Telemedicine allows patients who may not have direct access to a specialist to receive the necessary medical services they need. Telehealth is slowly being more accepted by payers as a positive benefit for patients. With this trend becoming more popular with payers it’s important that providers learn more about the coverage and billing requirements for the insurer.
A majority of states already have passed legislation covering services that are provided by telemedicine, with most states already having laws in place regrading Medicare and Medicaid patients.
As of 2016 it was 31 states plus the DC that have private parity laws.
Private parity laws require that telehealth services need to be covered and reimbursed at the same rate as regular face to face doctors’ visits
State and federal agencies currently don’t agree on a common definition of what telehealth is.
California, for example, defines telehealth as:
“The mode of delivering healthcare services and public health via information and communication technologies to facilitate the diagnosis, consultation, treatment, education, care management, and self-management of a patient’s healthcare while the patient is at the originating site and the healthcare provider is at a distant site. Telehealth facilitates patient self-management and caregiver support for patients and includes synchronous interactions and asynchronous store and forward transfers.”
While the Federal Health Resources and Services Administration (HRSA) defines telehealth as:
“The use of electronic information and telecommunications technologies to support long distance clinical healthcare, patient and professional health related education, public health and health administration.”
A result of the varying definitions there is little consistency on how telehealth services are currently covered and reported. Currently no two states have the same policies regarding telehealth services.
This often causes confusion when it comes to billing telehealth services for private payers, since it can vary greatly. Not all states currently have a parity laws which depending on the payer could mean that telehealth services may be reimbursed at a lesser rate than a face to face service, or they may not be covered at all. Fortunately, the Center for Connected Health Policy (CCHP) offers a free interactive map of all the telehealth policies to easy confusion.