Reimbursement for Telehealth
The primary hurdle for the expansion of telehealth is reimbursement levels for care provided. Many healthcare organizations say that limits on reimbursement constrict their ability to expand telehealth services for patients. Medicare and Medicaid offer different degrees of flexibility, while private payers also represent varying levels of funding.
Medicare only pays if the originating site (service location of the patient) is either in a non-Metropolitan Statistical Area (MSA) or a Health Professional Shortage Area (HPSA), limiting the types of providers and facilities that can provide telehealth services.
Medicaid systems in 48 states (as of this writing) reimburses telehealthcare if it’s provided via live video systems while 19 state Medicaid programs will pay for RPM. Twelve state programs finance store-and-forward telehealth and seven states allow payment for all three telehealth categories. Rules governing payment through state Medicaid programs vary considerably, however.
For example, care through telehealth must satisfy federal requirements of efficiency, economy, and quality of care; however, states can offer flexibility to create innovative payment methodologies for services that incorporate telemedicine technology.
States may reimburse a physician or other licensed practitioner at the distant site and refund a facility fee to the originating site. States also can reimburse any additional costs, including technical support, transmission charges and equipment, and add-on costs included in the fee-for-service rates or separately reimbursed as an administrative cost by the state.
Also, there is no federal mandate requiring private payers to reimburse for telehealth services. Some states have or are creating parity laws, which compel payers to cover the same types of services provided through telehealth as that provided face-to-face. They also require payers to reimburse telehealth services at the same payment rate as in-clinic services.