Healthcare Revenue Cycle Management, ICD-10, Claims Reimbursement, Medicare, Medicaid

Policy & Regulation News

Telehealth Reimbursement Needed for its Growth, Advancement

By Jacqueline DiChiara

- An increasingly digitalized healthcare system has experienced significant telehealth reimbursement changes — even within the past five years — as it becomes more routinely integrated.

The snowballing demand for telehealth solutions is becoming evident as the most valuable healthcare professionals now require a certain tech savviness. As the influence of telehealth continues to grow, more physicians and nurses are merely a tap away from an operating room thousands of miles away.

Last September, multiple American Telemedicine Association reports found some states in opposition to telemedicine as a result of limited coverage and reimbursement as well as physician practice standards and licensure.

“One disappointing observation includes the lack of coverage and reimbursement for telemedicine under state employee health plans,” as the ATA State Telemedicine Gaps Analysis Report stated. “Eighty-two percent of the country is ranked the lowest with failing scores including Arkansas which will only cover the use of store-and forward for diabetic retinopathy screening, and Nebraska which requires their plans to cover autism treatment via telemedicine.”

Disparities in coverage were also reported. According to the same report, the most covered services were for mental and behavioral health, mental health assessments, individual therapy, psychiatric diagnostic interview exams, and medical management.

According to ATA CEO Jonathan Linkous these findings “serve as a wake-up call to those who are failing to extend quality and affordable care to the residents of their state.” And they are signs that additional work is necessary.

“We hope that states will respond by streamlining policies to improve medical practice rules, licensure, healthcare quality, and reduce costs through accelerated telemedicine adoption,” Linkous explained in an interview with mHealthIntelligence.com.

That is not to say that improvements have not occurred.

“There is more reimbursement for fee-for-services,” Linkous revealed. “We are moving into more broad care where the payment systems are such that you don’t need to justify each and every time you use a telecommunication device, which makes it a lot easier to use those services.”

For Linkous, the demand for telehealth is increasingly widespread and far reaching, especially among those with influence in the industry or those who were slow to integrate it.

“It is being accepted, not only by the healthcare profession and healthcare, but it is going into the C-Suite where the CEOs are actually asking for it and the payers are starting to really reimburse,” he said. “Also the medical societies that used to be an opponent to telemedicine are now embracing it.”

Telehealth’s future is unknown yet great

When it comes to telehealth reimbursement, Medicare has some needed catching up to do, which might take extended time. “Medicare pays for a limited number of Part B services furnished by a physician or practitioner to an eligible beneficiary via a telecommunications system. For eligible telehealth services, the use of a telecommunications system substitutes for an in-person encounter,” according to the Centers for Medicare & Medicaid Services (CMS).

“Medicare is the slowest to adopt the use of this technology, so it is going to be a few years for them to really come in line to do everything they should,” Linkous maintained. “There is some reimbursement now through Medicare and as we move through other kinds of payment mechanisms — the payment for quality rather than quantity — and when those take hold it is going to accelerate it, but we have to move faster than that pace.”

Looking to the future, the ATA foresees vast opportunity for telehealth adoption so long as legislation continues to promote its integration into healthcare.

“There are a number of bills — in particular in Congress which the House introduced — which we have been working with to develop some of the language,” Linkous revealed. “I don’t know if it will all get passed this year, but the fact that it has very broad, bipartisan support and is endorsed by the leadership, is a sign of where we are going.”

All in all, there is good hope that telehealth will play an important role in the transition from fee-for-service to value-based reimbursement.

“We are still in the beginnings of it, but clearly the tidal wave is coming,” Linkous said. “Teamed with that on the state level, the fact that we have some 40 states that are moving in the direction of putting legislation through the state governors’ offices that mandate private payer insurance or expanding Medicaid reimbursement or other types of incentives.”

 

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