Practice Management News

Telehealth Reimbursement Complications Paint a Vague Future

By Jacqueline DiChiara

- Despite its overwhelming benefits for improved patient quality of life, reimbursement complication is a major negative aspect regarding teleheath’s evolving legislation limitations.

Fluctuating definitions regarding location may affect expected telecare reimbursement

The grim reality is that telehealth costs are not always reimbursed. This is  an ongoing problem for medical specialists located in rural areas — or areas redefined as such.

Medicare offers reimbursements when the practicing site is classified as a traditional medical facility. This includes practitioners’ offices and hospital/rural health clinics where the patient is located within a Health Professional Shortage Area (HPSA), as HRSA states.

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  • Fluctuating locale definitions foster confusion. Patients spanning 97 counties lost access to Medicare’s telehealth services in 2013 when their areas were newly categorized from rural to “metropolitan.”

    Reimbursements are also not offered for home visits. And, Medicare pays for face-to-face interactive video consultation services in cases where a face-to-face interaction is mimicked.

    Organizations are in disagreement about mHealth’s revenue potential

    “The lack of an overall telehealth reimbursement policy reflects the multiplicity of payment sources and policies within the current United States health care system,” the Center for Telehealth and e-health Law reports.

    Although there is no single universally utilized standard for private payers in effect, several states — namely New York, Idaho, and Oregon.—are in the midst of passing bills regarding reimbursement, some in the process of active amendment. Most of the financing and reimbursement is sourced via Medicare in relation to the Balanced Budget Act of 1997.

    Vaguely presented Medicare reimbursement definitions

    Earlier this month, EHRIntelligence reported 20% of US participants believe mobile technology has no potential for a healthcare provider to efficiently generate revenue.

    “Under the current fee-for-service model, which still provides the majority of revenue for most healthcare organizations, keeping patients healthy and out of the hospital is simply bad business,” as was reported.

    Medicare narrowly defines what specific services and technologies are tangibly reimbursed.

    Not included are store-and-forward technology in addition to a list of common treatment options.

    “In 2015, only 75 individual service codes out of more than 10,000 physician services covered through the Medicare physician fee schedule are approved for payment when delivered via telehealth. This constrained list stands in stark contrast to the private payers operating in telehealth parity states,” says AHA Executive President Rick Pollack in a January report on teleheath’s potential.

    Fiancial gain of telehealth legislation and the informed, involved patient

    The tangible connection between mHealth improved cost structures is a potential reality. Many executive leaders advocate for mHealth fostering strengthened patient engagement.

    50 percent of surveyed executives anticipate the mHealth infrastructure will overcome revenue hindrances to eventually decrease costs and, in turn, further beneficially support patient contact within the healthcare continuum.