Telemedicine continues to emerge as a cost-effective alternative to face-to-face visits. But do payers reimburse physicians for providing these services?
The answer is increasingly ‘yes,’ but with several caveats, says Barry Herrin, attorney at Herrin Health Law, P.C. in Atlanta, Georgia. The good news is that many states have enacted telemedicine parity requiring certain payers to pay for telemedicine consultations just as they would reimburse face-to-face visits, Herrin explains. Currently 35 states have private parity laws and 8 states have pending laws awaiting approval.
The bad news is that if you dig more deeply into these laws, you quickly realize that they vary significantly from state to state. “Every state has its own set of rules,” says Herrin. “There’s no national pre-emptive telemedicine standard.”
Also, just because a parity law is in place doesn’t mean that telemedicine is covered all the time, every time, says Herrin. “Parity doesn’t always mean parity. It may be limited to a particular geography, kind of activity, type of originating site, and more,” he adds.
According to the American Telemedicine Association (ATA), thirty-five states have legislated parity for private coverage, and eight states have proposed such laws. Forty-eight states and the District of Columbia have laws requiring Medicaid coverage of telemedicine through live video, according to the Center for Connected Health Policy (CCHPA). Twenty-two states reimburse for remote patient monitoring. Many states have also enacted parity laws for state employee health plans, and Nevada even requires parity for worker’s compensation plans, says Herrin.
It can be daunting to try and determine whether payers will cover telemedicine services, and if so, whether any restrictions apply. Herrin says physicians inquiring about telemedicine parity laws should consult these resources:
- ATA’s state legislation matrix Use this matrix that was last updated July 24, 2017 as a starting point to delve into more specific research.
- CCHPA’s resource center on state laws and reimbursement policies This website provides all current and pending laws and policies, including links to source documents.
- Centers for Medicare & Medicaid telehealth services guide Published by the Medicare Learning Network, the guide helps physicians identify the correct CPT codes and other documentation requirements.
- Federation of State Medical Boards’ telemedicine policies overview This source provides important licensing-related information as well as details about state-by-state reimbursement parity.
- Medicare Telehealth Parity Act of 2015 If enacted, this law would greatly expand telemedicine coverage for Medicare beneficiaries.
- National Conference of State Legislatures’ telehealth web resources This source provides helpful information about telehealth policy trends and coverage.
- State Medicaid department For example, Georgia provides a telemedicine handbook. Colorado provides a similar telemedicine handbook.
- State medical boards Many boards issue guidance on the use of telemedicine. Consider this example from the Alaska state medical board.
As physicians review their state parity laws, consider the following questions:
- Does the law include telemedicine licensure restrictions?
- Does the law restrict where the telemedicine must occur (i.e., where the patient and physician must each be located)?
- Does the law include a formulary or list of telemedicine services that are covered?
- Do telemedicine services require prior authorization?
- What documentation pertaining to the telemedicine visit is required for payment?
Keep in mind that legal developments occur frequently, and sources can become quickly outdated and inaccurate, says Herrin. “Everyone is trying to catch up with the technology, and [reimbursement] isn’t exactly crystal clear all of the time,” he adds. That’s why it’s always best to consult an attorney before your practice decides whether it’s feasible to move forward with offering telemedicine options to patients, he says.
Join our webinar: Increase Revenue and Improve Patient Care With Kareo Telemedicine