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Understanding Telemedicine Reimbursement

Why aren’t more providers offering telehealth services? We know that virtual care is more clinically advanced than ever, with the right platforms empowering providers to deliver secure, evidence-based medicine. Hospitals can streamline their clinical workflows, manage capacity intelligently and provide faster critical care. Underserved patients can receive life-changing medical treatment. So why are some providers reluctant to adopt telemedicine solutions?

The most common answer is reimbursement. Or rather, misconceptions about reimbursement. To help providers separate fact from fiction, we just published a guide called The Truth About Telemedicine Revenue and Reimbursement. It shares the top 10 myths and realities of getting paid for virtual services, explains how to drive revenue and ROI, and provides a list of grant and funding resources.

Even if you think you’re up to date on payer guidelines and the telemedicine landscape, we recommend reading it – because the world of healthcare reimbursement is a moving target.

For now, here are a few tips for maximizing telemedicine reimbursement in your practice or hospital.

Administrative Changes

  • Have the right licenses. There’s no “telemedicine licensure” but federal law does require providers to be fully licensed to practice medicine in the patient’s state. You can also apply for the Interstate Medical Licensure Compact to practice in multiple states.
  • Make sure your claims capture all services provided via telehealth, including codes for both live video transmission and diagnostic services.
  • Stay current on reimbursement and parity laws in your state. Telehealth bills are pending in Congress; Centers for Medicare & Medicaid Services (CMS) has announced policy changes and new coverage as well. Resources like the Center for Connected Health Policy can help.
  • Get funded. Think of your virtual health program like a startup, then pursue funding from grants and subsidies.

Patient Changes

  • Educate your patients. Put up signage, discuss virtual care during office appointments, and include flyers with their statements. As with all marketing, emphasize the benefits to them – and stress that their sensitive and medical data will be secure.
  • Approach patients even if their policy doesn’t cover virtual care. Many patients will prefer paying an out-of-pocket fee than leaving the house when sick or paying emergency room prices.
  • Offer after-hour appointments. Instead of working late hours, providers can be available from home for patients who would otherwise need to find an urgent care center at night or on weekend.
  • Create new revenue streams through specialist consults. The lack of specialty care in rural areas opens up possibilities for both city specialists who can remotely treat rural patients, and rural clinics who can connect their patient base to expert care without them leaving their community.

Staff Changes

  • Train your front-end staff to check each new patient’s telemedicine coverage, just as they check eligibility before each appointment. While it’s true that major payers like Cigna, BCBS, UHC and Aetna cover telemedicine, coverage can differ between policies. If a patient’s policy isn’t favorable, have your practice manage call the payer and request coverage.
  • Stress downstream referrals to keep money in your network. Location is not a factor with telemedicine – so you can refer patients to radiologists, labs and other providers in your system.
  • Go through practice runs with your staff to ensure they’re comfortable with the hardware, software and workflows – and that they can help your patients have a positive virtual care experience.

To find out more ways to maximize telemedicine claim payment, download our free guide here:

Get our infographic: 10 Telemedicine Reimbursement Myths and Realities

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Ready to talk to someone about how you can take advantage of telemedicine reimbursement? Contact Us

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