Telemedicine is the use of telecommunication and information technology to provide remote diagnosis and treatment of patients. Today it is one of the fastest growing sectors in healthcare. Indeed, as technology advances, telemedicine becomes more available. For example, people can now access medical help with online video chat apps like Skype or Facetime.
Telemedicine: Technology Leads The Way
With the wide variety of mobile health apps and new mobile medical devices that are consumer-friendly, patients can monitor and track their health. Simple home-use medical devices now diagnose ear infections, monitor glucose levels, and measure blood pressure. Patients get a doctor’s diagnosis without going into their office.
Telemedicine: Available Services
Telemedicine provides patients 24/7 access to medical care with an on-call doctor contracted by that company. In addition, it gives hospitals and larger health centers access to extra clinical staff and specialists, s well as allows for outsourcing of special cases. Still other doctors use it for virtual visits with their patients. Increasingly, this technology gives medical practices an edge in a profession where it’s difficult to stay independent or maintain a healthy bottom line.
Telemedicine: Services Provided
Telemedicine can be used for a wide variety of health services. Here’s a short list of common conditions a primary care doctor may treat via this technology:
- Arthritic Pain
- Colds and Flu
- Insect Bites
- Respiratory Infections
- Skin Inflammations
- Sore Throats
- Sprains & Strains
- Bladder Infections
- Sports Injuries
Services also can range widely by specialty. A surgeon might use telemedicine to do post-operation check-ins with patients, to make sure their wound is not infected. A gynecologist may also provide birth control counseling. An endocrinologist can do live video chats with patients to discuss recent lab results and answer questions.
This list can certainly be expanded and there is a wide range of health services that are reimbursable. One caveat, though, is just common sense, and that is telemedicine should not be used for any condition where an in-person exam is required because of severe symptoms, certain protocol-driven procedures, or aggressive interventions. Indeed, for a medical emergency patients should go to the ER or call 911.
Healthcare providers need to use their professional judgement to decide when telemedicine is appropriate.
Telemedicine: Medicare Reimbursement
An important question with the introduction of this new technology is, how are health providers reimbursed? Initially, Medicare only reimbursed providers for very specific health services rendered, often with strict requirements. In the past few years with the rapid growth in the this industry, Medicare has expanded the list of reimbursable services but still imposes many restrictions.
Here are a few things you should know about Medicare reimbursement and telemedicine.
- Medicare reimburses for telehealth services offered by a healthcare provider at a distant site, and to a Medicare beneficiary (the patient) at an Originating Site. The originating site must be in a HPSA (Health Professional Shortage Area). The types of originating sites authorized by law are:
- Physicians or practitioner offices
- Critical Access Hospitals (CAH)
- Rural Health Clinics
- Federally Qualified Health Centers
- Hospital-based or CAH-based Renal Dialysis Centers
- Skilled Nursing Facilities (SNF)
- Community Mental Health Centers (CMHC)
Independent Renal Dialysis Facilities are not eligible originating sites.
- The patient must be in a HPSA. In order to be eligible for Medicare reimbursement, the patient (Medicare beneficiary) needs to be receiving virtual care at one of the clinical settings mentioned above, that is also located within a Health Professional Shortage Area (HPSA). To see if the health facility is in a HPSA, use this CMS tool
- Facility Fees. In addition to reimbursement for the telemedicine service, Medicare will pay the originating site a facility fee. For example, if you’re a primary care provider with a patient in your office and you do a telemedicine visit to consult a physician in another location, you can bill for two separate things, the telemedicine service, as well as a facility fee for using your practice to “host” the patient visit.
Under Medicare, the following healthcare providers can use telemedicine:
- Nurse Practitioners
- Physician Assistants
- Nurse Midwives
- Clinical nurse specialists
- Clinical Psychologists
- Clinical Social Workers
- Registered dietitians or nutrition professionals
Type of telehealth. Medicare only reimburses for live telemedicine, where the physician and patient are interacting in real-time through secure, video chat. This type of telemedicine visit is meant to substitute a face-to-face in-person visit. The only exception is in Hawaii and Alaska, where Medicare reimburses for store-and-forward telemedicine as well.
Telemedicine and Medicaid
Unlike with Medicare, Medicaid programs are state-run and therefore subject to state law on telemedicine practice. That means reimbursement through Medicaid is widely dependent on what the policy is in your state.
Here’s a quick overview of what Medicaid reimbursement for telemedicine looks like across the U.S.:
- 46 states Medicaid programs cover live video
- 9 state Medicaid programs will cover store-and-forward telemedicine
- 14 state Medicaid programs cover remote patient monitoring
- Only 3 state Medicaid programs (AK, MN, MS) offer coverage for all three types of telemedicine
- 26 state Medicaid programs cover a facility or transmission fee, or both.
Factors that Affect Reimbursement
Since telemedicine requirements vary by state and aren’t always 100% clear, it’s good to know what to look for. Here is a quick list of items that can affect your telemedicine reimbursement through Medicaid.
- Health Services covered
- Eligible providers (NPs, PAs)
- Is cross-state medical licensing allowed?
- Is a pre-existing relationship with patient required?
- Location restrictions on patient or provider
- Applicable CPT codes
- Type of fee reimbursed (transmission, facility, or both)
Telemedicine is rapidly making its presence felt in the health care market. As technology evolves, Federal and state government will no doubt step in to regulate practices for physicians as well as to insure patient rights are protected.
Watch this video on how telemedicine works effectively in a nursing care facility:
And , watch this report by PBS on the effectiveness of telemedicine in saving the life of a stroke victim.