Your Guide on Reimbursement

When it comes to telemedicine, navigating the reimbursement scene may seem tricky, but it doesn’t have to be! Private payors, Medicare and Medicaid are making big moves to covering more telemedicine services under their plans. These advancements in coverage through such major payors are even trickling down to some state employee health plans. Today we will discuss how much reimbursement for telemedicine services providers can expect, and how advancements in the upcoming year will continue to sweeten the deal.

Private Insurers

First off, let’s go over the terms. Parity means that there is legislation in place mandating private payors to reimburse for telemedicine services rendered. Over half of the United States have recognized the emergence and stronghold telemedicine has in the healthcare field and has implemented parity laws.
Let’s talk numbers:
47 states and the District of Columbia provide some sort of telemedicine reimbursement.
39 states have parity legislation in place
7 states are waiting on proposed parity legislation

Medicaid

Medicaid has been a proponent of telemedicine reimbursement for a long time, as early as the year 1999. Today, 48 states provide coverage for telemedicine behavioral health services.
Ready, set, get reimbursed:
To be reimbursed, you must follow federal guidelines and state guidelines.
You may be reimbursed a site facility fee, a transmission fee or both.
All costs must be linked to a reimbursable Medicaid fee schedule.
Just like private payors, Medicaid reimburses at the in-person rate.

Medicare

Originating sites (where the provider is located at the time of telehealth services rendered) are reimbursed a site facility fee. Medicaid is making big moves in coverage, starting in 2017 this program is expanding telepsychiatry projects, as well as remote patient monitoring for conditions like renal disease.

Bonus: State Employee Health Plans

Did you know that 60% of the nation’s largest employee health plans cover telemedicine services? Major payors are catching on to the emergence and stronghold that telemedicine has and are providing coverage for a wide array of services conducted via telehealth. It is estimated that in 2017, that number will jump to 90% of the nation’s employers covering some sort of telehealth benefit through employee health plans.

Ready to jump in on the telemental health movement? Contact one of our customer success representatives today by calling 888-958-2885.