Telemedicine: A New Benefit For Your Clients

By Megan Williams, contributing writer

Your clients may not be reimbursed for telemedicine offerings today, but that stands to change.

If you haven’t heard of the Medicare Telehealth Parity Act Of 2014, bookmark this page — your telephony, communications, and security clients stand to gain a lot if it passes.

The bipartisan bill (available in complete form here) would, simply, allow Medicare to cover telemedicine services. At present, providers have little incentive to use or recommend these services, as their chances for being reimbursed are slim.

Reimbursement Today

Right now, not all services falling under the telehealth/telemedicine umbrella are reimbursed, according to HHS. Medicare, which tends to set the standard for industry reimbursement, pays for the services when the originating site (the patient’s location) is classified as a Health Professional Shortage Area (HPSA) or a county outside any Metropolitan Statistical Area (MSA), as defined by the Census Bureau. The site must be a medical facility and not the patient’s home. The location from which the services are rendered does not influence reimbursement.

Medicare will also only pay for face-to-face interactive video consultation when the patient is present — essentially only reimbursing encounters that mimic traditional interactions between patients and providers. Private payors currently establish their own standards for telehealth reimbursement.

The Bill

The bill, introduced by Reps. Mike Thompson (D-CA) and Glenn Thompson (R-PA) would allow for the incremental expansion of Medicare reimbursement of telehealth offerings. Specifically, it has been proposed, that for CMS calendar year 2015, the following four services would be eligible for Medicare reimbursement if administered via telehealth:

• Annual wellness visits
• Psychoanalysis
• Psychotherapy
• Prolonged evaluation and management

It would also amend Title XVIII of the Social Security Act, which is responsible for the current limitation of Medicare reimbursement to rural areas.

After a six month period, the bill would require Medicare to cover telemedicine in urban areas with populations over 50,000 people and expand “acceptable care sites” to include retail clinics.

After two years, it would allow for reimbursement for outpatient services delivered via telehealth (like speech and physical therapy), expand coverage to urban areas between 50,000 and 100,000, include home telehealth as acceptable care sites, and require the U.S. comptroller to conduct a study of efficacy and potential savings to Medicare from the use of telehealth options.

After a four year period, it would make telehealth reimbursable in all areas, regardless of population size, and include chronic health conditions like chronic obstructive pulmonary disease (COPD), congestive heart failure, and diabetes in the mix. It would not include telephone audio conversations or emails between patients and providers.

Going Deeper

Read up on more of our coverage of regulations around telehealth here.