Telemedicine Reimbursement

Getting Paid for Telehealth Services

Telemedicine offers physicians, next-generation ACOs, hospitals and other providers the ability to expand the reach of quality healthcare. Whether you are considering a clinical telemedicine program for the first time or expanding the scope of your current services, you’ll want to check the availability of reimbursement sources.

Within the United States, there are typically three sources other than cash payments from patients: Medicare, Medicaid and private insurance.

Medicare

Medicare is the federally-run health insurance program for people 65 years and older, though it also covers certain younger individuals with disabilities. Coverage is the same for all states and the District of Columbia. Medicare uses the term telehealth when referring to clinical telemedicine. You can review the CY2018 Medicare Telehealth Services for more coverage details.

Covered Telemedicine Services

  • Medicare pays for a limited number of Part B services delivered to an eligible beneficiary via live, real-time videoconferencing.
  • Telemedicine patients must be at originating sites, which include doctors’ offices, hospitals, critical access hospitals, rural health clinics, federally qualified health centers, renal-dialysis centers, skilled-nursing facilities and community health centers.
  • Medicare will only reimburse providers for telemedicine visits if the originating sites and patients are in rural, medically undeserved areas.
  • The telemedicine visits must be done live.

Medicare Services That Are Not Covered

  • Direct-to-Consumer telehealth services in which a previously unknown consumer pays a fee to speak with a physician on the phone are not reimbursed.
  • With the exception of Alaska and Hawaii, there is no reimbursement for store-and-forward the capture of patient medical images for later viewing by a healthcare provider.
  • Medicare does not reimburse for remote patient monitoring expenses.

Medicaid

Medicaid and the Children’s Health Insurance Program (CHIP) provide free or low-cost healthcare coverage to millions of Americans, including some low-income people, families and children, pregnant women, the elderly and people with disabilities. Medicaid programs are managed by the individual states.

Covered Telemedicine Services

  • Most Medicaid plans provide coverage for live, real-time clinical telemedicine visits.
  • Reimbursement policies frequently mirror Medicare policies, but not always.
  • Some Medicaid plans cover store-and-forward; others provide reimbursement for remote patient monitoring.
  • Like Medicare, there is no coverage for Direct-to-Consumer Telehealth.

Private Insurance

Commercial and private insurance plan reimbursement policies can vary widely. To learn more about the current telemedicine reimbursement policy in your state, please email Roger Downey, Government Affairs Specialist at roger@globalmed.com.

Covered Telemedicine Services

  • 31 states and the District of Columbia have passed telemedicine parity laws to ensure that providers are reimbursed for virtual visits by private insurance at the same rate as in-person visits.
  • In the remaining 19 states, private insurance carriers may or may not cover telemedicine visits. If they do, they do not have to pay the same rate as in-person visits.
  • Some private insurers offer coverage for Direct-to-Consumer telehealth.

Contact Us

GlobalMed is about as customized and individual as you can be. They go in and literally assess the need. What specialties do you need this technology for, whether it be a stroke or pediatrics or tele-dermatology, and then they customize the product to those needs.

Garfield JonesVice President of Sales, REACH Call

I can do everything but touch the patientI see a lot of the studies that say telemedicine is equivalent to being there. But, I actually think there is a case for saying at times telemedicine is better than being there.

Kathleen WebsterMD, Loyola University Health System