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Regulation & Reimbursement Report
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What are the requirements for Medicare to reimburse for telemedicine?
Medicare is one of the largest providers of health insurance in the country, and many people rely on it to be able to afford medical services in a variety of specialties. They also have a very complicated reimbursement process, with very specific requirements for when they will cover services delivered through telehealth. View our resource page at the link below, with information taken from the Telehealth Resource Center’s informational booklet on the subject.
Medicare Telehealth Reimbursement Resource Page
Is where my patient is located eligible for Medicare telehealth payment? Is it considered “rural” or a Healthcare Professional Shortage Area by Medicare?
The Center for Medicare and Medicaid Services only covers telehealth services when the service beneficiary is located in specific geographic areas. The CMS resource booklet defines that type of area as: “a county outside of a Metropolitan Statistical Area (MSA); OR a rural Health Professional Shortage Area (HPSA) located in a rural census tract”. The Health Resources and Services Administration provides two tools to assist providers in determining if their chosen originating site lies within one of those areas for the purpose of reimbursing telehealth services.
What specific types of telehealth services will Medicare pay for?
Every year, CMS publishes a list of CPT & HCPCS codes that they will accept on claims for reimbursement of telehealth services. They also accept requests for the consideration of two types of new codes to be added to that list for the next year: Category 1, which include services that are similar to items that are currently on the list of telehealth-acceptable codes; and Category 2, which are services that are not similar to the current list of telehealth-acceptable codes. The list of codes from the current year and previous year is available on the CMS website.
What are the current and pending legislations in my state and federally that pertain to telehealth?
Each year there are more and more laws passed and regulations approved that advance the accessibility and practicality of using telemedicine in everyday medical practices. The Center for Connected Health Policy has an interactive map and searchable tracker designed to help you easily look up and access the current and pending legislation and regulations in any state that pertain to all aspects of telehealth.
Does my state have a law that requires private payers to reimburse telemedicine services the same as in-person services?
While there are many ways to get paid for offering medical services via telehealth, perhaps the most common and desired one is through a patient’s individual insurance plan. These private payers are regulated by state laws that tell those companies the minimum they are required to cover in terms of services. Each state, however, has the ability to write these laws as they see fit. These are called “parity” laws, where the states require private payers offering commercial plans in their state to cover or reimburse for telemedicine services the same as they would for the same service delivered via in-person or face-to-face delivery, with a wide spectrum of conditions and caveats. To see whether your state has enacted parity legislation, see our map at the link below, taken from the American Telehealth Association website.
What is the Medicaid telemedicine policy in my state?
Getting reimbursed for telehealth services through Medicaid is tricky, as each state has its own law governing what is covered and how it’s reimbursed. On top of that, every year there is more and more legislation passed at the state level affecting telehealth and Medicaid policy. Stay on top of the most current information by reading the Center for Connected Health Policy’s 50-state Medicaid Policy Scan. They have also presented the included information in an easy-to-read Infograph and Fact Sheet.
How do the coding procedures for telehealth differ when submitting bills to payers for telemedicine services?
What is the licensing policy for practicing telemedicine through the Medical Board in my state?
Practicing medicine in any capacity requires being up-to-date on the latest licensing policies in the state where you are located, and telemedicine is no exception. Licensing requirements and guidelines are regulated by state Medical Boards. The Federation of State Medical Boards keeps track of the regulations in each state, and has a helpful 50-State Telemedicine Policies overview as a quick-reference resource for physicians who may be asking this question.
Is my state a part of the Interstate Medical Licensure Compact?
One of the biggest benefits of telemedicine technology is the ability to provide medical services to anyone, anywhere. This is also one of the greatest barriers to physicians wishing to extend their practice across state lines – most reimbursement laws and rules require the physician to be licensed in the state where their patient is located. To address this obstacle, many states have opted to enter into an agreement with other participating states to create a common language and a standard of regulations in order to have one medical license that is valid in any of the participating states. This is now called the Interstate Medical Licensure Compact, and during each legislative session, more and more states are enacting legislation to join this agreement. To see if your state is one of them, check the interactive map on the ILMCC website, which provides current information on where each of the 50 states is in the process of adopting this compact.
Is my state a part of any other interstate licensing compacts?
Along with physicians, there are other types of providers for whom telemedicine has many advantages, and the licensing difficulties affect them as well. To address this, more and more licensing boards for various types of providers are following the example of the Interstate Medical Licensure Compact by creating their own interstate compacts. Currently, there are compacts active and live for Registered Nurses, Physical Therapists and EMS Personnel. There are two more compacts, one for licensed psychologists and one for Nurse Practitioners, that have been enacted but are waiting for a certain number of states to join before they go live. To see where your state is in the process of adopting any of these compacts, see the following pages for state-specific maps and information.
Physical Therapy Licensure Compact Recognition of EMS Personnel Licensure Interstate CompAct (REPLICA)
Psychology Interjurisdictional Compact (PSYPACT)
Legislative Tracker Advanced Practice Registered Nurses (APRN) Compact Information
I am a VA provider: are telemedicine services offered for my speciality through VA healthcare?
Healthcare for veterans is an important field of medicine. Travel to speciality clinics for veterans is often more difficult than for others, and to this end, the US Dept of Veteran Affairs has a list of specialties that are approved and covered for the use of synchronous video telemedicine services. Their website lists those specialists, as well as has many helpful links for other aspects of their telehealth policy.
Do the same requirements and restrictions on cross-state medical practice apply for VA telemedicine practitioners?
In almost every other sector of telemedicine, the barrier of cross-state licensing is an opposing one that is seeing some progress towards being eliminated, but slowly. However, as of June 11, the US Department of Veterans Affairs went live with a new rule that allows VA practitioners to see any patient anywhere in the country, regardless of state licensing laws, which is a large part of their “Anywhere to Anywhere VA Healthcare” Initiative. To read the full text of the new law, you can click the link below.
Does my telehealth practice comply with HIPAA regulations?
The Health Information and Portability and Accountability Act is one of the major players in determining policy for medical providers in all areas of practice. Telehealth is no different. As use of telehealth technologies becomes more common and widespread, practices must be careful to make sure that their policies comply with the regulations set forth in the Act. The National Consortium of Telehealth Resource Centers has published a helpful fact sheet to help you along on your quest for compliance.
What are the HIPAA regulations that affect telehealth?
The Center for Connected Health Policy has published a wonderful document that succinctly sums up the HIPAA regulations that affect telehealth.
This all sounds like Greek to me -- what do all these terms mean?
The world of telehealth reimbursement can be confusing and difficult to navigate and understand. At times there seems to be an entirely new language you need to learn just to get paid! To that end, the American Telehealth Association has published two resources to provide clarity to those seeking to understand this new frontier of medical practice. See their Telehealth Glossary and their Telehealth Definition Framework, which is a joint project between the ATA and the Telehealth Resource Center that seeks to provide a set of basic definitions for the terms used to describe these services that can be used to create cohesion across states and forums.
What guidelines and standards of practice have been created for practicing telemedicine in my field?
If you are in the process of implementing a telehealth program in your practice, you will invariably come to the point where you ask yourself, “Am I doing this right?” Thankfully, various professional organizations have published their own versions of guidelines for and standards of practice for telehealth programs.
Are there other guidelines I can refer to about specific types of medical practices and telehealth use?
The American Telehealth Association has published a series of guidelines for implementing telehealth in different scopes of practice. Standards and guidelines have been proven through multiple studies to enhance outcomes and the success of telehealth programs in physician practices; finding one for your field could make all the difference for you. To access these guidelines you must be a member, but the process is easy and free of cost.
How do I access the federal grants and resources that the government has put in place to expand telemedicine programs nationwide?
Over the past few years, many departments within the federal government have offered a variety of grants and incentive programs for medical practices wanting to implement telemedicine, in the hopes of increasing ease of access to medical care for our citizens. The Office of the National Coordinator for Health Information Technology at HealthIT.gov has a helpful guide of those departments, how they support implementation, and where you can find each program’s specific information. The National Consortium for Telehealth Resource Centers also offers a fact sheet on federal telehealth funding – it is a great overview of the kinds of funding available.
Where do I learn more about resources in my area for telehealth?
Looking to get more region-specific information about telehealth in your practice’s area? The National Consortium of Telehealth Resource Centers has an easy to use interactive map, showing which states belong to which region and linking to the regional telehealth resource center for each one.
What are the technology recommendations for telemedicine?
The cornerstone of implementing a new telemedicine program in any practice is making sure you make the right choices for which technology you utilize. The National Telehealth Technology Assessment Resource Center (TTAC) has many easy-to-access Toolkits for the various types of technology a practice might need in the process of implementation, including Home Telehealth.
How do I start integrating telemedicine into my practice?
While the benefits of offering telemedicine in any given practice have become increasingly obvious and necessary in this competitive market, sometime the thought of starting that process seems overwhelming. Again the National Consortium of Telehealth Resource Centers has come to your aid with a concise guide to implementing a telemedicine program in a practice, broken down into 15 steps. AMD Global Telemedicine, a pioneer of international clinical telemedicine technology, has also published a useful guide for implementing a successful telemedicine program, commissioned by the International Society for Telemedicine and e-Health, that gives more useful pointers on how to make this new venture work for your practice.
How do I market my practice’s new telemedicine option?
So, you’ve started the process of implementing telemedicine in your practice – now you need to let your patients know, as well as all the potential patients looking for a provider with a good telemedicine program. The California Telehealth Resource Center has published a wonderful guide to creating a marketing strategy for that purpose, easily adapted to a variety of clinical settings.