehealth Reimbursement

So you want to get paid for doing telehealth?

Getting paid for seeing patients via telehealth is possible and can be profitable, but it’s going to take some commitment and see-through on your part.

In this article we’ll provide a summary of the most common telehealth payment and reimbursement options. We’ll also briefly discuss alternative revenue models and methods for getting paid for telehealth. Here’s a summary of your options (and hurdles) for getting paid:

Which payers reimburse for telehealth services?

Most payers, both public and private, cover telehealth services to a certain extent. But different payers have different rules and limitations.

Then you throw into that mix state telehealth laws and state medical board regulations, and you can see how things get complicated fast.

So let’s break this down into the three main payer groups and discuss what you can generally expect on their telemedicine reimbursement policies and what you can do about it.

So let’s start with the biggest payer type – the employer-based private payers.

What do you need to know about getting telemedicine reimbursement from private payers?

States with Parity Laws for Private Insurance Coverage for Telemedicine

Reference from: http://www.americantelemed.org/policy-page/state-policy-resource-center

The first thing we need to answer is what are telehealth parity laws?

Private payers, such as Blue Cross, Blue Shield, Aetna and Cigna (just to name a few), are not required under federal law to provide coverage for any type of telehealth service.

However, at the state level, some many states have passed laws that impact telehealth reimbursement policies of private payers. These are typically known as telehealth parity laws and apply specifically to private payers.

As you can see from the map above about 35 states have some kind of telemedicine parity law on the books. For the absolute latest, you can check out the American Telemedicine Association site.

How do telehealth parity laws work?

So what is parity? Parity just means that the payer has to reimburse for the telehealth service the same way they would reimburse for the exact same in-person service.

However, as you can see from the map above, there is a lot of variation in how “parity” has been stipulated [w.c.]. Some states mandate just some sort of reimbursement without other requirements, while others mandate reimbursement at the same level as in-person care.

Still others stipulate reimbursement only under certain conditions or even for certain services.

While these telehealth parity laws are meant to be helpful, sometimes they can have the opposite effect as seen in New York state where the state’s parity laws forced telehealth physicians to take a payment loss on telemedicine visits in many cases. You can read more about the dark side of parity laws here.

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