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Are You Basing Your Telehealth Strategy on Reimbursement False Assumptions?

Although telehealth is gaining traction as a bridge between patient need for both rural access and urban convenience, reimbursement for telehealth services has made progress in 2018 but continues to lag.  Telehealth is one of the fastest growing segments in the healthcare industry. According to a 2018 Mordor Intelligence report, telehealth is expected to be a $66 billion dollar industry by the year 2021, yet only 32 US states have passed laws to allow for parity.  These laws allow healthcare providers to be reimbursed for telemedicine at the same rates they would receive if the patient received care in person.  Reimbursement for telemedicine has been one of the largest barriers in accelerating acceptance by providers and helping to proliferate telehealth technology.
 
Times are changing.  Dozens of telehealth bills are pending in Congress.  CMS has begun to take steps to change regulations both geographically and in services covered. Payers are changing their telehealth policies.   However, as I regularly make business development calls to health departments, private practices, and hospitals, I am amazed by how often I hear misinformation and incorrect assumptions driving an organization’s telehealth strategy.  Here are some “lessons” learned or myth-busting ideas and opportunities to think about when considering your telehealth plans:

1.    The extent of telehealth payment varies by payer and state to state.  Learn the regs.  Look at website portals and schedule a visit to uncover limitations up front and nuance requirements to unstick your claims processing, telehealth PAs and denials.

2.    The “Q” codes are for telehealth transmission!  They are not the only telehealth service you will
be paid for.  Make sure your organization is capturing all services provided via telehealth

3.    Payers are open to changing policies!  Invite them into your organization and present the business case and the patient populations that will be served locally. Show them improved patient compliance data with telehealth use and expected cost reduction. Ask about coverage for a waiver or pilot program if they don’t cover the telehealth service already. Payers are expected to be a major driver in accelerating increased telehealth adoption.

4.    Keep up with the new CMS Rules and Codes. CMS announced some big policy changes this year and have added new codes for virtual patient check-ins, remote evaluation of pre-recorded patient information, and inter-professional internet consultations. Third party carriers are expected to follow CMS lead.
 
5.    Coordinate A/R management between providers and health care organizations to maximize reimbursement- requirements, PA’s etc. must match on both sides.

6.    Health organizations are not waiting on payers or parity to get into the telehealth game!  Some healthcare organizations are offering subsidies to get their programs up and running and are moving forward with telehealth plans relying less on payer payment models. Patient engagement is a priority and we are seeing patients demand telehealth.
 
Telehealth has come of age and has demonstrated its value.  It will have a significant place in the future of healthcare and telehealth reimbursement is expected to remain in the spotlight.  Recent changes in telehealth reimbursement policies will help make moderate changes to allow for increased telehealth utilization in 2019.  Federal lawmakers and payers are offering continued and increasing support in the telehealth reimbursement area. Hospitals and healthcare systems have lagged in the adoption of telehealth. Now may be the time to progress your organization’s telehealth strategy and program.  Get creative. Have courage.  Keep up with the facts. Just don’t make telehealth strategic decisions or plans based on incorrect reimbursement assumptions.