Uneven telehealth coverage troubles providers

Doctor with table and smartphone

Despite telehealth’s potential to expand access to care, government and private insurers’ coverage policies still are largely inconsistent, according to Managed Care Magazine.

On the government side, Medicaid coverage of telehealth varies considerably from state to state, the article says. Yet the new Medicaid managed care regulations could be a boost to telehealth, as they suggest states consider telehealth when drawing up their network adequacy standards.

Coverage of telehealth is fairly limited in traditional Medicare, yet there, too, the federal government is in the process of liberalizing the rules. For instance, the federal government’s proposed Merit-Based Incentive Payment System would allow physicians to earn higher scores by implementing telehealth services.

While Medicare Advantage plans have leeway to provide telehealth services, only 69,000 Medicare patients used telehealth services in 2014, the article adds. The Congressional Budget Office has expressed doubt over telehealth’s savings potential.

The American Hospital Association, though, has argued that the CBO’s estimates are flawed and that new value-based payment models must lift geographic restrictions on the use of telemedicine. Indeed, uneven insurance coverage for telehealth also can make doctors who are otherwise enthusiastic about the concept wary of incorporating it into their practices, American Academy of Family Physicians President Wanda Filer tells the publication.

For private plans, the number of states with parity laws concerning telehealth coverage has doubled in the past three years, the article notes, and Blues plans in particular are expanding telehealth coverage. Independence Blue Cross, for example, announced in March that it would give health plan members access to virtual visits with their providers through a smartphone or other digital device for non-emergency medical issues.

But Ron Brooks, senior network medical director for Independence Blue Cross, tells the publication that payment for a telehealth visit isn’t equal to that of an office visit, noting that Medicare concluded that reimbursement for telehealth should be lower.

To learn more:
- read the article