The United States Congress recently tasked the federal Department of Health and Human Services (HHS) with producing a modern report on telemedicine, including an assessment of any barriers to its adoption. HHS has now delivered that report, and the department wastes no time in it stating plainly that “telehealth holds promise as a means of increasing access to care and improving health outcomes,” immediately thereafter identifying reimbursement and “the payment environment for telehealth services” as the first issue standing between telemedicine and the patients who need it.1
Telemedicine is effective, and its use is now inhibited not by technology but by policy. While money is not everything, it does keep the clinic lights on, and even the federal government is now looking for ways to pay doctors for their time online. Though some of these gears will turn slowly, there are already some great, straightforward ways for most doctors to get paid for telemedicine today. Read on for four of our favorites!
1) Bill Private Insurers Through Parity Laws
It’s not advertised very often, but more than half of all states have a telemedicine “parity” law in place, which requires private health insurers to reimburse for a telemedicine service if they would reimburse for that same service when provided in person.2 This can be a fantastic way to get paid for your efforts in telemedicine.
To investigate telemedicine parity laws for your specific situation, first check out the regularly updated guides from the American Telemedicine Association (ATA) and the Center for Connected Health Policy (CCHP).2,3 These reports break the situation down on a state-by-state basis and will help you get a sense of whether your state has a parity law and what its specific limitations might be.
Next, investigate the provider handbooks and contracts for the insurance companies that you deal with. These will often tell you which services are covered and how to bill for them. Telemedicine services are often reported using in-person CPT codes with an appended HCPCS modifier: “GT” for synchronous (live video) telemedicine and “GQ” for asynchronous (“store and forward”) telemedicine.
Sometimes parity laws fail to mandate equal pay for telemedicine services, and some parity laws include exceptions that may allow insurers to sidestep the spirit of the law, such as California’s provision that parity is “subject to the terms and conditions of the [insurance] contract.” However, these laws will likely allow you to collect on real bills for at least some of your patients, and you should give them a shot!
2) Disregard Medicare, Acquire Medicaid
The current Medicare telemedicine reimbursement policies are stifling at best.4 Unless you are seeing patients who are in a rural area (and also in a clinic or other approved medical facility) over a live video link for one of a short list of services, you will almost certainly not be collecting money from Medicare for telemedicine. This will be changing, at least in part, with the new MACRA legislation, but it has not changed yet.
Medicaid programs, on the other hand, are often much more progressive and have been so for years. The ATA and CCHP guides can tell you the exact situation in your specific state, but on the whole, 48 states provide some type of Medicaid coverage for telemedicine.2 While details vary by jurisdiction, policies are almost always more permissive than those of Medicare: 36 state Medicaid programs, for instance, permit patients to participate in telemedicine visits from their homes.
You may not be seeing Medicaid patients in your practice right now, but your state’s telemedicine laws and initiatives might mean that doing so via telemedicine would be not only viable but smart.
3) Charge out of Pocket but Less Than a Copay
For years, the idea of charging patients out of pocket for most services would have been laughable. Coverage was broad, and copays were minimal or nonexistent, at least for those with medical insurance.
Now, however, there is an ongoing shift toward higher deductibles, more coinsurance, and increased out-of-pocket patient financial burden in general. In the current climate, a typical copay for a primary care visit ranges from $20 to $40, while the copay for a specialist visit is more often $30 to $80.5
Given this situation, if you can make your telemedicine services available for $40 to $80 per encounter, you will be very attractive to a large chunk of patients who won’t be losing any money by skipping their insurance when they see you. They’ll be paying the whole bill, but it will still be less than they’d pay out of pocket for a traditional visit, once you factor in the effects of their copay, coinsurance, and deductible.
This strategy will also rid you of paperwork duties and fights with insurance companies over reimbursement claims, both of which have tangible monetary benefits. And, for a final bonus, you will be a valuable resource for uninsured patients, who depend on transparent and reasonable service pricing.
4) Go Concierge Lite
If you don’t want to worry about billing for each specific telemedicine encounter, you can instead add a “concierge lite” layer to your current practice. In this model, patients on your panel would pay a concierge retainer fee (monthly or yearly) to have access to you for telemedicine visits. On platforms like the one we offer through Spruce, you can also easily make other features available to sweeten the deal, such as the ability to securely message with your office staff.
The “concierge lite” approach allows you to explore both telemedicine and the world outside of insurance-based fee-for-service without necessitating a jarring overhaul of your current practice. With the right platform (*cough* Spruce *cough*), you won’t have to sign a long-term contract or pay any onerous fees, so you’ll have a safe and easy way to dip your toes into the telemedicine waters and leave if you don’t like it. If you have a few patients that you think might be excited by telemedicine in a concierge format, then this approach almost couldn’t be easier to try. Give it a shot!
- Office of Health Policy, Office of the Assistant Secretary for Planning and Evaluation (ASPE). Report to Congress: E-health and Telemedicine. (U.S. Department of Health and Human Services (HHS), 2016).
- Thomas, L. & Capistrant, G. State Telemedicine Gaps Analysis: Coverage and Reimbursement (2016). (American Telemedicine Association (ATA), 2016).
- Gutierrez, M. & Center for Connected Health Policy (CCHP). State Telehealth Laws and Medicaid Program Policies (August 2016). (Center for Connected Health Policy (CCHP), 2016).
- Medicare Learning Network. Telehealth Services (calendar year 2016). (Centers for Medicare & Medicaid Services (CMS), 2015).
- Rae, M. et al. Patient Cost-Sharing in Marketplace Plans, 2016. The Henry J. Kaiser Family Foundation (2015). Available at: http://kff.org/health-costs/issue-brief/patient-cost-sharing-in-marketplace-plans-2016/. (Accessed: 25th October 2016)