With Telehealth on the Rise, Policy & Payers Are Catching Up

Posted in Accountable Care Organizations (ACOs), Medicare, Telehealth

Telehealth is a key element of our country’s health care transformation – and health care providers, payers and patients are getting on board today more quickly than ever. After all, getting timely and convenient medical diagnosis and treatment using your computer, phone or tablet – anywhere, anytime, is of incredible value in our busy, technology-driven lives.

The American Telehealth Association highlights the benefits of telemedicine including: improved access, cost efficiencies, improved quality, and meeting consumer demand. Here are some fast facts and statistics that offer a clearer picture of the increasing adoption of telemedicine services in this country.

  • Modern Healthcare reports that the use of telehealth services has increased more than 50% between 2016 and 2017 – growing at a faster rate than any other site of care.
  • The American Hospital Association reports that 76% of U.S. hospitals connect with patients and consulting providers using video or like technology.
  • Most major employers are offering medical coverage for telehealth in an effort to improve access and reduce healthcare costs. In fact, the National Business Group on Health (NGBH) reports that 96% of the country’s largest employers will cover telemedicine visits in 2019.
  • According to a white paper published by Fair Health, telemedicine claims by private payers increased by more than 1200% between 2012 and 2017.
  • According to claims data, telehealth services are most commonly used for mental health (telepsychiatry), injuries, acute respiratory infections and digestive problems.

Eliminating Complicated Reimbursement Policies

Complicated reimbursement policies related to telehealth services are prevalent, but vary among private and government payers. In previous years, these complicated policies left many health care organizations reluctant to make investments in the technology and resources needed to develop successful telehealth programs. Fortunately, commercial payers have gotten on board in recent years, with government payers now catching up.

While every state’s Medicaid program currently covers some type of telehealth services, the coverage has been relatively sparse, with many states placing limitations on eligible services, providers types and participating organizations. The great news is that many states have started to lift some of these restrictions that most would argue should have never been put into place to start with.

On the Medicare side, progress has been even slower to broadly cover telehealth services. In fact, coverage for many services is currently only available in rural areas, and telehealth services delivered in a patient’s home aren’t eligible for reimbursement. This is particularly disappointing considering the obvious barriers many elderly patients experience in trying to access health care services – including transportation, mobility, and financial constraints.

Variations in policy from state to state are also common – and have historically limited both the delivery of telehealth services as well as reimbursement in some cases. Lawmakers in each state evaluate complex concepts such as reimbursement eligibility criteria and practice standards to determine whether to cover telehealth services and how much to reimburse.

Reimbursement eligibility criteria may include: modality, care sites, clinical area, geography, practitioner type and parity. Practice standards evaluated include considerations such as – can providers practice across state lines?; can they prescribe remotely?; are clinical protocols different for virtual care?; how do patients give informed consent for treatment?; can providers truly establish a relationship remotely?; among others.

Fortunately, the tides appear to be changing. Several recent policies will expand reimbursement to certain patients in 2020, including those attributed to an Accountable Care Organization (ACO), or certain cardiac care and joint replacement patients. Several additional bills are in Congress that aim to expand the reach of telehealth for Medicare patients.

This shifting regulatory environment is the light at the end of the tunnel – giving hope to health care providers and patients alike that there should be a LOT more advancements and offerings in telemedicine coming as these arbitrary limitations are lifted across the industry.

GeBBS Healthcare Solutions is well-versed in telehealth policies in every state – as well as the many payer nuances that exist as it relates to telehealth coverage and reimbursement. Whether your organization needs support with billing, coding or clinical documentation improvement for telehealth services, GeBBS’ experts can support your team.