Services

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The national Medicare Chronic Care Management Program (CCM), which went into effect January 1, 2015, reimburses for telemedicine services provided by licensed professionals to patients with two or more chronic conditions. It is the first time the national government has made an exception to the originating site rule which mandates Medicare patients must live in rural and physician shortage areas. Visit our Medicare Chronic Care Management page to learn more about incorporating it into your care delivery.

With the exceptions of services provided through the Medicare CCM program, videoconferencing is the only service that is reimbursable through Medicare. Store-and-forward technologies, such as email, will not be reimbursed by Medicare unless delivered to patients through the Medicare CCM program.

CMS currently decides to approve a submitted Current Procedural Terminology (CPT) code based on the type of service that was provided over telehealth. There are certain services for which they will reimburse and others for which they will not. Essentially, Medicare attempts to determine two things:

• If the service was accurately described by the corresponding CPT code when delivered via telehealth
• Whether the use of telemedicine to deliver telemedicine to deliver the service revealed a clinical benefit to the patient

In addition to limiting services and methods of telemedicine care delivery, Medicare has several other requirements that patients and providers must meet in order to be reimbursed through Medicare for telemedicine.

Currently, 37 states have parity laws that mandate private payer reimbursement for telemedicine. Typically, these mandates only cover real-time video conferencing, but there are few states that cover store-and-forward technology. Let's discuss how reembursementwill work for your organization to learn more about the patient and provider requirements that determine reimbursement. Additionally, the Center for Connected Health Policy provides in-depth information on legislation for both public and private healthcare programs and is a fantastic resource for those looking to dive deep into individual state policy.

Getting reimbursed for telemedicine is easy with MDVCare

CCHP’s most recent fifty-state survey of state telehealth laws and Medicaid program policies was completed in Spring 2018. The full PDF report is available, as is an interactive map of existing and pending telehealth-related policies by state. Below are some key findings:

• 49 state Medicaid programs reimburse for some form of live video
• 15 state Medicaid programs offer some reimbursement for store-and-forward, not counting states that only reimbursed for tele-radiology
• 20 state Medicaid programs offer reimbursement for remote patient monitoring
• 9 state Medicaid programs (Alaska, Hawaii, Illinois, Minnesota, Mississippi, Missouri and Washington) reimburse for all three
• 32 states will reimburse either a transmission, facility fee, or both

Only those practitioners who are allowed to provide telemedicine care as outlined in the state legislation will be reimbursed for these services.

Currently, 49 states have some form of reimbursement legislation outline in their public healthcare program. The state that contains absolutely no mention of telemedicine or telehealth in their public program is Massachusetts.

Each state’s public program determines the services that may or may not qualify as reimbursable. For example, one public program may reimburse for store-and-forward while another state’s program may only reimburse for video conferencing.

Per state telemedicine reimbursement through the public program is extremely nuanced. Programs may place patient location requirements, specifically prohibiting reimbursement for services provided to a patient who is not at an established medical site when receiving telemedicine care. They may require practitioners to document that a patient has a barrier to receiving in-person care in order to receive reimbursement for delivery of remote care.

MDVCare launches full-scale deployment of its Telemedicine platform.