Telehealth reimbursement growth a slow process

Despite progress in obtaining reimbursement for telehealth services from private payers, change is coming slowly, according to a study published this month in Telemedicine and e-Health.

For the study, the American Telemedicine Association conducted an online poll in 2012 of its members and others about their experiences with reimbursement for telehealth services.

Among the findings:

  • Private payers take their cues from the government, suggesting that friendlier federal and state policies on reimbursement could lead to more accommodating policies among private payers, as well
  • Administrative rules treat telehealth differently than in-person care, which can be a barrier to providing care remotely and to reimbursement; those differences include preauthorization, use of code modifiers and more denials than for in-person care
  • Providers need more education on the billing and coding processes for telehealth services--the billing codes used vary considerably--and how to advocate for telehealth services reimbursement

States have been enacting "parity" laws requiring equal reimbursement for telehealth services that mirror in-person services. Yet services still fall under a patchwork of state laws on not only reimbursement, but also licensure and standards of care.

Eighty-one percent of respondents said they were getting paid when they billed for telehealth services, though respondents listed various reasons for not billing. The authors couldn't say why 19 percent were not being paid--whether it was due to providing the service through telehealth or that the service itself was not covered.

Only 9 percent said telehealth reimbursement took longer than for in-person care, while 40 percent said the time was the same and 51 percent didn't know.

Forty-eight percent said they did not provide telemedicine services because they were not reimbursed, while 55 percent continued to provide services even without being paid.

The ATA argued that the Federation of State Medical Boards' model policy for states set the bar higher for telehealth than for in-person care.

To learn more:
- read the research

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