The landscape of telehealth is rapidly changing. As more and more data is collected on the efficacy of telehealth, patients’ willingness to use the technology and the savings it presents to our healthcare system, more and more legislation is being passed in support of telehealth practices. With this rapidly evolving field, providers should feel positive about adopting telehealth into their practice.
Getting reimbursed for telehealth services varies by state and by payer. The ever changing landscape makes it an exciting time for telehealth providers, but it can also be confusing to navigate.
About 15% of Americans are enrolled in Medicare, making it an important player in the evolution of reimbursement for telehealth services. There are a number of factors that dictate fee-for-service reimbursement through Medicare. The two biggest factors dictating reimbursement include the patient setting and geographical location. Medicare requires the originating site (where the patient is located) to be a covered clinical setting (e.g., hospital, physician’s office and other).
Additionally, the patient must be in a HPSA (Health Professional Shortage Area). To see what areas qualify as a HPSA, use the CMS search tool.
Though reimbursement for telehealth services is limited due to “originating site” restrictions, it is worth noting that many of those enrolled in Medicare Advantage are currently covered for telehealth services, regardless of location.
Each state determines how it will reimburse for telehealth services under Medicaid, so terms can vary greatly from state to state. Currently, 49 states and the D.C. offer some type of telehealth coverage. Each state has slightly different policies. You can look up your state’s coverage terms on this interactive map. Medicaid expands the definition of originating site and includes the patient’s home in about 25 different states. New polices are being adopted at a rapid pace to expand Medicaid’s coverage for telehealthservices. Consult your state’s Medicaid website for more information.
It is promising to see so many private insurance companies reimbursing for telehealth services. These companies rarely do anything that is not proven cost-effective, so this paves a bright future for telehealth services. Currently, 29 states have parity laws in place, which specify that providers must be reimbursed for telehealth services at the same rate as in-person services. Many of the big insurance companies, such as BCBS, Aetna and UnitedHealthcare cover telehealth services under many of their policies.
There are positive indicators that telehealth is being more broadly adopted across all the payer types. As advocates work with legislators to highlight the lower cost and improved care that telehealth provides patients, providers should see positive changes implemented that will affect their practice.