News and Notes on Telemedicine Innovation

Browse resources for helpful industry insights, updates and tips.

Quick Hits

Reimbursement

Policy

Z

Best Practice

Helpful Links

How do I Get Paid for Telemedicine?

Using FaceTime for Telemedicine [Whitepaper]

Overview of the HIPAA rules and SimpleVisit

Building a Virtual Practice?

Find expert advice on best practices and tools used for virtual care.

Regulation & Reimbursement Report

BLOG ARTICLES

Road to Reimbursement: Location

Reimbursement policies usually present more of a challenge to telemedicine adoption than technology or training. Healthcare providers have reported high interest in offering remote care for their patients but question whether it makes good business sense if they...

read more

Moonshot Interview with StartUp Health

Startup Health is an incubator and investing network “organizing a global army of entrepreneurs committed to achieving health moonshots”. SimpleVisit is proud to be among the select “Health Transformer” utilizing our unique technology to improve access to care in the...

read more

A New Year for Telehealth

As we embark on a new year, we at SimpleVisit thought it would be good to look back at what has happened in the telehealth industry throughout 2018 and what is on the horizon for 2019. State Legislation In 2018, 65 legislative bills and 49 regulations were passed that...

read more
read more from our blog

RESOURCE LIBRARY

Reimbursement

Medicare

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.

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.

 

Legislation

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.

Medicaid

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.

Policy

Online Prescribing

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.

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.

 

Legislation

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.

Medicaid

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.

Z

Best Practice

Helpful Links